Fundamentals of Industrial Hygiene - PowerPoint Presentation

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Fundamentals of Industrial Hygiene6th Edition

Chapter 26

:

Occupational and Environmental

Medicine

Physician

Compiled by Janvier Gasana

Associate Professor, Environmental & Occupational Health

Florida International University

Focus of Occupational MedicineIn the past decade, focus increased on environmental aspect of preventive medicine specialty

New challenges

nanotechnology

hazards

aerospace

and undersea environments

Maintain partnership with government, industry, and labor scientists in ongoing evaluation of hazards in industrial operations

What is in workplace gets into air, soil, water, and into our bodies via food and drinks

History of OEM PhysicianFrom very early days physicians have noted the importance of occupation in causation of disease and injury

Bernardino

Ramazzini’s

three causes for upper extremity cumulative trauma disorders:

constant sitting

incessant movement of the hand in the same direction

lack of benefits of moderate exercise

In late 1800s, states required medical school degrees American Medical Association (AMA) founded in 1846Council on Medical Education issued Flexner Report in 1910 criticizing 131 medical schools—70 survived

I

nnovations helped U.S. move from agricultural society to industrial society

anesthesia use, aseptic technique, diagnostic instruments and tests, identification of disease-causing organisms, and development of vaccines

In 1860s, railroads and mining companies employed physicians

to treat victims of industrial accidents

Workers’ compensation laws did not exist until early 1900s

History of OEM

Physician (cont.)

History of OEM Physician (cont.)ACOM (American College of Occupational Medicine) now known as the American College of Occupational and Environmental Medicine (ACOEM)

More than 30 occupational medicine residency programs were developed at major universities across the United States

Approximately 75 physicians per year

Fiscal crises caused number of programs to drop to 28

Over 4,000 doctors are members of ACOEM

A

pproximately 1,500 members are board-certified as specialists, more than half approaching retirement age

Since 1984, all physicians graduating medical school required to complete residency or fellowship program to become eligible to take Occupational Medicine Board Exam2-year program, usually after full or partial residency in another field (e.g., internal medicine)content

includes public health training in toxicology, epidemiology, and statistics, and practicum year of clinical, research, corporate placements, public sector agency rotations

most

academic occupational medicine residency programs focus heavily on toxicology and epidemiology

Credentials and Professional Associations

OMB Exam offered once a year by American Board of Preventive Medicine200–300 physicians who take examination annually must demonstrate proficiency both in preventive medicine and occupational medicine

to

pass.

Recertification

examination

required every

10

years

Internet can also be path to MPH degree

Part-time residency programs allow qualified physicians to make transition without disrupting personal lives

Alternative credentialing being explored because there are not enough qualified practitioners to meet needs of country

Credentials and Professional Associations (cont.)

Corporate medical departmentcorporate medical directors likely consultants to human resources department

medical

directors provide medical review for workers’ compensation cases

Other duties may include fitness-for-duty evaluations, development of medical surveillance protocols for occupational exposures, and the establishment of wellness programs.

corporate-based

OEM physicians or consultants frequently need business and fiscal-management skills and computer skills.

physicians

working for multinational corporations also need to become experts in travel medicine

Practice Settings

Multispecialty Group Practice / Hospital-Based Programs

Physician may work in separate occupational medicine department or as subspecialist, usually in division of

medicine or family practice, sometimes as part of emergency/urgent care.

Usually these positions are primarily clinical, and frequently require heavy patient load of 20 to 30 patients per day.

Additional responsibilities may include

developing programs to attract local industry (e.g., injury care, pre-placement examinations, wellness efforts, and drug testing)

performing consults for colleagues from other departments or divisions on environ-mental exposures or work or disability issues

helping to ensure that workers’ compensation visits are correctly reported and billed

Freestanding Occupational Health ClinicsMay be single entity or part of chain of

clinics developed

to serve multiple local companies by providing range of

services

Sometimes industrial services

are combined with urgent care for nonindustrial problems

Do not usually have access to specialized services available to hospitals or multispecialty group practice programsOften practitioners are required to see 30–40 patients per day, are not specialists in field, and focus on injury illness treatment and pre-placement and

surveillance

examinations

Many

working

in these clinics have little time or training to deal with complex health

and safety issues

Private Consulting FirmsMany academically trained, board-certified occupational medicine physicians chose to join or set up their own consulting firms. Allows a wide range of practice opportunities, including

consulting with companies, local government agencies, and unions

performing medical surveillance & other examinations

acting as expert witnesses

doing epidemiological research

participating in environmental hazard investigations

Frequently these firms have close working relationships with industrial hygienists, epidemiologists, toxicologists, and occupational health nurses

Academic Occupational Medicine DepartmentsThese have been established in all of the universities with occupational medicine residency programs and many others,

and

are growing in

number

s

Responsibilities in this setting include research

and teaching and patient care, consulting, and expert witness testimony. Occupational medicine physicians working in academic settings are board-certified, frequently in occupational medicine and another specialty, and may be allotted additional responsibilities, for example, attending on medicine wards, proctoring medical students, etc.

Environmental Agencies & Nongovernmental OrganizationsGlobal environmental crisis has spurred significant growth in activist and

scientific environmental organizations with legislative campaigns to forestall

and/or

clean up hazardous sites,

and

reduce body burden of industrial chemical contamination through product substitution.

Government AgenciesPolicy development and regulatory agencies in areas of occupational and

environmental health and

safety

often

have one or more staff

physicians to provide scientific oversight and backup. NIOSH, federal and state OSHA programs, EPA, and other

federal, state,

and

local governmental agencies have in-house, well-trained,

and

credentialed occupational and environmental physicians who are significant resources

of information for industrial hygiene

and

safety personnel.

All

branches of military also have active occupational medicine

programs.

A growing field that is attracting number of board-certified occupational medicine physicians Rapid industrialization in Asia, South America, and some parts of Africa has created significant industrial

and environmental

problems

OHS professionals

from

U.S.,

Canada, and Europe are finding jobs as consultantsduties range from training of local professionals and conducting epidemiological research studies to consulting on governmental policies and

legislation

and

making presentations at international

conferences

International Occupational & Environmental Health Consulting

OHS has long been an important

issue for unions whose members face exposure to significant chemical hazards,

and

is

a growing

issue for newer service sector unions, such as Service Employees International

Union

Union

efforts have been key factor in spurring legislation mandating stronger workplace health

and

safety regulations.

Professional medical expertise plays critical role both in creating

and supporting such

legislation

Union Occupational Health Physicians

Familiar with state and

federal workers’ compensation

systems

be

able to evaluate

and

treat common work-related

injuries/illnesses

Able to

perform pre-placement, DOT,

and

basic medical surveillance examinations for respiratory protection/exposure to

toxins

Board-certified OEM physicians should

:

Provide

expertise and guidance

on more complicated toxic

and

other workplace hazards, including difficult issues regarding causation.

Be familiar with important local

and

national legislative developments, including employment

and

health-

and

safety-related

issues

e.g., Americans

with Disabilities Act, status of upcoming bills on hot topics such as ergonomics, changes in workers’ compensation laws,

legislation

about medical surveillance requirements, protocol

and policy development

Scope of Practice

Clinical Practice

Occupational health history

brief

occupational health history should be part of all medical histories

most

physicians

still not appropriately trained in how to take good occupational history

safety

& health professional must rely on referral to specialists in

field.

most

employees find

form easy to fill out

should

be instructed to do so

chronologically

Clinical Practice (cont.)In addition to past

and

current occupational history,

form

also covers moonlighting jobs

and hobbies—often source of significant exposures separate from or in addition to those in full-time

occupation

Questions about reproductive history are also important

to occupational

history, as effects from certain

chemicals and other

hazards may present first or only in this

area

When evaluating specific job, including questions that focus on

workstation and

work tools, work tasks,

and

individual’s work

practices

may be useful addition to baseline

questions

Drug testing and medical review officer examinationsdrug testing

a

major

focus for many companies concerned about job

safety

required

as part of

pre-placement

screening process,

and

many companies also require employees to agree to testing in

event

of

work

injury, or, in sensitive occupations, randomly during

course

of

work

year

OEM

physician can help

employers

develop

useful

monitoring program

and

can

also provide medical review officer services to evaluate

results

of testing if physician

is MRO

certified

certification

requires significant additional training

and ongoing accrual of annual continuing education points

Clinical Practice (cont.)

Special laws cover

federal employees who are injured on

job, such as maritime

, railroad,

and

long shore industries

OEM

physician practicing in

specific

geographic area should familiarize themselves with both

state

and national laws relevant to that

area

Most workers who are injured on

job

recover

and continue

working

.

Psychosocial

factors also play

major

role in

15–20%

of cases

with delayed

recovery

Workers’ Compensation Case Evaluation & Treatment