Why you should take a closer look at occupational and environmental medicine

Burnout and satisfaction are major issues for the physician workforce in the United States. Many feel trapped working in a specialty in which they are unhappy. For most practicing physicians, however, there are few realistic options to make a major career or specialty change due to the opportunity costs of reduced pay and the time required for additional residency training.

One little-known medical specialty stands above the pack, with particularly high job satisfaction and low burnout compared to other specialties. This is occupational and environmental medicine (OEM), a lesser-known specialty that many remain unaware of even after years in practice. Though a popular choice among those who are familiar with it, relatively few learn about it until after they have already committed themselves elsewhere. Recent surveys indicate that even among current and recently graduated OEM residents, only about 20% knew about the specialty before they completed medical school. For this reason, a large percentage of OEM specialists switch over after starting in a different specialty.

For those interested in making a career change, like I was, OEM may be one of the best-kept secrets in medicine. A specialty under the American Board of Preventive Medicine, OEM focuses on the prevention, diagnosis, and treatment of workplace and environmentally-related injuries and illnesses. It offers a unique blend of direct clinical care of workers and public/population health to improve workplace wellness and protect worker health. The environmental side of OEM reaches populations on a larger scale, looking at health related to pollution, climate change, and environmental contaminants. OEM offers opportunities at multiple levels (workplace, city, county, state, national, and international) for clinicians interested in policy or advocacy work. OEM physicians also work across multiple areas of medicine, such as toxicology, sports medicine/orthopedics, pulmonology, cardiology, and OB/GYN, to name a few. Several factors explain why satisfaction is so high and burnout so low:

• A diverse variety of job opportunities ranging from medical centers, academics, government, military, public safety/law enforcement, large multinational corporations (which can include a surprising amount of global health), industrial sites, private/group practice clinics, consulting, and niche areas like nuclear, mining, oil and gas, theme parks, etc. Compared to other specialties, it is easy to mix it up if you get tired of your current role.
• OEM jobs range from 100 percent clinical to 100 percent non-clinical and everything in between.
• Excellent work/life balance due to the low burden of working holidays, nights, and weekends.
• Getting reimbursed for 100 percent of the care you provide.
• Many consider it a purer form of medicine, with functional outcomes and reduction in lost workdays being more important metrics than RVU generation or encounter volume.
• More than just following clinical care algorithms, OEM docs use a broad range of skill sets such as risk communication, working collaboratively with a wide range of non-medical stakeholders, dealing with complex medicolegal issues, hazard recognition during site visits/investigations, program administration, disability management, and emergency preparedness/response.

Moreover, there is a high demand for OEM specialists across the country. Jobs are plentiful, and salaries are on par with other non-surgical specialties. Transitioning to OEM doesn’t mean abandoning your current skills and expertise. Instead, it offers an opportunity to apply your medical knowledge in a new and more fulfilling context. Experience from working in another specialty is often highly valued and can open additional doors for some job roles.

There are 23 different OEM residency programs across the country. For those who have already completed an internship, OEM residency can be completed in just two years. For those with more than one year of GME under their belt, there are one-year training options, too. Part of what makes OEM residency so great is that you are paid during residency to complete a Master of Public Health (MPH) or equivalent degree, further enriching your skill sets.

I personally became interested in OEM after a career in the U.S. Navy as a family physician and a flight surgeon – a physician whose purpose is to keep service members in aviation healthy and safe to perform their work duties and to help get them back to work after injury or illness. Primary care lost its luster for me, but I always felt rewarded when patients got back to their important activities, whether at work or in their personal lives. I saw firsthand the impact of lost work time from excessive work restrictions and observed the stress and challenge to the organization when members were out or unable to work to full capacity. It helped me realize that what I did impacted more than just the patients I treated. This experience prepared me for my transition to a career in OEM.

Having left the Navy to pursue a second residency in OEM, I was excited by the diverse career opportunities to suit various interests. On the interview trail, I spoke with many OEM physicians who had diverse career paths, sometimes balancing a variety of simultaneous interests or cycling among a few different roles. During OEM training, I rotated through the poison control center, medical center employee health, multiple occupational medicine clinics with different organizational structures and patient/industry populations, the state health department, and corporate medicine. Regardless of your prior training or career, it is easy to find one or more niches where your personal and professional interests can thrive. It is almost impossible to find a practicing OEM physician who wishes they were in another field of medicine.

In conclusion, for physicians seeking a change, occupational and environmental medicine offers a compelling alternative as a specialty that prioritizes well-being, meaningful medicine, and professional satisfaction. OEM is also a good choice for students to go straight into medical school. Don’t let unfamiliarity with OEM deter you. Instead, consider doing what I did – take a close look at OEM and embrace the opportunity to carve out a more fulfilling career that aligns with your passions and values.

Robert Nathan Clapp is an occupational medicine physician.