DIP Episode 649 - What is Occupational and Environmental Medicine?

All right, welcome. My name is Divine. This is episode 649 of the Divine Intervention Podcast. And into this podcast, I'm going to be discussing a topic that I've titled What is Occupational and Environmental Medicine? What is Occupational and Environmental Medicine? This is a residency program that almost nobody knows about. You ask medical students, you ask other physicians like, hey, do you have your heard of Ahmed and the CN? No, I've never heard of it before. Which is kind of strange because honestly, it's probably one of the best hitting gems in all of medicine. It's a great field. It's very good, very intellectually stimulating. It has a lot of flexibility. So I want to talk about it just to increase awareness of this field. This is actually what I'm training in as well. I'm an Occupational and Environmental Medicine resident. All right, so let's go ahead and hit through this. So first things first, let's get right to it. So what's the length of this training? Well, the thing is the classic thing for most people is you have one year of preliminary something, right? So either like one year of internal medicine, or one year of transitional year, or one year of preliminsterge, or whatever. And then the actual Ahmed residency is two years. So kind of like anesthesia where you do like a year of something, like an intern year, and then you go into like anesthesia for three years.

This one is an intern year, and then you go into occupational and environmental medicine for two years. Right? And one thing I'll probably mention here is that quite a number of people in occupational medicine, there are people that switch out of another field in medicine, right? And then they move on to occupational and environmental medicine, right? So generally, as long as you have an intern year, then you should be good. Then you have two years of residency. There's even this, I believe it's called a complimentary pathway where, see, for example, you, let's say you have like an MPH for whatever reason, and you've done like two years of residency, then there are quite a number of programs that would just put you through a one year program, like almost like a fellowship in a sense, and you're able to challenge the occupational medicine boards and become a board certified, right? So again, your intern year is pretty much like any intern year, right? So what is the actual residency like? What is an occupational and environmental medicine residency like? Well, basically you have like an MPH, like a master's in public health for about eightish months of the residency, right? And it's typically paid for by the program that you're doing the residency with. And then the rest, you have your clinical rotations, right?

So you have a clinical rotations in things like cardiology, pulmonology, neurology, occupational medicine clinics, urgent care, addiction medicine, orthopedic surgery, you have some occupational safety and health administration rotations, so OSHA rotations, sports medicine rotations, emergency medicine rotations, VA rotations, employee health rotations, emergency preparedness rotations, there's lots of variability in programs, but most programs tend to have the MPH and most of these core rotations that I'm talking about. And one thing I'm going to say about many of these rotations is that they are outpatient rotations, probably about 80 to 90% of the rotations you're doing residency are primarily outpatient, right? So now a question many people may ask is, divine, what exactly do you do in occupational medicine? Well, there's actually a lot of variation, right? There's a lot of variation, right? So you can work in an occupational health clinic, you can work in an employee health clinic, you can hand you hand to workplace injuries, you do department of transportation, physicals, right? So all these CDL drivers, these commercial truck drivers, do you think that they can drive without getting like a detailed medical evaluation? I know they can't, right?

Basically every two years, that's like the maximum amount of time you can get, you do need to get evaluated by somebody that is probably an Ahmed physician that you know determines your you know your fitness for being able to do the job, you know, and things like that, right? So, or people that work in safety sensitive positions, right? So say for example, like pilots, for example, people that work in safety sensitive positions, the vast majority of these people are evaluated by occupational medicine physicians, right? Immigration examinations, those are done by people called civil surgeons, those are very detailed medical exams, that's going to be done by an occupational medicine physician, there are many occupational medicine physicians that work in the veterans affairs administration, the VA. So all these things like respiratory fitness, fitness for duty, right? Like is the person fit to perform certain jobs? That's done by occupational medicine physicians, corporate medicine, right? So say for example, you can be an occupational medicine physician and you can be an executive at a plant or something like that, like a manufacturing plant or whatever, and you're basically the one that determines, okay, this is how the workplace should be set up, this is this, this is that, so that workers don't get injured, right? This is how we make sure that we're keeping with OSHA requirements and things like that. And they also manage a lot of exposures, right?

So, you know, like I know many of many people think that this is just stuff that you read from first date, but things like silica, things like lead, things like beryllium, people do get exposed to those things, things like radon, things like asbestos, millions of people believe it or not every year, get exposed to those things, right? So occupational medicine physicians are the ones that are knowledgeable in, okay, how do we do medical surveillance for these exposures? How do we screen people for diseases related to these exposures? And what do we do for these people, right? So that's again largely done by occupational medicine physicians. So doing things like workers compensation, disability examinations, that's also done by occupational medicine, environmental health, toxicology, that's done by occupational medicine, return to work. So let's say for example, a person had a heart attack, you know, and they have, you know, they have a cardiac cathana everything and they're about to return to work. Well, who does that return to work evaluation if they are fit to come back to work or not? That's going to be done by occupational medicine physician, right? So, again, making a workplace less hazardous fitness for duty evaluations, toxicology, right? All these environmental exposures, like an oil spill and all those things. Again, many occupational medicine physicians handle things like that, right? The medical aspects of those things, right?

Disaster preparedness, emergency preparedness, public health work, medical surveillance exams, medical legal work, right? A lot of Ahmed physicians do consulting, we do like medical legal work, right? Or even like another, crazy, it's not even crazy, like it's pretty common, right? So say for example, you have like a big facility, right? So let's say you have like a car coming like a Toyota facility that employs a thousand people. Many times these places are going to have like an on-site clinic. Who do you think manages that on-site clinic? It's typically going to be an occupational medicine physician, right? I'm literally scratching the surface of what an occupational medicine physician does, right? There's even some of these like very niche jobs, right? So like for example, like you can have like these national labs or like a nuclear facility or whatever. And again, who do you think is in charge of managing workplace injuries at those places or monitoring workers for like radiation injury and things like that? It's going to be an occupational medicine physician. It's a very specialized field of medicine. It's broad, but it's also very specialized. That's when we are, I will probably describe occupational medicine. It's broad, but it's very, very specialized. It's broad, but it's also very, very specialized, right? It is probably one of the, if I will probably judge this as being one of the most flexible fields in all of medicine, right?

And the thing is, many times in occupational medicine, you can do your primary job and then do a lot of other supplemental things like you can do a lot of consulting work, you can be a medical review officer where you review drug tests and things like that. So there's a lot of things that you can do, right? So now what's the pay like? The pay is very strongly, I'll say on average, on average, on average, right? Like on average is very comparable to internal medicine. If not somewhat higher than internal medicine, okay? It's very, very comparable to internal medicine. And I'll say probably many cases quite a bit higher than internal medicine, you know, quite a bit higher than internal medicine. And for those that are in corporate medicine, the salary can approach that of a sub specialist, you know, like specialty, like anesthesia, right? So again, if you know what an anesthesiologist makes, a person that's doing corporate medicine in occupational medicine can make that much, if not even more, right? And the thing is the job market is pretty good, right? So again, if you want a salary range is between like above internal medicine to sub specialist wages, like an anesthesiologist or radiologist, right? So it pays pretty well. And the job market is pretty good, right? The thing is there are lots of people retiring, literally lots of people retiring, and there's not a lot of people entering the field.

In fact, I think the most current figures are that about 35 people nationwide are currently training in occupational medicine, 35 people nationwide are currently training in occupational medicine, and a lot of people in the field are old and they're retiring, right? They're old and they're retiring, right? There's not a lot of people in training, there's about 20 training programs nationwide, there's about 20 training programs at national wide, right? And one thing I think I want to mention here that's actually like a very nice perk of occupational medicine, of occupational environmental medicine, OEM, is that many of the insurance squabbles that many people worry about in other disciplines, it is very, very minimal, mostly nonexistent, right? So all these things like prior off, so prior authorizations, Medicare problems, those you don't even think you basically don't even think about those in in occupational medicine, right? And now what's the schedule like? What's the schedule like? Well, in a residency, there is phenomenal work life balance, right? Most of the time your work is going to be like 924, 925 from Monday to Friday, that's it. You basically never work weekends, and that's pretty much what your job will also look like, although again, it depends on the job you get, but I'll say that for probably like 95 to 99% of occupational medicine, like real world jobs, that's kind of how the schedule is as well, right? And who is this for? Who is this for?

Well, what are some things I will say you should kind of keep in mind if you're a person that is thinking of occupational medicine? Well, number one, you should be a person that has an attention to detail, right? So you need to be a person that has good attention to detail, right? You need to be a person that is very flexible, right? It's a very flexible field, and again, anything could come, let's say you work at an on-site clinic at a big manufacturing facility, anything could come through the door, right? It could be a bone fracture, it could be something where you need to refer them to the emergency room, right? It could be something where you need to stabilize them and then refer them out, right? So you need to be very flexible. There's a lot of flexibility even just in terms of career, right? You also need to be a person that likes outpatient medicine, right? A lot of the work you do is outpatient medicine if you're involved in clinical occupational medicine, and I guess they may be coming from this flexibility aspect of things, right? So you can actually do pure 100% clinical occupational medicine, but you can also do occupational medicine that is like 100% administrative, like 100% administrative policy work, public health work, like nothing clinical. If that's what writes your boat, you can absolutely do that. You can absolutely do that, you can absolutely do that.

And then it also has, it's also a discipline that I will say again, largely a mix of clinical and policy slash administrative slash public health work, right? Again, you're basically a person that is working to make a work, please see for, and you're, I like to think of it as like you're essentially like the internist slash emergency medicine physician of the workplace. You're the internist slash the emergency medicine physician of the workplace. That is a gross oversimplification, but there's many other things. In fact, let me say you're probably like the internist, the family medicine doctor, and the emergency medicine physician of the workplace. So let me, let me break that down like why do I see that? So the thing is the emergency medicine angle is a workplace injury that arises. Obviously, it's going to be an acute problem, right? You're going to manage those. And then from the internal medicine perspective, right? You have to consider many things in evaluating a person's fitness for duty, right? So say for example, if a person is a truck driver, right? If a person is a truck driver, you need to evaluate their cardiovascular systems, you need to evaluate their respiratory systems, you need to evaluate their neurologic systems, right? Before you say, okay, I'm going to certify you to work, to, I'm going to give you a medical card to be able to work for two years as a CDL driver, right? As a commercial truck driver. You have to consider many things, right?

Like for example, when I do DOT physicals, right? Department of Transportation Physicals, I have to evaluate the patient like, okay, wait, does this person have obstructive sleep apnea? Does this person have high blood pressure? What is this person's vision like? What is this person's hearing like? Does this person have a murmur? Does this person have a seizure disorder? You need to know quite a bit about general medicine to make the right determination because the thing is if you make the wrong decision, you can kill a lot of people. That's the truth, right? So say for example, you grant a medical card to a commercial driver and you know, you didn't do a proper evaluation and things like that, you didn't think through things, you grant the person a medical card and then the person goes out, you know, they're driving their truck and then the, they fall asleep on the job, right? Or they're impaired or they have a seizure or whatever, right? If you have a commercial truck accident, you're probably going to kill tons of people, right? You're probably going to kill tons of people, you're going to cause significant damage, right? So like that's the internal medicine aspect of things, like the, hey, I got to think about many things, right? And then the family medicine part of things, preventive medicine part of things is like surveillance, right? So say for example, a person works in construction, right?

And let's say, you know, they're like a people that build countertops and things like that. Well, those people are going to be exposed to silica, a lot of silica, so the thing is you need to be the one, because those people, they have medical surveillance exams where basically like every three years, they come in for a medical evaluation if they meet certain criteria, so you typically work with a company to see like, okay, does this person meet the criteria for evaluation? Okay, how frequently should this person be evaluated? What should be the content of the exams? Like this person is probably going to get spirometry, this person is going to get a chest x-ray and it's going to be rating a very specific way. There's like a bunch of things you need to be cognizant of, right? So that's like the medical surveillance, almost like the preventive medicine aspect of occupational and environmental medicine, right? And you're going to be another thing that I'll say is, you know, a characteristic you should probably have if you're interested in op med is you need to be willing to talk with people, right? Talk with people, educate people, that's something you need to be willing to do, because it's a people specialty, you're going to be talking with people a lot, right? And then you also need to be a person that is willing to work with autonomy, right?

So not necessarily having people breathing down your neck, again, you probably will have bosses or whatever, but the thing is in many settings, in many situations, you're kind of the lone ranger, right? There are sometimes in the military, you have an occupational medicine physician and you're the only op med doc on the base, right? And you're the one that has to basically handle most the workplace injuries, the fitness, for duty evaluations, and things like that, right? And you also need to be a person that is a leader, right? Leadership, leadership, leadership, right? Many occupational medicine physicians and leadership positions, especially if you're in corporate medicine, you're probably going to be on the, in some settings, you can actually be like an executive in the company, like the vice president of something, right? You know, you'll see like a large healthcare system and things like that, right? And, you know, you also need to generate quite a number of reports, right? So you need to be a person that is, you know, well versed in writing, right? You have a diversity of diversity of interest. If you're a person that has a diversity of interest, right? And again, a person that values work life balance, right? So like for example, you know, many of you that listen to those podcasts, you know that I'm a, a graceful or, you know, I'm a person that, you know, I love to go to church on Sundays. And I like to make podcasts that, you know, prepare people for the USML exams.

You know, I have many interests outside of classical medicine, right? Occupational medicine is a great feel for a person that has that kind of orientation, right? If you're a person that has a family, right? Again, it's a great feel for physicians that have families, right? So it's a really great feel. And you know, I think I, I've even neglected to talk about some other things that I don't, right? Like employee health, right? Like these employee health clinics, you'll find that like the VA or at a hospital or whatever. Again, who do you think runs those employee health clinics? It's going to be an occupational environmental medicine physician in many cases, all right? So if you're interested in this field, I will encourage you, just do some research on it, right? I will probably God willing in the future, make some other podcasts. Excuse me. Excuse me. Excuse me. Make some other podcasts relating to occupational medicine in the future. God willing will see. But I'm really surprised by how, how little people know about this. So again, it's something to consider. If you're applying for, you know, for residency, it's certainly something to consider. It's certainly something to consider. It's, it's certainly something to consider. I think many people, if more people knew about this field, I have a feeling that more people would go into this field, right?

There are many people that were family medicine physicians, they were internal medicine physicians, they were surgeons burnt out in their fields and they switched occupational environmental medicine, right? So just something to think about. And there, I guess also some sister specialties that are in related occupational medicine, like preventive medicines, another separate residency, that's probably like a whole other podcast. And then aerospace medicines, another residency, that's like a whole other podcast. Just pretend to work at like NASA or Space X or, you know, things, things like that. So I'm going to go ahead and stop here. Again, if you love the way I teach, you love the way I make integrations, you love the classes that I offer, I also offer one on one tutor and all that stuff. So, and I have these podcasts on Apple Google and Spotify and I have a You Tube channel, Divine Intervention, USMD podcast and videos that I should check out. There's tons of videos there, right? And I also have another website called Divine Intervention Lifelessens.com. Divine Intervention Lifelessens.com. Again, many of you know I'm a Christ follower. So every week, I post like one or two podcasts, we're from a biblical perspective. I address a life lesson, right? There's actually I think like 389 podcasts on there. Now, and there's actually an Apple podcast, you know, called the Divine Intervention Lifelessens.com podcast. So thank you for listening to me today.

Again, I really, really think more met students and I'm really trying to raise more awareness of a gubision and environmental medicine. That's literally what I'm being trained in now. That's what I'm going to be doing for a living after I'm done with training, right? So I think it's a really great field, something that is not considered by many people, but I want to try to bring more eyes and more ears to our field. Because again, it's a really great field. Again, I know it may sound like I'm really glazing the field, but I promise you it's it's that good. In fact, I think I'm probably with this podcast like heavily underselling, occupational medicine, but you should really dig into it. You'll be quite shocked at what you will discover. So I will see you God willing episode 650. That's a nice round number. I will have a wonderful rest of your day. God bless you and bye for now. Thank you.

Determining fitness for duty and managing health risks related to workplace exposures and injuries.

DOT physicals (commercial drivers), civil surgeon exams (immigration), and fitness-for-duty assessments (e.g., pilots).

It emphasizes the public health, policy, and preventive aspects of medicine, not just acute clinical care.

Silica, lead, beryllium, asbestos, or radon.

Insurance squabbles (like prior authorizations/Medicare issues) are often minimal or nonexistent compared to other specialties.

They can act as an executive (e.g., VP), determining how the workplace should be set up to prevent injuries and ensure OSHA compliance.

To monitor workers exposed to specific hazards (like silica or asbestos) for early signs of related diseases, allowing for preventive intervention.

Because incorrect decisions regarding fitness-for-duty can have catastrophic consequences (e.g., certifying a commercial driver who has undiagnosed sleep apnea).

The "internist/family medicine doctor and emergency medicine physician of the workplace."

Department of Transportation (DOT) physicals, or civil surgeon examinations (for immigration).

The schedule often allows for phenomenal work-life balance, typically 9 to 5, Monday through Friday, with minimal weekend work.

Policy and administrative work (e.g., managing OSHA compliance or developing workplace safety protocols).

To monitor workers exposed to specific hazards (like silica or asbestos) for early signs of related diseases, allowing for preventive intervention.

Because incorrect decisions regarding fitness-for-duty can have catastrophic consequences (e.g., certifying a commercial driver who has undiagnosed sleep apnea).

The "internist/family medicine doctor and emergency medicine physician of the workplace."

Department of Transportation (DOT) physicals, or civil surgeon examinations (for immigration).

The schedule often allows for phenomenal work-life balance, typically 9 to 5, Monday through Friday, with minimal weekend work.

Policy and administrative work (e.g., managing OSHA compliance or developing workplace safety protocols).