Would I recommend GPs take up an interest in occupational medicine? Absolutely.
What is the attraction?
There are reportedly 1,500 GPs practising in this specialty with over 1,000 holding the diploma of occupational medicine. In my experience at least half of all specialist (consultant) occupational physicians started out as GPs.
For me, this is best illustrated by the fact that in my 13 years with a part-time practice in occupational medicine, I have met several full-time specialists who ‘used to be a GP’. I have yet to meet a GP who used to be a specialist occupational physician.
What is occupational medicine?
Occupational medicine covers the relationship between health and work.
The focus is to ensure that workplaces and work practices are safe and not detrimental to employees’ health, and that employees are fit for the job they are doing.
If there are problems, the occupational physician’s role is to advise on workplace adjustments and to give appropriate advice and support.
Traditionally occupational medicine has an important role in rehabilitating people back into work after sickness or injuries.
However the improving safety culture in the UK, together with an aging and ‘stressed’ workforce, means our role is increasingly to help people with long term conditions or mental health problems stay at work and manage their symptoms within the context of employment.
What about pay?
Occupational medicine is clearly an attractive, and sometimes lucrative, field of work. According to the BMA, it should pay - and certainly can pay - at least as much as hospital doctors earn at various grades including as consultants.
GPs can seek out this type of work and undertake suitable training. In my case, my interest in occupational medicine was down to a chance introduction at my first practice.
We were close to a new warehouse and distribution park in the East Midlands. The first companies to set up in the park needed pre-employment medicals, particularly for their large goods vehicles (LGV) drivers.
They sent their staff to our practice and our service became known by word of mouth. Gradually, many HR managers came to us to carry out statutory medicals and sickness absence assessments.
Within a year or two, around 10% of the practice income was from this type of work.
What are the advantages?
The pace of occupational medicine work is a welcome relief compared to the 10-minute appointments and rushed visits in general practice.
A typical appointment is for 30 to 45 minutes and allows time to explore a case in detail.
There is certainly the feeling that your opinion is important and holds great value for the person you see and the company they work for.
I enjoy developing working relationships with HR managers and the opportunity to understand the culture of private corporations.
The importance of work to an individual’s health and wellbeing is well understood, so the ability to really make a difference to keep someone at work can be rewarding.
What are the challenges?
Switching from an advocacy role to one of impartiality is probably the main challenge for GPs.
While there are no statutory training requirements, I agree with most occupational physicians, that formal training should be a requirement to ensure good practice.
The Faculty of Occupational Medicine (FOM) awards the diploma of occupational medicine. This provides GPs with the extra competencies to understand the effects of work on health, assessment of fitness for work, health surveillance, rehabilitation, workplace visits, ethics and the law.
The training and assessment for being awarded the diploma is not cheap and is a significant commitment for busy GPs. For example, Manchester University’s fee for a 12-month part-time course in preparation for the FOM’s diploma examinations is £3,450.
How do you find clients?
Setting up a client base can be difficult. Local contacts have been the main source of new work for many of us.
Some GPs work with their local NHS occupational health department but remuneration is typically low.
There are a number of national occupational health agencies always on the lookout for GPs with the diploma to perform sickness absence medicals.
But in my experience, the work is less rewarding and pay less than half of what can be earned by building up a local network of customers.
What support is available?
Most GPs in this field have to work in relative isolation.The most valuable support tends to be informal from other interested GPs in the locality.
The Society of Occupational Medicine (SOM) is a group for doctors working in, or with an interest in, ouccupational health.
GPs make up around a third of members and have access to a monthly journal with local and national meetings. There is a good website and I would encourage colleagues to join.
What about the future?
Occupational health is changing. Around 75% of long-term sickness absence is attributable to mental health and long-term conditions that make up a significant proportion of a GP’s workload.
Some 30% of GP consultations have a mental health component, 12% are for musculoskeletal problems and 49% involve pain as part of the presentation.
Clinically, the case-mix in primary care and that in occupational health has never been closer. This fact was well recognised by Dame Carol Black in her review of the working age population in 2008 and in the Sickness Absence Review in 2011.