Occupational medicine questions

[qozu]

I recently learned about Occupational and Environmental Medicine and had some questions for people more familiar with the field. A lot of the information I found online and on old threads is a bit vague, so I was hoping for some more specific information.

1. What are the advantages of completing an OEM residency/fellowship if one has already finished a different residency? Some of the job postings I have found online accept applications from physicians boarded in various specialties (Medicine, PM&R, etc.); do employers have a preference for OEM-boarded physicians? Are certain types of jobs only available to OEM-trained folks?

2. What is the job market like? It seems that the field is growing in popularity; is the job market becoming more saturated?

3. What are typical salaries like in the field? I'm particularly interested in the west coast and northeast, if that makes any difference.

4. Do you have any opinions about the big corporate players in the field (U.S. HealthWorks, Concentra, etc.)? What are the downsides to practicing with these companies?

5. What are the dynamics with mid-levels in the field? Is there a big risk of employers turning more to mid-levels for staffing rather than physicians?

Thank you for any help. I'm not sure if this is the best forum to post this, but I think a fair number of occ med physicians come from Internal Medicine, so I thought I'd try here.

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[gutonc]

Moving to Gen Res.

 

[ThoracicGuy]

Paging @fantasty!

 

[fantasty]

Paging @fantasty!

Sorry for the delay - and I probably can't marathon post but high points for the OP...

Synopsis - More jobs than preventive medicine, but not as many an internal medicine. Reasonably high career satisfaction rates compared to other specialties. Low acuity much of the time, with predictable hours and little/no call. I know some folks who are doing well, especially with midlevels working for them. I don't think the market is saturated -- I think there are plenty of opportunities.

Note: I am *not* OEM but prev med. Sister specialties. There's a backdoor route into getting boarded in OEM after PM residency without doing an OEM residency. I'll discuss more later if interested.

1. What are the advantages of completing an OEM residency/fellowship if one has already finished a different residency? Some of the job postings I have found online accept applications from physicians boarded in various specialties (Medicine, PM&R, etc.); do employers have a preference for OEM-boarded physicians? Are certain types of jobs only available to OEM-trained folks?

To get into OEM, you need at least one clinical year in another specialty anyhow. Many do two full residencies and become dual-boarded (IM/OM, etc). There are aspects of OM that can be compartmentalized and done with short training and certification for specific tasks. When I was applying for jobs (in the OEM world), I was contemplating completing certain certifications to become more marketable. Dept of Transportation; FAA; Medical review officer; Independent Medical Examiner; Workmans compensation, and probably others I'm blocking out of my memory.

But, yes... you can get some OM-related jobs without being OM-boarded (particularly if combined type of job like industry-based family practice clinic or urgent-care/occ med hydrid). But, most jobs will want you to be BE/BC if they are fully OEM.

2. What is the job market like? It seems that the field is growing in popularity; is the job market becoming more saturated?

In my opinion - no. Small-ish field. But, not a lot of people interested so I think demand will continue to outpace supply.

3. What are typical salaries like in the field? I'm particularly interested in the west coast and northeast, if that makes any difference.

I'm not a good person to ask. But, AECOM (their professional society) does salary / compensation surveys periodically. I did a rotation with a president of that organization so I did have some access to the database. But, I honestly don't recall many details, particularly regional variations. But, that being said... any place I interviewed and seemed to be a reasonable contender for was offering starting salary about 20% higher than I expected. (But, understand that my expectations are based on Prev Med salaries, which are very low on the specialty food chain.).

4. Do you have any opinions about the big corporate players in the field (U.S. HealthWorks, Concentra, etc.)? What are the downsides to practicing with these companies?

I can't say if the trends toward being employed by these players is good or bad. People I know at Concentra seem happy (or at least they did a couple years ago). Again, back when I was doing rotations, a "hot topic" in the field was Urgent Care powerhouses moving in on Occ Med work, and traditionally OM powerhouses like those starting to expand into urgent care as well.

5. What are the dynamics with mid-levels in the field? Is there a big risk of employers turning more to mid-levels for staffing rather than physicians?

Can't say with authority. But, most of my observations were small number of docs in a practice and a slightly higher number of midlevels. Midlevels were busy and generated a lot of revenue. But there are a lot of specific responsibilities that must be done or directly overseen by physicians. (Most of those certifications above, for example, are physician-level only).

I recently learned about Occupational and Environmental Medicine and had some questions for people more familiar with the field. A lot of the information I found online and on old threads is a bit vague, so I was hoping for some more specific information.
.

Hope that helps. Take with a huge grain of salt as I'm still an outsider. Realized I didn't quote or tag you so added this so you'd see that there was activity.

 

[qozu]

Thank you so much for the reply, @fantasty, that's very helpful.

 

[trixmd]

Hi!

I'm a dual boarded occ med/prev med doc, but I'm in the military, so my perspective is a little skewed. I'm looking at moonlighting in occ med now and getting out of the military in the next 5 years or so.

The advantage to training in occ med vice practicing occ med after a different specialty is that you learn the nuances of the specialty that you might not pick up otherwise (IE where the big paying industries are, how to work in the population health perspective of occ med that would make you competitive for leadership positions in a company, practicing in a niche field like corporate wellness). If you'd be content practicing bread and butter occ med (workmans comp, return to work exams, surveillance) and you're already boarded in a clinical specialty like FM, IM, or PMR, you probably don't need any further training.

The job market is pretty robust. There are a handful of residencies but a lot of people are retiring and more employers are looking for occ med folks.. (That's why the jobs are often open to other specialties.) In the year I've been looking at part time occ med jobs, the salary has been higher for BC/BE folks. It's not evident to me at this point that the field is saturated.

In 2016 I went to ACPM, and spoke to occ med recruiters. The jobs that fit the parameters I wanted (location (West Coast/California, Washington, and Hawaii) and setting (not industrial)) started at $225k, no nights and no weekends.

I've worked with some midlevels - similar to non-residency trained folks, they get a lot of the bread and butter stuff.

Hope that helps.

Trix

 

[qozu]

The advantage to training in occ med vice practicing occ med after a different specialty is that you learn the nuances of the specialty that you might not pick up otherwise (IE where the big paying industries are, how to work in the population health perspective of occ med that would make you competitive for leadership positions in a company, practicing in a niche field like corporate wellness). If you'd be content practicing bread and butter occ med (workmans comp, return to work exams, surveillance).

This is all very helpful, thank you so much. I had a somewhat specific question about training that I was hoping you could answer:

I started looking at some of the residencies out there, and it seems that some offer a part-time option that gets you board eligibility through the ABPM "complementary pathway" for occ med. The way at least one of them seems to work is that you work full-time in occ med anywhere in the country, then you meet for several days every month at their main hospital for didactics.

Do you have any experience with this type of training track or know other people who do? The obvious advantage to this set up seems to be that you could still get a full attending salary while working toward board eligibility, but I'm wondering if you lose some of the more nuanced training that you alluded to.

Thanks again for your help.

 

[trixmd]

The only part time program of which I’m aware is at UPenn. I don’t know anyone who has done it though.

 

[fantasty]

I'm horrible - I haven't responded to a PM yet (different poster but seeing this bump up reminded me that I owed them a response).

Just 2 cents add on (as @trixmd is clearly more knowledgeable). And I've alluded to this before but I haven't checked to see if it's technically considered part of the alternative pathway to certification. But, I do know that someone from an PM residency program who works in the field of Occ Med for 5 years (and presumably picks up structured CME to round out their knowledge base, perhaps in the manner described above) can register and sit for the OM boards.

It seems to me that a fairly significant proportion of PM grads end up following that route, and several of the recent grads from my residency program are included.

 

[trixmd]

The alternative pathway is sort of how I qualified for my Occ Boards - in my military job we do a lot of occ med AND I was a Navy flight surgeon before I trained in PM so I had the experience/years of occ med practice. I also did a CDC fellowship (EIS - it's fantastic!) and during that time spent a summer at NIOSH looking at injuries. looking thru their B reader films, and reviewing the ATDSR case studies, so had some structured time to fill in my knowledge gaps. Some of my PM colleagues from the Navy who didn't have that opportunity studied the same way, passed the boards, and also practice OM on the side.

FWIW, I think practicing PM in the military is really interesting. My time is split between getting units ready to deploy to far flung places, outbreak investigations, and global medicine (most recently I was in Nepal training UN peacekeepers). However, I've dipped my toe in the Occ Med pool because that's likely the subject area where I'll practice when I get out as the part time gigs are more prevalent and pay more. The other thing I may do is clinical informatics (also an ABPM specialty) but that's a whole other ball of pasta!

 

[fantasty]

The alternative pathway is sort of how I qualified for my Occ Boards - in my military job we do a lot of occ med AND I was a Navy flight surgeon before I trained in PM so I had the experience/years of occ med practice. I also did a CDC fellowship (EIS - it's fantastic!) and during that time spent a summer at NIOSH looking at injuries. looking thru their B reader films, and reviewing the ATDSR case studies, so had some structured time to fill in my knowledge gaps. Some of my PM colleagues from the Navy who didn't have that opportunity studied the same way, passed the boards, and also practice OM on the side.

FWIW, I think practicing PM in the military is really interesting. My time is split between getting units ready to deploy to far flung places, outbreak investigations, and global medicine (most recently I was in Nepal training UN peacekeepers). However, I've dipped my toe in the Occ Med pool because that's likely the subject area where I'll practice when I get out as the part time gigs are more prevalent and pay more. The other thing I may do is clinical informatics (also an ABPM specialty) but that's a whole other ball of pasta!

See @Winged Scapula ... there are more of us. Time for our own forum

 

[Apollyon]

I also did a CDC fellowship (EIS - it's fantastic!)

I was just talking about this a few days ago. I was saying, at least when I looked at it, the EIS didn't get you any "paper" - no Master's degree, no board eligibility, nothing, but it was thrilling. I couldn't work it out, so I wasn't more than just looking, but it looked like almost an "Indiana Jones" opportunity.

Best of luck!

 

[fantasty]

I was just talking about this a few days ago. I was saying, at least when I looked at it, the EIS didn't get you any "paper" - no Master's degree, no board eligibility, nothing, but it was thrilling. I couldn't work it out, so I wasn't more than just looking, but it looked like almost an "Indiana Jones" opportunity.

Best of luck!

I have a fair number of friends/colleagues who have done it - experiences widely vary based on placement and interest. But, it was how my mentor through my training became engagement in preventive medicine (back in the 70s). (And, vets, PhDs, other health professions can do it, too).

 

[trixmd]

EIS is a great experience, even for someone like myself who was already on a career glide path w the Navy and had publications and research grants. I think most physicians end up going back to some kind of clinical work. But for the rest especially folks looking to get in w the CDC, NIH, etc - it gets you the secret handshake and access to a rolodex, both of which open many doors.

 

[Winged Scapula]

See @Winged Scapula ... there are more of us. Time for our own forum

So that makes 3?

 

[fantasty]

So that makes 3?

So, I found out when I got my board results... There were ~ 100 General Prev Med and only ~80 Occ Med examinees (which really makes me question my assumptions of why there are so many more job postings for OM... although again... people may not seeking BC status or using other routes). But, there were over 1100 addiction medicine examinees and ~ 250 clinical informatics folks. (Aerospace and hyperbaric were too small to report).

 

[Lawpy]

An occupational medicine forum would be nice. I know little of the field but am interested to know more.

I'm sure there are more members here in the field.

 

[trixmd]

... There were ~ 100 General Prev Med and only ~80 Occ Med examinees (which really makes me question my assumptions of why there are so many more job postings for OM... although again... people may not seeking BC status or using other routes)... .

Many people practice both w/out board certification. I think there are more OM job postings because the salary is lucrative (much more so than PM, in general), and there seems to be a demand signal for folks BC'd in OM while so many folks are retiring out of the field. I forget the numbers exactly, but a recruiter did an occ med presentation at ACPM a couple years ago and said each year there was something like 2ish occ docs retiring for every new grad. Food for thought!

 

[fantasty]

Many people practice both w/out board certification. I think there are more OM job postings because the salary is lucrative (much more so than PM, in general), and there seems to be a demand signal for folks BC'd in OM while so many folks are retiring out of the field. I forget the numbers exactly, but a recruiter did an occ med presentation at ACPM a couple years ago and said each year there was something like 2ish occ docs retiring for every new grad. Food for thought!

Supposedly, the same is true for health commissioners and medical officers in local health departments. (The mass retirement thing, not the lucrative pay part... not by a long-shot). Hiring process is a lot different in government, though. I'm a bit irritated because I've seen a lot of positions that "required preventive medicine board certification" go to non-boarded primary care docs.

2 weeks to ACPM! I'm jazzed.

 

[trixmd]

Aloha- anyone going to AOHC this year? It’s in Anaheim at the Disneyland Hotel!

 

[fantasty]

Aloha- anyone going to AOHC this year? It’s in Anaheim at the Disneyland Hotel!

Acpm is in Pittsburgh. Woot.