Occupational medicine activities and skills: an empirical study.
Harber-P; Wu-S; Bontemps-J; Rose-S; Saechao-K; Liu-Y
Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, R01-OH-008647, 2013 Aug; :1-12
This research quantitatively describes activities and skills of three occupational health professional disciplines. This may inform educational curricula, professional certification criteria, organization of services, and training program impact assessment. This research was based on empirical data rather than opinions of experts or general surveys of practitioners. The researchers recruited a national sample of 412 occupational physicians, 129 occupational health nurses, and 196 industrial hygienists, all of whom answered baseline descriptive questions and submitted logs describing activities at specific times. These professionals generated a total of approximately 11,600 individual activity logs. Analyses show: (1) Despite three distinct practice patterns -- "injury care", "subspecialty care", and "population/management medicine" -- occupational medicine has common elements which distinguish services from those of other physicians. Musculoskeletal problems are most common, but there is a significant component of pulmonary and toxicologic problems. (2) Board-certified occupational physicians provide a greater variety of services, use more skills, and are more public health-oriented than those who are not certified. (3) Occupational health nurses and industrial hygienists are predominantly employees of large entities and are more directly associated with specific worksites than physicians, who are more frequently in smaller clinical (i.e. non-worksite) offices and compensated by fee-for-service workers' compensation payments. (4) Management and communication activities are common for all three disciplines. Nurses perform as much direct "hands-on" care as indirect patient care. Industrial hygienists perform more evaluation than control activity. (5) Activity patterns vary with career stage, and significant career transitions are frequent. The proportion of physician first jobs in a corporate or other nonclinical setting is lower than in the past, but transitions from clinical to nonclinical roles occur over time. (6) Interactions are predominantly within discipline rather than between professional disciplines. (7) The work of occupational physicians and nurses is very focused in occupational health rather than environmental health. Industrial hygienists are similarly focused. Implications: (a) There are significant incongruities between actual practice skills and many educational curricula. (b) Formal training and board certification in occupational medicine has significant beneficial impact in terms of diversity of skills and incorporating population-based approaches. (c) Managerial as well as technical skills are necessary and should be addressed in training/certification. (d) The study underscored the need for improving interdisciplinary practice interactions. (e) The online point in time methodology developed for this study may be applicable to other analyses of services' structure and function. (f) Worker health and productivity may be enhanced by carefully targeting the education and skills of occupational health professionals. Professional certification for occupational physicians, occupational health nurses, and industrial hygienists may be informed by empirical understanding of their actual work activities.
Medical-personnel; Questionnaires; Physicians; Statistical-analysis; Public-health; Education; Health-care-personnel; Training
Philip Harber, MD, MPH, Mel and Enid Zuckerman College of Public Health, University of Arizona, Medical Research Bldg, Room 112, 1656 E Mabel St, Tucson, AZ 85719
Final Grant Report
NTIS Accession No.
National Institute for Occupational Safety and Health
University of California, Los Angeles