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INTRODUCTION

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The Occupational Safety and Health Act of 1970 (OSHAct) ensures "every working man and woman in the United States safe and healthful working conditions." This act created the Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH). At the time the OSHAct was passed, occupational medicine was one of the country's smallest medical specialties, with only a few residency-trained specialists in academic positions, consulting practices, or employed by major corporations. Private practitioners provided care for occupational injuries, sometimes in industrial settings, but mostly as a part of other services provided in a private office or hospital setting.

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As a result of passage of the OSHAct and formation of OSHA and NIOSH, occupational medicine became the center of considerable attention by medical schools, hospitals, clinics, and physicians from many different specialties. The opportunities for public health practice, union-based clinical care, and independent consulting created new career opportunities for medical students. Medical schools received financial support for training from NIOSH, and OSHA gave occupational physicians a voice in the increasingly regulated industrial setting.

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OPPORTUNITIES IN OCCUPATIONAL MEDICINE

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Institute of Medicine (IOM) states that there is a critical shortage of specialty-trained occupational and environmental physicians in communities, in academic medical centers, and in public health and related agencies. Moreover, the IOM reports a severe shortage of frontline primary care physicians who are willing and able to care for patients with occupational and environmental illnesses. The IOM concludes that data from the Bureau of Labor Statistics (BLS) are significant underestimates of occupational diseases, which emphasizes the need for more and better diagnoses of occupational diseases by primary care practitioners. The IOM recommends that "all primary care physicians be able to identify possible occupationally or environmentally induced conditions and make appropriate referrals for follow-up."

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Since passage of the OSHAct, US employment has more than doubled, from 56 million workers at 3.5 million work sites to 130 million workers at nearly 8 million work sites. Most of the labor force expansion during this period was in service sector companies with fewer than 500 employees. Although these companies are not likely to employ occupational physicians, they do add to the demand for injury and illness care as well as for health and safety consulting. Employers expect to hire almost 500 occupational physicians over the next 5 years and are looking for residency-trained specialists. Skills in evidence-based clinical evaluation and treatment, determining fitness for work, and worker and management communications are the most important technical skills needed by employers. The estimated number of occupational physicians that employers expect to hire over the next 5 years is substantially higher than the number estimated to be produced from current training programs. Opportunities in occupational medicine, and in the increasingly important specialty of environmental medicine, vary by region. There are many industrial areas with an established medical community serving their needs, yet in ...

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