What is Occupational Medicine and Occupational Health? What’s the difference?

Occupational Health (OH) is an umbrella term for the specialist multidisciplinary field which focuses on the interactions between work and health.

Occupational Medicine refers to the medical practice of OH by doctors / physicians.

Globally, most doctors practicing Occupational Medicine will call themselves Occupational Health Physicians (OHPs).

What does a career in Occupational Medicine involve?

This varies considerably and depends on many factors including the employer and sector. You may come across 2 OHPs who describe highly differing working weeks.

Some OHPs do no clinical work (see no patients) and work in a predominantly leadership or management capacity.

OHPs generally work in a consultancy or advisory capacity, meaning they are non-prescriptive and provide advice to an employer on the management of an individual or workforce, depending on the setting. They have a dual interest relationship with both the employee and the employer, and is expected to provide impartial advice, although in practice this can be quite a challenge.

Examples of types of work OHPs do include:

• Management Referrals – Determining fitness to work having reviewed an employee who has been referred by their employer for work related health issues

• Medicals and/or Health Surveillance – Statutory or non-statutory with reference to assessing the health of an individual related to exposure to a known hazard and/or according to legislative standards (e.g. Hand-Arm Vibration Syndrome, Drivers Medicals, Occupational Asthma, Oil and Gas, Offshore)

• Health Promotion – Proactive and preventative measures to support good health (e.g. flu vaccine campaigns, staff health and wellbeing days, smoking cessation, education etc.)

• Pre-Employment Assessments – Assessments of employees before they commence a post to determine suitability

• Ill Health Retirement Assessments – To determine and support employees who are too unwell to work for the foreseeable future

The list really does go on …

Although historically most OHPs were usually on the road performing personal visits to warehouses, nabbing a flight in a helicopter to later escape from one in a swimming pool simulation, or hanging out in diving bells to ‘better understand the job’, most roles are now predominantly office based and somewhat less energetic (!).

Why should I consider a career in Occupational Medicine?

OM is a great specialty for those with a broad base of experience in medicine (or surgery), are able to work independently as well as in a team, and possess an inherent curiosity as to what everyone gets up to in their day at work in detail!

Some other obvious benefits compared to other medical specialties include:

• Excellent pay – particularly in the private sector
• A holistic approach to ‘patient’ assessments – not just focused on the medical. You get to perform a biopsychosocial assessment covering everything else essential to determining fitness to work.
• More time with your patients / employees – averages about 45 minutes but can vary from 30-60 minutes
• You have the option not to see patients (but only in a few jobs).

It’s also important to be aware that with an increasing focus on the importance of health and wellbeing in the world of work, there will likely be an increasing amount of opportunities for Occupational Health specialists in this space.

Particularly considering that the vast majority of practitioners working in the Workplace Wellness space are not necessarily healthcare professionals and possess no formal training (!).

Why shouldn’t I work in Occupational Medicine?

There are few reasons not to do OM, however here are a few things to consider:

• If you’re passionate about prescribing / dictating over providing an advisory, then you’ll find the work a challenge. However there are many GPs who work as OHPs wearing both hats their week
• If you find it difficult to remain impartial
• There is a lot of independent practice in OM – even in the largest companies. If you need a regular team to keep you motivated day to day, then this may present as a challenge.
• You need to develop a good understanding of topics you’ve never ever come across in your clinical practice such as Health and Safety Law, Occupational Hygiene, Toxicology and more
• If you’re obsessed with needing a hard evidence base for your practice, OM is not for you. Although there is a reasonable amount of research in the field, day to day management decisions are not always based on that and can be quite complex.
• OM is frequently cited as the medical specialty that experiences the most medico-legal complaints. This is likely because the role involves work related decisions which impacts on employment matter which is always an emotive subject. Therefore medico-legal insurance is costly.

What do I need to get into Occupational Medicine?

Surprisingly little to get started – however a lot of luck is involved.

Most doctors working in OH will say they ‘accidentally’ got into it. They will go on to say that it came up one day in their clinical practice, they were asked to do more by their local manufacturing company down the road who needed a doctor to do some basic medicals, and then before you know it, they were doing it full time.

The easiest way to get started in finding a job is to network like hell and write to lots of companies, shadow other OHPs, sign up to agencies and do your best to immerse yourself in the world as much as possible.

The next thing to do is at least get a basic qualification or go on some sort of training to get your interest formally and transfer-ably recognised.

Certification

This can be somewhat confusing and has changed back and forth over the years.

Before I outline certification, it’s important to be aware of the following bodies as they will be mentioned quite a lot!

Faculty of Occupational Medicine (FOM): The regulatory body for Occupational Medicine in the UK. They run all the exams, determine the curriculum and report to the GMC.

Society of Occupational Medicine (SOM): The professional and educational community for Occupational Health in the UK (started off as doctors only but now open to OH nurses). If you sign up as a member tell them Medic Footprints (or Abeyna!) sent you!

National School of Occupational Health (NSOH): Under the Health Education England umbrella for mandating / overseeing specialty training standards.

A summary of current recognised qualifications in the UK:

Diploma in Occupational Medicine (DOccMed)

A basic qualification that any doctor can take within a few months. You can either do an intensive 2 week course or a CPD university module in the subject (Manchester, Birmingham or London). You can then sign up for the exam (which is also the MFOM Part 1 – MCQ), a Viva and Portfolio (includes a workplace visit and a clinical case).

I personally advise ALL doctors to take the Diploma – even if they’re not sure whether OH is for them or not. It will be great for your clinical practice regardless of what you choose, and it can REALLY open doors!

Associate of the Faculty of Occupational Medicine (AFOM)

Open to doctors usually with a minimum of 2 years experience in Occupational Medicine / Health. Completing this qualification means you have to take the MFOM Part 1 paper (see Diploma), and the MFOM Part 2 (3 papers over 6 hours followed by an OSCE style examination in Sheffield a month later.)

This is like the equivalent to being an Associate Specialist and with this qualification you can easily work at a senior level in OH.

Member of the Faculty of Occupational Medicine (MFOM)

There are 2 ways to achieve this – both ways will lead to entry on the GMC register as a specialist in Occupational Medicine.

Specialty training in OM, which is for 4 years from ST3. Training numbers are relatively few since the recession where many training posts were lost from the private sector. There’s specific eligibility criteria to get in which may not suit everyone.

The exams you also need to take are the same as the AFOM, however you will also need to do a pesky dissertation (which many are trying to get rid of as we speak!).

Do-it-yourself training in OM where you develop a portfolio similar to that of being a trainee, collect the evidence and present it to the GMC and Faculty of Occupational Medicine. This is called the Certificate for Eligibility in Specialist Training (CESR) and is available for all medical specialties (but not talked about very much for some reason..)!

With the MFOM you are likely to be able to command some of the best pay, senior level responsibilities, and your qualification will be recognised worldwide due to GMC specialist registration. Good for those who are looking for a qualification passport to travel with.

Fellow of the Faculty of Occupational Medicine (FFOM)

These are reserved for OHPs who have worked for at least 5 years as an MFOM and is rarely a pre-requisite for employment.

Membership of the Faculty of Occupational Medicine in Ireland (MFOMI)

This is a certification offered by the Irish Faculty of Occupational Medicine. This includes completing a detailed portfolio of evidence plus similar exams to the MFOM, without needing substantial research or a dissertation.

Many international doctors elect for this option as it is somewhat more.. accessible.. than the MFOM, however it is important to note that in the UK it is currently only recognised as the equivalent to the AFOM, not the MFOM and does not (on it’s own) automatically confer GMC specialist registration.

Although apparently it is recognised as a higher qualification in the EU, and many employers in the private sector may consider taking MFOMIs on as an MFOM (similar to how they would take on AFOMs).

Are you confused yet..?

It’s good to know that..

You can get highly experienced OHPs with no more than a Diploma and you can get less experienced OHPs with the top specialist qualification in the UK (MFOM or FFOM).

This may gradually change. Although it’s likely to get worse in the short to medium term considering the top heavy demographic of the OHP workforce, which will result in many retirements in the not-too-distant future. This means fewer OH specialists resulting in the reliance of those in the workforce with Diplomas or just any relevant experience.

What does the recruitment process into Occupational Medicine involve?

This varies depending on the sector:

NHS

If you wish to apply for training, this is done through a standardised process of National Selection led by the National School of Occupational Health. Very similar to other specialty programmes. They assess you according to a set standard as to whether you can enter a training programme. After which they will allocate you to a post of your preference according to your national ranking.

If you’re applying for a stand-alone job or locum, you will need a Diploma at minimum to pass through the doors!

Private

These posts come up as and when – it’s very difficult to predict and can be announced pretty much anywhere. Therefore I recommend signing up to the SOM, Indeed and keeping your ear to the ground on LinkedIn.

If you are looking for a training post, these are even fewer and far between, but somewhat increasing now with the ongoing campaign for demonstrating the Return on Investment (ROI) for taking on a trainee in the private sector.

If you’re looking to simply apply for a private sector job, you could theoretically go in at any level (depending on the type of job). Without any qualification you could either look at doing medicals (e.g Drivers Medicals), or find a company that offers to train doctors whilst supporting them with the Diploma or even further through the non-training route (CESR).

However most commonly, many companies prefer doctors who have a minimum of a Diploma.

Medic Footprints’ members can also get access to numerous webinars for more insider knowledge on a career in occupational medicine.

How can I boost my chances of establishing a career in Occupational Medicine?

Network, network, network!

As mentioned before, it’s not easy to find a job, particularly if you’re interested in working primarily in the private sector. Remember there are also military and NHS jobs available too but these are not as prevalent as other specialties.

Attending conferences, events, shadowing other OHPs, and joining the SOM will be your best bet and can open up doors for you.

To find out more about developing a career in occupational medicine in general, including some work case studies, check out our Occupational Medicine webinars.

Otherwise, make sure you attend lots of events, ask lots of questions, and don’t be too shy to ask to either shadow or have a cup of tea with an OHP. They are a very friendly, down to earth bunch!

Don’t forget to also read my article on Occupational Medicine via the CESR route!

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