Occupational medicineBMJ 2007; 335 doi: https://doi.org/10.1136/bmj.335.7613.s47 (Published 04 August 2007) Cite this as: BMJ 2007;335:s47
- Massoud Mansouri, SpR in occupational medicine ()1,
- Mike Tidley, consultant in occupational medicine and regional specialty adviser1
It's much more than hepatitis B checks, say Massoud Mansouri and Mike Tidley
Occupational physicians act as impartial specialist medical advisers on the interaction between work and health. Large industries and many NHS trusts have an in-house occupational health service. Some services are outsourced. Occupational physicians can work for an employer or work independently as specialist advisers.
Reactive to proactive
Occupational medicine is a branch of medicine within the broader discipline of occupational health. Occupational health practice has moved from a reactive hazard oriented approach to proactive multidisciplinary team work. Occupational physicians work with other professionals such as occupational health nurses, health and safety officers, hygienists, ergonomists, psychologists, and physiotherapists. An occupational physician provides an impartial advisory service to ensure high standards of health and safety at work are achieved and maintained.
Occupational medicine is a diverse specialty dealing with a wide range of health problems from orthopaedics to psychiatry. Because of its diversity, occupational medicine requires a broad range of knowledge and skills.
Occupational physicians should be aware of work related hazards and be able to assess and control risks in different workplaces. They should also be competent in diagnosis and management of occupational diseases.
Fitness for work
Occupational physicians have an important role in evaluating workers' fitness and their rehabilitation back to work after illness. They should have good knowledge of specific workplaces to assess the fitness of workers to do their duties and give advice on their long term prospects. They also advise employers on necessary adjustments to work, redeployment, and ill health retirement.
Pros and cons of a career in occupational medicine
Civilised working hours in most jobs
Scope for research
Opportunity to develop a special interest
Wide range of career options, including private work
Isolation from other clinicians
No salary banding for NHS training posts
Increasing number of complaints
Occupational physicians advise employers in relation to disabled workers' fitness to do specific tasks and adjustments needed in specific workplaces to enable disabled workers to perform their jobs.
Health and safety law and ethics
Good understanding of legislation related to employment and health and safety is vital. High ethical standards should be maintained, particularly in relation to patient confidentiality and data protection.
Occupational health professionals believe the workplace is a suitable place to provide health promotion programmes.
Occupational physicians may also act as advisers to employers and employees about controlling environmental hazards and pollutants.
The Postgraduate Medical Education and Training Board (PMETB) is responsible for approving specialist training posts in occupational medicine. The Faculty of Occupational Medicine of the Royal College of Physicians sets out the curriculum and assessments to maintain high standards of training and competence. Higher specialist training posts are available in the NHS and in other occupational health services such as industry and the armed forces. NHS vacancies are advertised via the Medical Training Application Service. Training posts in industry may be advertised in BMJ Careers or through the Society of Occupational Medicine. Training programmes are currently under review in line with Modernising Medical Careers.
Generally the numbers of training posts are limited compared with other specialties. The Specialty Training Committee report (2005-6) states there are 57 trainees in the NHS, 77 in industry, and 20 in the armed forces. At least two years of postregistration experience in medicine or general practitioner training is required to apply for a specialist training job; no postgraduate qualifications are needed to enter the programme. Trainees must pass the exam for associate of the Faculty of Occupational Medicine (AFOM). They usually sit this exam at the midpoint of their training period, and the pass rate is typically more than 50%. Distance learning courses run by a number of universities nationally prepare trainees for the AFOM. A dissertation is submitted to obtain membership of the Faculty of Occupational Medicine (MFOM) on completion of the training programme.
Medical partnerships under the NHS:
Arrangements for training in the new system will be finalised shortly. The latest information about the changes in the training programme by the Faculty of Occupational Medicine will be available on the website. The training programme will be competency based, and there will be workplace based assessments and a different examination system. Workplace based assessments will be a combination of formative and summative assessments. Specialist trainees will have to pass two examinations: one will be after the first year of training and the other will be an exit examination in the final year.
General practitioners with a special interest
Many organisations recruit GPs with a special interest in occupational medicine for part time work. The Diploma in Occupational Medicine is aimed at doctors who are not specialists in occupational medicine but who wish to develop skills in this area.