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Occupational medicine is in demise

BMJ 2015; 351 doi: (Published 11 November 2015) Cite this as: BMJ 2015;351:h5905

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Re: Occupational medicine is in demise

We agree with Raynal’s opinion that occupational medicine is in demise (1) but we attribute causation to several other conditions as well as absent regulation to mandate access to occupational health services. The Health and Safety Executive (HSE) Employment Medical Advisory Service has been decimated over recent decades, and this may have reduced demand for specialist occupational physicians. Only around 13% of UK labour force can access a specialist occupational physician. However, there are other factors which have reduced both supply and demand for our specialty. It is in the main employers who have the statutory duty to protect their workers from risks at work and consequently from occupational disease. The world of work has changed phenomenally as a result of trends such as globalization and off-shoring of manufacturing jobs. Whereas most people used to work for large employers that could afford to provide in-house occupational health services now over 99% of British employees work for small and medium sized enterprises (SMEs) employing 0-249 people (2). It is not practicable for SMEs to employ their own occupational health staff, and and even less practicable to provide occupational medicine trainee posts which have all but disappeared along with British industry.

The number of specialists in occupational medicine is falling and the specialty has a low profile in medical schools and among junior doctors. The General Medical Council observed that the number of occupational physicians fell by almost 5% during 2010-13 and that occupational medicine had more doctors over 50 years old than any other specialty (3). Consequently half of current specialists in occupational medicine could retire within a decade. Not only are occupational physicians reaching retirement age, but they are not being replaced. It is generally acknowledged that there is a crisis in training with recruitment of trainees in recent years being at an all time low. Faculty of Occupational Medicine Annual Reports state that recruitment is at half the long-run average. In 2011 the Centre for Workforce Intelligence reported that significant recruitment issues remain (4). The Chief Medical Officer England’s 2013 Annual Report identified lack of access to specialized occupational healthcare and includes a policy suggestion that ‘the numbers of doctors being recruited into occupational medicine should be extended’ (5). Health Education England committed to an intake of 46 OM trainees in England this reporting/fiscal year (6) , yet in the first recruitment stage in 2015 only 12 trainees were recruited. More must be done by those responsible as a matter of urgency.

At its annual representative meeting this year the BMA noted with concern the crisis in occupational medicine in the UK caused by an alarming fall in the number of qualified occupational physicians and of doctors entering the specialty; and reaffirmed the urgent need to increase the number of trainees and accredited specialists. The meeting demanded that:-
i) occupational medicine specialist training posts are wholly centrally funded;
ii) salary protection is clarified and better publicized to attract those doctors who may wish to change career and commence training in occupational medicine.
We believe that action is needed on several fronts to increase both supply and demand for specialists in occupational medicine. These actions include enforcing current regulation by the HSE, central funding for more posts, improved salary protection, more varied and hybrid training rotations including mandatory non-NHS elements in industry, higher education and the armed forces, dual time credits for appropriate primary care and other training placements, less than full time training options, increased efforts to retain senior specialists and to attract doctors with a diploma to take the plunge into specialist training.

1. Raynal A. Occupational medicine is in demise. BMJ 2015; 351.
2. Rhodes C. Briefing paper. Number 06152, 16 November 2015. Business statistics. House of Commons Library.
3. The State of Medical Education and Practice in the UK. General Medical Council. 2014.
4. Medical Specialty Workforce Summary Sheet. Occupational Medicine. Centre for Workforce Intelligence 2011
5. Public Health Priorities: Investing in the Evidence. Annual report of the Chief Medical Officer 2013. Department of Health September 2014.
6. Investing in people for health and healthcare. Workforce plan for England. Proposed Education and Training Commissions for 2015/16. Health Education England.

Competing interests: No competing interests

21 November 2015
Paul J Nicholson
Specialist occupational physician
Nigel L Wilson
BMA Occupational Medicine Committee
BMA House, Tavistock Square, London WC1H 9JP