Fundamentals of Industrial Hygiene 6th Edition
Description: Fundamentals of Industrial Hygiene 6th Edition Chapter 26: Occupational and Environmental Medicine Physician Compiled by Janvier Gasana Associate Professor, Environmental Occupational Health Florida International University Focus of
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slide1. Fundamentals of Industrial Hygiene 6th Edition Chapter 26:
Occupational and Environmental Medicine Physician
Compiled by Janvier Gasana
Associate Professor, Environmental & Occupational Health
Florida International University<br>
slide2. Focus of Occupational Medicine In 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<br>
slide3. History of OEM Physician From 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<br>
slide4. In late 1800s, states required medical school degrees
American Medical Association (AMA) founded in 1846
Council on Medical Education issued Flexner Report in 1910 criticizing 131 medical schools—70 survived
Innovations 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.)<br>
slide5. 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
Approximately 1,500 members are board-certified as specialists, more than half approaching retirement age<br>
slide6. Since 1984, all physicians graduating medical school required to complete residency or fellowship program to become eligible to take Occupational Medicine Board Exam
2-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<br>
slide7. OMB Exam offered once a year by American Board of Preventive Medicine
200–300 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.)<br>
slide8. Corporate medical department
corporate 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<br>
slide9. 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<br>
slide10. Freestanding Occupational Health Clinics May 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 programs
Often 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<br>
slide11. Private Consulting Firms Many 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<br>
slide12. Academic Occupational Medicine Departments These have been established in all of the universities with occupational medicine residency programs and many others, and are growing in numbers
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.<br>
slide13. Environmental Agencies & Nongovernmental Organizations Global 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.<br>
slide14. Government Agencies Policy 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.<br>
slide15. 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 consultants
duties 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<br>
slide16. 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<br>
slide17. 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<br>
slide18. 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<br>
slide19. 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<br>
slide20. Drug testing and medical review officer examinations
drug 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.)<br>
slide21. 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<br>
Occupational and Environmental Medicine Physician
Compiled by Janvier Gasana
Associate Professor, Environmental & Occupational Health
Florida International University<br>
slide2. Focus of Occupational Medicine In 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<br>
slide3. History of OEM Physician From 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<br>
slide4. In late 1800s, states required medical school degrees
American Medical Association (AMA) founded in 1846
Council on Medical Education issued Flexner Report in 1910 criticizing 131 medical schools—70 survived
Innovations 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.)<br>
slide5. 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
Approximately 1,500 members are board-certified as specialists, more than half approaching retirement age<br>
slide6. Since 1984, all physicians graduating medical school required to complete residency or fellowship program to become eligible to take Occupational Medicine Board Exam
2-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<br>
slide7. OMB Exam offered once a year by American Board of Preventive Medicine
200–300 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.)<br>
slide8. Corporate medical department
corporate 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<br>
slide9. 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<br>
slide10. Freestanding Occupational Health Clinics May 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 programs
Often 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<br>
slide11. Private Consulting Firms Many 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<br>
slide12. Academic Occupational Medicine Departments These have been established in all of the universities with occupational medicine residency programs and many others, and are growing in numbers
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.<br>
slide13. Environmental Agencies & Nongovernmental Organizations Global 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.<br>
slide14. Government Agencies Policy 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.<br>
slide15. 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 consultants
duties 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<br>
slide16. 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<br>
slide17. 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<br>
slide18. 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<br>
slide19. 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<br>
slide20. Drug testing and medical review officer examinations
drug 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.)<br>
slide21. 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<br>