Career: Occupational hazards

Occupational medicine promises a varied career with many opportunities both within the NHS and beyond 

FEW medical specialties offer the promise of an international career covering such varied interests as aviation and space, travel, radiation and diving.

Occupational physicians can work all over the world, in both the public and private sectors, in a specialty that covers the multi-faceted relationship between health and work. Occupational medicine (OM) specialises in the diagnosis, management and prevention of disease that is due to – or exacerbated by – workplace factors. It is concerned with all aspects of the effects of work on health and health on work.

It has an important part to play in rehabilitating employees back into work after sickness or injury. Specialists will be called upon to provide high quality, objective, professional advice, sometimes in difficult situations, and with an awareness of the various agendas of government, employers, employees, trades unions and pensions trusts.

And as issues of employment and fitness to work become increasingly important in these economically straightened times, occupational medicine is moving up the political agenda and is likely to play a larger role in future government policy.

Entry and training

Doctors interested in pursuing a career in this field can enter via a variety of routes. You can complete either core medical training or the acute care common stem in acute medicine (ACCS) and enter OM training at ST3 levels.

But there are other routes. Instead of undertaking core training in acute medicine, doctors may choose to start specialist training in a number of other disciplines, namely: general practice, psychiatry, public health and surgery. Post-foundation level training generally lasts six years: e.g. two years of core medical training (ST1, ST2) followed by four years of specialist OM training (ST3 to ST6). All specialist trainees must register with the Faculty of Occupational Medicine (FOM) and pass exams in the first (ST3) and final years of specialist training. More detailed information on the training pathway can be found on the faculty’s website at www.fom.ac.uk.

The desirable personal qualities for OM trainees include an ability to build rapport/ listen/persuade/negotiate, a capacity to take in the perspectives of others and to “see patients as people”. Doctors must also be able to work in multi-professional teams, supervise junior medical staff and show leadership. The Faculty also recommends doctors applying for specialist training demonstrate an interest in OM as well as showing evidence of achievement outside medicine including “altruistic behaviour” such as voluntary work.

In addition, physicians must have knowledge of employment and anti-discrimination legislation, as well as of environmental and health and safety law. They must also have an understanding of epidemiology, disease prevention and toxicology.

In practice

A typical day in occupational health practice can vary enormously depending on the role and setting. The FOM says specialists could find themselves working in settings such as an international company or in the NHS as a private provider. You could be advising on the health of oil rig workers or call centre staff or ambulance drivers. You will come across a huge range of physical and mental health problems and could, for example, be the first to identify the link between a hazard in a factory with an industrial disease.

Often the work will involve a clinical element: assessing individuals for capability, eligibility for ill-health retirement or other specific purpose. It will also likely involve monitoring people’s health in relation to the statutory duties to control risk at work. Occupational physicians assess the workplace and work activities, advising on control measures in liaison with other related specialists such as safety officers, occupational hygienists or ergonomists.

There will almost always be a team to either manage or work with. In most organisations occupational physicians work with others to formulate policy and procedure in line with relevant health and safety legislation.

Occupational physicians are often based in the workplace, working normal office hours. Sometimes they can be based at a local centre where individuals will attend for assessment and there is often a certain amount of travelling required. They will also work closely with both medical and non-medical colleagues such as occupational hygienists, union and safety representatives, disability employment advisers and managers. The specialty is almost invariably provided by a multidisciplinary team with occupational physicians and nurses playing key roles.

Patients tend to be of working age – generally between 20 and 65. Sometimes doctors will consult with retired workers although these are usually workers who have retired early through ill-health. The time taken to assess patients would typically be around 45 to 60 minutes for new patients and around 15 to 30 minutes for a review.

Pros and cons

The work of an occupational physician is varied and can depend on the industry sector in which they work. There are opportunities to move around within the specialty and for career development as well as the enjoyment of working with non-medical managers as a technical expert within an organisation. One challenge the role presents for doctors in this field is to remain independent when providing opinions and to avoid being partial to either workers or management.

The opportunities for flexible training are many as it can be carried out within the NHS, in industry and the defence medical services. Training posts must, of course, be GMC approved with deanery approval for all appointments. More than half of OM training posts are outside the NHS, making this specialty distinct from many of the others.

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Q&A: Dr Rae Chang, specialty registrar in occupational medicine

What attracted you to occupational medicine?

For many registrars, occupational medicine is a secondary career. It was only as a medical officer in the Royal Australian Air Force and then an airline doctor that I learned about the specialty. This included carrying out workplace risk assessments, making decisions on fitness to fly and for overseas deployment, giving advice to commanders and workforces as well as individuals. There is overlap with public health – looking after a deployed population requires a working knowledge of exercise physiology, heat and cold injury, food hygiene, injury prevention and rehabilitation. Ten years as a GP gave a good grounding in clinical medicine which is helpful for giving authoritative and credible advice. And I’ve found myself recruited from Australia to Dubai and now the UK working in occupational and aviation medicine.

What do you find most challenging about the job?

The legal aspects. This is the specialty most likely to interact with tribunals and courts; if you are giving advice to a company about employment law and disability discrimination cases, you need to make sure it’s accurate and defensible. Fortunately there are senior colleagues and CPD courses to learn from, and a number of occupational physicians also complete a law degree. Ethics is another tricky area – because we have a dual duty of care to the worker and employer, and not a typical therapeutic relationship, we need to be scrupulously objective and fair when liaising with medical colleagues and translating medical jargon into practical advice without giving unnecessary detail.

Has anything surprised you about the role?

I think the sheer variety of medical jobs you can aspire to. There are occupational physicians working in the oil and gas industry, NHS hospitals, military, aerospace, transport, mining, fire and ambulance, automotive and so on. As the health adviser usually in a senior position, strong leadership and teamwork skills are essential to develop. You may work in a multidisclipinary environment with nurses, physiotherapists, occupational hygienists, safety engineers, human factors scientists and health and safety reps. Just learning about what people do for work in all walks of life is fascinating. Timely advice can possibly save someone’s job even if not their life. For example, when you see Joe Bloggs on the hospital ward, do you think about how his hand injury is going to affect his work long-term if he is a self-employed plumber? And when you see a professional pilot with a suspected TIA in A&E, do you consider that she needs to inform the regulatory authority that she has a significant condition with a high risk of recurrence and public safety implications?

What do you consider the most important personal characteristic in a good occupational physician?

Common sense. We need good plain-speaking skills when explaining to workers and employers what a condition means in terms of effects on daily function and work, what workers are capable of doing as opposed to ‘unfit for’. Being practical and not afraid to get your hands dirty visiting worksites and trying out some of the tasks – if you understand the role, you can give relevant advice.

What is your most memorable experience so far?

There aren’t many medical jobs where you can fly first class regularly in the private suite of an A380 / B777 – bonus of working for an international airline!

Is there any advice you could give to a final year or FY trainee considering occupational medicine?

There is a world beyond hospital medicine. If you are a people person and enjoy adventure through a road less travelled, having flexibility to look after your family and pursuits whilst working reasonable hours – it is worth considering. Some medical schools offer a taster in occupational medicine in FY 1/2 years and the Faculty of Occupational Medicine offers funding for student electives in occupational medicine through the Mobbs Corporate Health Fellowship. Ask the FOM to put you in contact with your medical school teaching lead or a practising physician in a specific industry.