The Role Of An Occupation Medical Physician
Although there is strong evidence that employment has a positive impact on health and wellbeing, there are adverse effects of work that can coexist1. Each year in Great Britain, over a million workers are injured or made ill by their work2.
Despite its importance, occupational medicine is poorly represented as a specialty in the undergraduate curricula and relatively few medical trainees seek out the speciality for their career.
This guide will reveal the opportunities available when you elect to follow a career in occupational medicine and the key milestones towards becoming a consultant occupational medical physician.
The World Health Organisation (WHO) Committee on Occupational Health describe the aims of occupational health as: ‘the promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations.’1
The role of an occupational physician is much more than Hep B checks and health questionnaires. In fact, compared to most traditional hospital specialities, it is extremely diverse. As well as maintaining clinical contact with patients through the assessment of work-related health issues and helping patients return to work after illness, this specialty requires physicians to have a detailed understanding of employment and anti-discrimination laws and ethics.
The profession opens gateways to management positions and chief advisory roles, with consultants having a large-scale positive health impact on patients with regards to understanding health risks and promoting compliance with relevant environmental and health and safety legislation3.
Unique to a career in occupational medicine, a larger proportion of job posts are outside the NHS. Organisations such as the Emergency services, the Armed Forces, transport organisations such as Transport for London, and other independent providers of occupational health all directly employ occupational medical physicians.
The growing demand for occupational physicians across the UK means that the specialty may need to be fully integrated with the NHS in order to support the number needed to go into training4.
Occupational health also has a strong holding in business and government agendas, with awareness of this continually increasing. In the period 2017/18, the total costs of workplace self-reported injuries and ill health in the UK was £15.0 billion2.
Moving forward, occupational health is likely to become a more established part of government policy in order to improve economic efficiency. With better health care at work, comes better engagement in the workplace, and fewer people requiring early retirement or paid leave due to work related health issues.
A Typical Week
The life of an occupational medical physician will vary greatly depending on their role and their place of work, whether they work for the NHS, an external provider of occupational health or in-house provision. A working week can include clinical work such as assessing individuals for capability, eligibility for ill-health retirement as well as workplace visits and assessments surrounding health risk.
In senior management roles, physicians are likely to move away from clinical attachment and instead influence company policies or even diverge into research from the angle of public health and epidemiology.
Depending on your place of work there are opportunities to subspecialise. Special interest areas include:
Disability Assessment Medicine
Occupational Respiratory Medicine
Sports and Exercise Medicine
Although occupational medicine consultants can venture in different directions, working hours are limited to 48 hours per week and on-call and weekend work is minimal. Working normal office hours means that the career allows scope for great work-life balance.
The Route To Becoming An Occupational Medical Physician
Similar to its uniqueness regarding the variety of potential employers, the training pathway to becoming an occupational medicine consultant also differs compared to most conventional medical career paths.
3 steps to becoming a consultant in occupational medicine
Complete medical school and foundation training - As with all training routes to becoming a consultant physician, a medical degree must be obtained, and clinical foundation years completed.
Core training (2/3 years) - After foundation training, medical trainees apply for core training, usually in line with the specialty training they wish to pursue at a later date, eg. A trainee wishing to apply for specialty general surgical training would first complete core surgical training. However, to prospectively enter specialty training in occupational health medicine, two years of higher training can be completed in a variety of disciplines. Listed below are all training routes that would lead to eligibility to apply for speciality training in occupational health:
CT1 and CT2 - Core Medical Training, CMT - two years
CT1 and CT2 - Core Surgical Training - two years
CT1 and CT2 in anaesthetics, or radiology, or paediatrics - two years
CT1-3 - Acute Care Common Stem, ACCS (acute medicine) – three years
CT1/ST1 and CT2/ST2 in psychiatry – two years
ST1-3 in general practice – three years
phase 1 of the Faculty of Public Health training – two years
Specialty training in Occupational Health (4 years) – Speciality training in Occupational Health begins at ST3 level and the 4-year curriculum is overseen by the Faculty of Occupational Medicine (FOM). A distinct feature of the specialty is that half of all GMC- approved training posts are outside of the NHS, and therefore means you can train to become a consultant as part of a private organisation, such an engineering or aviation company. Applications to an NHS training post are made via the national NHS recruitment website ‘Oriel’, whereas training vacancies available in industry or the non-NHS public sector are advertised mostly via BMJ Careers. During training, two separate exams must be passed, and a written dissertation and portfolio completed. If specialty training is completed successfully, at the end of the 4 years trainees will have obtained their Certificate of Completion of Training (CCT) and be added to the GMC specialty register. Additionally, a number of trainees choose to undertake a Masters in Occupational Medicine during their specialist training, although this is not obligatory.
What is the competition like?
Occupational medicine is a very small specialty and with an expected demand for occupational medicine consultants, there is a lack of new doctors entering into and successfully completing specialist training. In the NHS, in 2007 there were 27 ST3 training posts, now in 2019 there are just 9.
This means competition ratios are high with 2.78 people applying per post. However, it is important to remember that over half of all training posts are outside the NHS, and that opportunities to train via other organisations are increasing.
For doctors interested in working part-time in occupational medicine but would rather pursue a full-time career in a different specialty, there is an option to complete a Diploma in occupational medicine (DOccMed). This is most frequently taken by general practitioners who wish to add to their practice portfolio by providing occupational health services to local companies.
NHS consultant salaries are the same for all specialties but vary between Scotland (highest), England, Northern Ireland, and Wales (lowest) and increase with service (up to 19 years). In 2020 the salary bands range from £77,779 to £109,849. Salaries can be further enhanced with NHS clinical excellence awards. As most occupational medical physicians work outside of the NHS, the BMA provides guidance for both occupational physicians and employers.
The BMA state that ‘as a minimum, doctors working as occupational physicians outside the NHS should earn a comparable amount to doctors who work in the NHS.’ When taking into account clinical excellence awards the BMA recommend the salary of a senior occupational medical physician to be between £86,369 to £139,6827.
For more information on salaries within the NHS, please feel free to review The Complete Guide to NHS Pay.
Related Job Sources With BMJ Careers
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Ivanovich Mikheev M. Occupational health for all: the strategy of the World Health Organization. Environmental Management and Health. 1997;8(5):199-201.
Statistics - Costs to Britain of workplace injuries and new cases of work-related ill health [Internet]. 2018 Hse.gov.uk. Available from: https://www.hse.gov.uk/statistics/cost.htm#:~:text=The%20total%20costs%20of%20workplace%20self%2Dreported%20injuries%20and%20ill,costs%20(%C2%A35.2%20billion).
Mansouri M, Tidley M. Occupational medicine. BMJ. 2007;335(7613):s47-s47.
Torrance I, Heron R. Occupational health should be part of the NHS. BMJ. 2017;:j2334.
Leckie A. Wither or whither now training in occupational medicine?. Occupational Medicine. 2015;65(6):426-428.
Specialty Training > Competition Ratios [Internet]. Specialtytraining.hee.nhs.uk. 2020 Available from: https://specialtytraining.hee.nhs.uk/Competition-Ratios
BMA Occupational physicians pay scales[Internet] 2020 Bma.org.uk Available from: https://www.bma.org.uk/pay-and-contracts/pay/other-doctors-pay-scales/occupational-physicians-pay-scales