Similar to others in the twilight of their career, I find it disturbing that the practice of Occupational and Environmental Medicine (OEM) appears threatened. Not due to a lack of need for occupational physicians and nurses, but the fact that OEM is not on the radar of many in business, government and healthcare.
It alarmed me to hear from an inter-state colleague who said that hospital-based occupational medicine service was not considered an essential or even necessary service, even in the times of COVID-19, and they were going to close the service.
It is also disturbing that many more recent Fellows who practice OEM do so only in the realm of medico-legal opinion. Occupational medicine is one of the most rewarding of all medical disciplines, taking you into workplaces large and small, and providing a major interface between public health and the health of working populations.
When I came to Tasmania 10 years ago to do a job for 12 months, little did I know that I would still be here, working full-time in both occupational medicine and public health. However, I also found out that I was one of a handful of doctors in Tasmania heading towards retirement and that there were no trainees to take our place. The problem is complex, but there is no occupational medicine in the undergraduate medical curriculum in Tasmania and OEM is largely a forgotten specialty.
To make matters worse, there are no occupational physicians employed within the government in Tasmania. Dr Martin Bicevskis was the last OEM physician employed by the then Tasmanian Department of Health and Human Services. Dr Niki Ellis was also (for a time) employed by the Health Department. Both Dr Bicevskis and Dr Ellis have been key drivers for OEM in Australia, but are also in their twilight years.
The main OEM physicians in private practice in Tasmania are Dr Peter Sharman, who trained with the assistance of the Hydro-Electric Commission, Dr Andreas Ernst who worked with Comalco, Dr Tim Stewart who worked at the ZincWorks, and Dr Helen McArdle the current head of the Australian Medical Association in Tasmania.
Training positions with large employers in Tasmania no longer exist, and there is no funding for training OEM physicians within the public health system. When we went to the WorkCover Board to discuss the imminent medical OEM manpower problem their response was “what has that got to do with us?”
Although there has been a growing respect for OEM physicians within parts of the profession, along with insurers, lawyers and employers, the opportunity for training and supporting registrars simply does not exist. In times of COVID-19 where businesses need to remain open and COVID-free, this is perplexing.
Dr Sharman, Dr Ernst and I decided we had to do something. We established the Tasmanian Foundation for Occupational Medicine (TFOM), a not-for-profit charitable foundation, a first in Australia, with the aims of:
- promoting the specialty of occupational and environmental medicine within Tasmania through education, awareness-raising and training programs, including lobbying to achieve the objectives of the Foundation.
- raising and distributing funds to achieve the Foundation’s objectives through industry sponsorships, government grants, provision of training, and donations.
- providing funds for research relevant to OEM in Tasmania
- supporting the training of specialist OEPs in Tasmania through:
- scholarships and other types of financial support to trainees
- financial support to practices providing training
- mentoring and educational opportunities for trainees
- support to newly qualified OEPs in setting up a practice.
The work to establish the Foundation has been longer and more difficult than initially expected, but I am pleased to announce that TFOM is now a registered charity with the Australian Charities and Not-for-profits Commission.
We currently have two registrars in OEM in training, one in Hobart and the other in Launceston. Our aim is to have up to six registrars within two to three years. Webinars have commenced with key stakeholder bodies and are fighting for the future of OEM and seeking sustainable funding for our scholarship scheme. Our audacious goal is an efficient system of OEM training and support within Tasmania, by engaging key stakeholders as active partners in the future of occupational and environmental medicine.
Dr Barry Gilbert
Specialist Public Health Physician and Occupational Medicine Consultant, Launceston, Tasmania