As OH positions are cut in both the private and public sectors and the number of specialist trainee positions falls, the profession is facing a crisis of worrying proportions, Dr Richard Preece says.
There is truly a crisis in OH nursing and occupational medicine. For years, concern has been expressed about the future sustainability of the specialist workforce, but now that predicted future has arrived.
In a recent commentary titled “Defining the future of physicians globally”, Nyla Medlock, a leading figure in OH recruitment in the US from Medlock Consultancy, observed that:
- the number of positions available has increased over the past few years;
- the positions available (and that will become available) are good positions, with an opportunity to make a difference in the lives of workers, the success of employers and the health of communities across the country;
- changes in healthcare will result in a demand for primary care and clinical specialty medicine services; and
- fewer [clinicians] are likely to enter the field mid-career.
Medlock highlighted the demographic issues that show many more are retiring from the specialist workforce than are being trained to replace them.
Medlock’s observations resonate in the UK. At a multidisciplinary meeting in March, Dame Carol Black illustrated the workforce challenge with a picture of the white cliffs of Beachy Head. Tellingly, the picture was taken from below the cliffs, not from a position on top of it.
The specialist workforce has fallen precipitously for some time. From a recruitment perspective, Medlock emphasised the market value of the remaining cohort of specialists and the skills needed to enhance this.
“Team collaboration, individual growth, networking and adaptability are keys to having influence and becoming a leader in today’s [OH] world,” she said.
In the UK, the development of the specialty has reflected all of these. Examples include: the Royal College of Nursing hosting conferences on collaboration; the Society of Occupational Medicine opening its membership to all disciplines; allied health specialties developing OH competencies; and nursing reflecting on the suitability of current specialist programmes and the future role of advanced nursing practice.
Team collaboration, individual growth, networking and adaptability are keys to having influence and becoming a leader in today’s [OH] world.”
Nyla Medlock, Medlock Consultancy
On the topic of medical training, Medlock said: “The pipeline for training is so constricted and so few physicians are in [OH] residency programmes that there are nowhere near enough physicians to take these positions.
“Only 85 residents each year are graduating, while about 250 [OH] physicians are lost to attrition each year.”
The position in the UK is similar – occupational medicine training posts in large companies have all but disappeared, training posts in commercial OH providers are few and far between, and training posts in the military and NHS are reducing or under threat.
It is almost impossible to measure changes in the number of nurses training in OH, but currently there appears to be little cause for optimism.
It seems many OH workforce challenges are global in nature – but not all. In the UK, for example, we are not training specialists even where the opportunity exists: there are far too few practice teachers to support specialist OH nursing students, almost no OH nursing academics and a small number of educationalists and occupational medicine training posts remain unfilled. Where they are filled, there is insufficient competition to give confidence that the specialty is attracting the most able candidates.
Time ran out a while back to stop the OH profession going into serious decline. But it is not too late, as the specialty falls towards the rocks, to fill the wings of OH and make it soar upward higher than before.
In a competitive market, technical skills are not enough – personal qualities will make individuals stand out. As Medlock suggested, this will take “team collaboration, individual growth, networking and adaptability”. Those who refuse to change will not survive.