What Do OEM Physicians Do?

What do OEM physicians do?  This is a great question that defies a simple answer.  OEM physicians work in diverse roles and use a wide range of skill sets.  To help give a detailed idea of what OEM docs do, we can look at it three different ways:

  1. OEM competencies
  2. Specific examples of what OEM docs do in their day-to-day practice
  3. Additional training and certifications that OEM physicians often obtain

OEM Competencies

The below is a concise summary based on the 2021 ACOEM Guidance Statement on OEM Core Competencies.  The entire 30-page document can be viewed here.  Resident physicians specializing in OEM get training in all ten competencies.  While each OEM physican develops more detailed knowledge and skills based on their area of practice, all are expected to be fully competent in these ten competencies.  The ten core OEM competencies are as follows:

  1. Clinical OEM – the knowledge and skills required to evaluate and treat all manner of illnesses or injuries that are occupationally or environmentally related.  OEM physicians seek to maximize the functional ability of their patients.  With their deep understanding of the occupational roles and demands of their patients, they are particularly well-suited to prevent future injuries by identifying and correcting modifiable workplace risk factors. OEM physicians make clinical decisions on return-to-work plans and timelines, limitations and restrictions, medical qualifications for safety-sensitive job roles, and causation determinations.
  2. OEM Related Law and Regulations – the ability to understand and effectively apply statutory and regulatory guidance relevant to occupational and environmental health and the interactions between work and health.  OEM physicians serve a critical role in their organizations in ensuring adherence to regulatory and legal guidance, compliance with applicable law, and following standards and guidelines as they relate to occupational health and safety.
  3. Environmental Health – the ability to recognize and address potential chemical, physical, and environmental causes of health concerns in individuals as well as communities.  OEM physicians have knowledge of common clinically-significant environmental agents (i.e., lead, asbestos, radon, arsenic), understand dose-response relationships, and are able to apply biomonitoring data. 
  4. Work Fitness and Disability Management – the skills and knowledge to determine whether workers can safely be at work and perform required job tasks.  This often involves a combination of direct clinical evaluation, coordination with outside specialists, utilization of evidence-based guidelines, and discussion with other professionals such as safety specialists, ergonomists, human resources, and supervisors to facilitate the best possible outcomes.  Some OEM physcians perform comprehensive disability evaluations or independent medical exams (IMEs) using current impairment rating resources.
  5. Toxicology – the ability to recognize and manage the effects of toxic exposures.  OEM physicians are very familiar with a wide range of resources to accurately characterize the potential risk from such exposures, such as industrial hygiene reports which can be used to determine likely routes of exposure and potential for overexposure.  
  6. Hazard Recognition, Evaluation, and Control – the ability to assess health risks in the workplace or environment, and the ability to work collaboratively with other non-medical professionals to eliminate that risk or reduce to the extent feasible.  With a unique understanding of both clinical medicine and the complex interactions between work and health, OEM physicians are well-positioned to reduce health risk and improve worker wellness. 
  7. Disaster Preparedness and Emergency Management – the knowledge and skills to ensure preparedness for potential disasters affecting health, and if necessary, to manage treatment of those affected by emergency situations, including emergency responders themselves.  OEM physicians played this role particularly well during the COVID-19 pandemic.
  8. Health and Human Performance – the ability to identify and address both individual and organizational factors that adversely impact health and productivity.  OEM physicians are critical for targeting the most impactful ways to optimize worker health and improve job performance, and often advise leadership on how to effectively implement health and wellness initiatives that give the organization a good return on investment.  
  9. Public Health, Surveillance, and Disease Prevention – assessment and response to individual and organizational or population risks for occupational or environmental health problems.  OEM docs can prevent harm by catching injury trends early and addressing the causative factors before others are affected.  OEM physicians provide expertise on preventive health measures that maintain the health of the population.
  10. OEM Related Management and Administration – knowledge and skills to to plan, design, implement, manage, and evaluate comprehensive occupational and environmental health programs and projects.  OEM physicians work with leadership and governance to ensure the health and safety of employees.  With an understanding of health care benefits, workers’ compensation systems, electronic health records, and knowledge of the laws and regulations applicable to their jurisdiction, OEM docs are able to work collaboratively with the larger occupational health team to optimize health for their organization. 

Examples from Day-to-Day Practice

Below is a sample list of things that OEM physicians take on in their day-to-day job responsibilities.  Not all OEM physicians do all of these, as the scope of responsibility varies with different job roles, but the list gives a good idea of the kinds of problems and challenges that OEM physicians regularly deal with.  For each item, the corresponding OEM competency is given in parentheses to help demonstrate how OEM docs use all of these skill sets. 

  • Evaluate and treat a worker for an ankle injury sustained on the job (1).
  • Evaluate an employee for their ability to safely return to work after being recently treated in a local emergency room for a non-occupational medical condition (4).
  • Conduct a travel health evaluation, including the need for vaccination or chemoprophylaxis and well as offering general health counseling, on an employee preparing for an overseas work trip (1, 9).
  • Perform a follow-up examination for a worker currently on a worker’s compensation claim due to prior work injury (1). 
  • Evaluate a healthcare worker with a needlestick injury from a blood needle, where the source patient was known to be HIV-positive (1). 
  • Perform an OSHA-mandated medical surveillance exam to ensure no health effects from exposure to metals in the workplace, such as lead, beryllium, and cadmium (1, 9). 
  • Evaluate a nurse with persistent long-COVID symptoms for their ability to safely wear a respiratory on the job (1, 4). 
  • Perform an annual certification/surveillance examination on a firefighter (1, 9). 
  • Respond to an acute workplace complaint of foul-smelling odor in a specific work area that is making staff feel sick (3, 5). 
  • Help a worker with a back injury file a new worker’s compensation claim (10). 
  • Evaluate a healthcare worker with a positive quantiferon or tuberculin skin test, ruling out active tuberculosis and then making determination on the need for treatment for latent tuberculosis (1, 9).
  • Evaluate a pregnant patient who works around chemicals which are known developmental hazards for recommendations on the need for any temporary job restrictions (4, 5).
  • Provide input for a draft employee survey that is to be used to in performing a health risk assessment among organization employees (8).   
  • Provide remote guidance for a developing medical situation in an employee currently working in an isolated geographic area, far from advanced medical facilities, where medical evacuation will be very difficult and expensive (1, 10).  
  • Respond to a question from a nurse at a remote clinic regarding a concern that a merchant mariner does not meet medical standards for their assigned job role (4).
  • Evaluate an employee who had a documented overexposure to xylene in the workplace, and perform counseling on long-term risk to health such as fertility and cancer risk (5). 
  • Respond to a concern from leadership regarding the potential health hazard from styrene exposure due to the use of Styrofoam containers in the organization’s cafeteria (5). 
  • Work with a multi-disciplinary team such as HR, safety, facilities management, labor-employee relations, and legal to determine the best course of action for an employee with a recent history of disability adversely affecting their ability to perform an essential function of their job (2, 4). 
  • Offer guidance to management on the medical necessity/legitimacy of an unusual request for reasonable accommodation in the workplace due to a non-work-related medical condition (2).
  • At the request of human resources, perform a fitness-for-duty examination on an employee who was noted to be acting erratically in the workplace (1, 4). 
  • Design a workplace wellness program tailored to reduce the rate of absenteeism across the workforce at a manufacturing plant (8).  
  • Create a workplace policy to reduce the health risk from a new chemical that is being introduced into a facility (5, 10).
  • Update an organization’s COVID policy in response to recent changes in guidance from the U.S. Centers for Disease Control and Prevention (7, 10). 
  • Evaluate an employee with a note from her primary physician saying she is cleared to return to work with no restrictions after her recent elective surgery, but for which the supervisor has lingering concerns about the safety of both the employee and staff (4).
  • Conduct a risk communication talk in a townhall-style meeting for community residents who are concern about local media reports of a toxic contaminant in their drinking water (3, 9). 
  • Develop a plan to optimally protecting workers from potential exposure to COVID-19 in the workplace while also maximizing productivity (7, 10). 
  • Testify in a court case regarding an employee’s claim of long-term disability from a work-related exposure (1, 2).
  • Counsel a pregnant woman who is concerned about the effect that contaminants in her well water might have on her fetus (3). 
  • Visit a worksite to increase familiarization among your clinic staff with the job duties and exposure of employees at that job site (6).
  • Perform an urgent evaluation on an animal handler with a monkey bite, including determination of the need for post-exposure prophylaxis for Herpes B virus (1).
  • Make a decision on the need to create a surveillance program after the industrial hygiene team discovered elevated levels of asbestos at a worksite (9, 10). 
  • Provide evidence-based analysis to leadership regarding the concern for potential work-relatedness in an employee who was recently diagnosed with a rare form of cancer (1, 5).
  • Evaluate a patient with chronically elevated lead levels from an unknown source (1, 3).
  • Along with your safety specialist, industrial hygienist, and facilities engineering, investigate a worksite to evaluate for adequate hazard recognition and control after you recently diagnosed a case of occupational asthma in a worker from a facility where employees are exposed to isocyanates (6, 9). 
  • Write a pandemic influenza response plan for your organization (7).
  • Update your organization’s heat stress program policy (10).
  • Field a phone call from a concerned supervisor about a potential exposure to mercury among his staff while cleaning out an old warehouse that day (5).
  • Advise leadership on an employee’s medical qualification status while ensuring adherence to the ADA and HIPAA (2, 4).
  • Respond to a complaint about health concerns due to possible visible mold growth in a old office building (3). 
  • Work with other organization stakeholders to implement a health and wellness initiative for a worksite with the highest healthcare costs in the organization (8, 10).
  • Provide guidance to leadership during an emergency situation in which multiple employees were accidentally exposed to a large amount of a hazardous chemical (5, 7).
  • Contact a hiring manager regarding your concern that their list of physical requirements for a particular job role may not be medically necessary and may instead be discriminatory (2).
  • Work with IT to ensure that the new electronic occupational health record system meets requirements to meet the organization’s needs (10).
  • Provide a recommendation to leadership on what healthcare capabilities, if brought on-site, would do the most to reduce absenteeism among employees (8).
  • Evaluate whether a federal civilian employee recently put on anticoagulation is medically fit to deploy to a remote and dangerous geographic area in support of a national security mission (4).
  • Perform a pre-employment (post-offer, pre-placement) examination to determine if a new hire is medically qualified to work as a police officer (1, 4).

Additional Training/Certification

Many OEM physicians choose to pursue the below additional certifications or training.

  • Independent Medical Examiner certification (detailed disability determinations)
  • Medical Review Officer certification (review and make determinations on drug testing results)
  • Department of Transportation (DOT) FMCSA medical examiner certification (required to evaluate and make qualification determination for commercial truck drivers)
  • Federal Aviation Administration (FAA) medical examiner certification (required to evaluate and make qualification determinations for pilots/aircrew)
  • Subspecialty training and board certification
    • Hyperbaric Medicine (aka dive or undersea medicine)
    • Addiction Medicine
    • Clinical Informatics
    • Pain Medicine
    • Medical Toxicology
    • Healthcare Administration, Leadership, and Management
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