Are occupational pulmonary problems evaluated by low patient volume occupational medicine subspecialists?
Wu-S; Harber-PI; Bontemps-J
Am J Respir Crit Care Med 2012 May; 185(Meeting Abstracts): :A2305
INTRODUCTION: Understanding the distribution of pulmonary cases among groups of occupational medicine practitioners can guide health service organization and training. Some posit that occupational lung disease (OLD) patients are primarily seen by my intensity, low-volume practitioners. METHODS: The OMP representative national survey of occupational medicine (OM) physicians included 252 who regularly saw patients. Participating physicians completed 25 activity logs describing activity at specific times. Patient load for clinicians was categorized by quartile of patients / week, and proportion of OLD was dichotomized above or below the 4% mean. Mantel-Haenszel Chi-Square analyses were used. RESULTS: There was no statistical relationship between quartile of patient load per week and proportion of pulmonary patients in occupational medicine practices. Similar results were seen for all toxicology cases. In contrast, there were strong relationships between patient load and frequency of musculoskeletal or spinal problems, with high patient load clinicians seeing disproportionately more of these cases. 38% of all participating OM physicians had >= 1 OLD matter among the 25 activities sampled. Analysis by OM Board certification status showed a nonsignificant trend for certified physicians to have at least one OLD activity (43% versus 33%). Career stage did not affect the likelihood of having >= 1 OLD). CONCLUSIONS: An average of 4% of occupational medicine physicians' patients involved OLD. These patients are seen by all occupational physicians, not just low volume/high intensity subspecialists. Improved understanding of practitioners' necessary skills and competencies should inform reimbursement and educational criteria. These data show that OLD is an important component of many occupational medical practices rather than being an esoteric subspecialist problem.
Medical-services; Training; Education; Physicians; Medical-personnel; Questionnaires; Health-care-personnel; Statistical-analysis
American Journal of Respiratory and Critical Care Medicine
University of California, Los Angeles