The barriers to attracting potential residents to residencies include the following:
Residencies cost institutions $30,000 to $40,000 per year, and unlike more clinically oriented residency programs, occupational medicine residents have relatively little direct patient contact to generate funds.
Physicians who anticipate doing nearly 100 percent outpatient clinical activities (the recent trend in occupational medicine) see less value in occupational medicine residency; thus, the supply of future residents may actually decrease.
Most importantly, many physicians become interested in occupational medicine some years after graduation from medical school. Pearson and colleagues (1988) surveyed a random sample of preventive medicine specialists and found that of 166 self-identified occupational medicine specialists, 86 percent had entered the field after one or two career changes and 51 percent were 44 years of age or older. Return to full-time student status in an occupational medicine residency is not an attractive option for this population.
The Occupational Physicians Scholarship Fund, an independent organization founded and directed by occupational medicine physicians from both academia and a wide variety of industries, has been successful in providing funding for some residents. However, because of financial limitations, the number of residents that can be supported is limited. To date the fund has provided 122 scholarships to 84 individuals. By the year 2011 the total number of scholarships is expected to be 250. The fund averages 45 applicants per year. Clearly, not all applicants are able to receive funding (Bronstein, 1998). An attractive option is the more widespread use of distance education like that conducted by the Medical College of Wisconsin. This is explored further in Chapter 8, but it addresses only the academic year of residency. The practicum year remains a serious obstacle for most established physicians. A more comprehensive solution requires reexamination of the current pathways to certification in occupational medicine, a major recommendation of the 1991 IOM Committee Addressing the Physician Shortage in Occupational and Environmental Medicine (Institute of Medicine, 1991). That study suggested exploring the possibility of offering certificates of added qualification to physicians who are board certified in internal medicine or family practice and who also have advanced training or experience in occupational medicine (a certificate for added qualification in geriatric medicine is already available). The IOM study also suggested modifying the current pathway to dual certification (internal medicine and occupational medicine) by allowing a year of occupational medicine practice in place of a practicum year. The current IOM committee believes that these ideas should be