VISIONS recently caught up with the presidents of the leading occupational health member organizations. They sat down to talk about their vision for occupational health. Participants were Dr. Karl Auerbach, president of the American College of Occupational and Environmental Medicine (ACOEM); Dr. Steven Crawford, president of the National Association of Occupational Health Professionals (NAOHP); and Ms. Catherine Pepler, president of the American Association of Occupational Health Nurses (AAOHN). The conversation took place on Sept. 7, 2012.
Q. Dr. Auerbach. Why did you make the commitment to serve as the president of ACOEM? Why, in your mind, is the commitment worth it?
Dr. Auerbach: It is a lot of fun, in a crazy sort of way. My involvement with ACOEM over the years had brought me to a point where I had something to offer, and being president seemed to be one of the ways that I could do that.
Q. What was it that you had to offer?
Dr. Auerbach: My perspective of over 30 years of practicing occupational health and training in business; I felt I could bring some of that back to the organization.
Q. Dr. Crawford, why your commitment to the NAOHP?
Dr. Crawford: The NAOHP combined two of my strong interests: clinical medicine and business. What really made the NAOHP different for me is that it talked about the business aspects of occupational health. I realized how important it was to combine the two to be successful, and the NAOHP was the only place I found that really combined the two components of occupational medicine.
Q. Ms. Pepler, your commitment to the AAOHN?
Ms. Pepler: I believe that we have a responsibility to give back. I have gained so much from my colleagues as well as from the association over the years. To be a part of the change you need to embrace, engage, and promote it. That includes facilitating growth and development and helping people rise to a higher level of ability and succes.
Q. Dr. Auerbach, what do you think is the ultimate role of occupational health in our nation’s healthcare system? In a best-case scenario, what is your vision for the occupational health world 10 or 20 years from now?
Dr. Auerbach: I would like every working person to have access to an occupational health provider. There are a lot of people who do not have access to a person trained in occupational medicine and that is detrimental because there are specific issues at the workplace that general physicians don’t understand as fully as they need to. There needs to be access.
Q. In the ideal world of tomorrow what might the model look like?
Dr. Auerbach: It would be great if we could adopt the model used by many European countries where there is a mandate that an occupational health physician be involved with every working person in their organization. The problem is that it is not the way that we do things in the U.S., so to a great extent it tends to be a voluntary system with perhaps some push from the insurance systems. Occupational physicians have to show their worth to the organizations.
Q. How do they do that?
Dr. Auerbach: A lot of it is through the business of healthcare, by showing the savings and the benefits to the workers and the organization. We must get companies to understand the importance of their workers having access to occupational medicine care.
Q. Dr. Crawford, what do you think is the role of occupational health and where is it headed?
Dr. Crawford: I remember sitting in on a lecture maybe 20 years ago, and somebody talked about universal healthcare insurance coverage, meaning one universal insurance system for all healthcare conditions. If you go to your private doctor and you have a heart problem, he refers you to a cardiologist. When you have a work-related injury, you should see an occupational health physician. Today there are two separate insurance plans for these two scenarios. The problem is that with the employer’s expanded insurance role post-World War II, these two insurance plans remained separate and distinct. The best-case scenario would be to have “universal” insurance coverage with medical gatekeepers making appropriate referrals regardless of where the medical condition originated.
Q. Ms. Pepler?
Ms. Pepler: Occupational health has a crucial role in shaping the health of citizens around the world. Our focus is on the worker and their family, so, in fact, the vast majority of people in the world. I believe the field will be seen as a vital part of our health system here in the United States. I do not believe that has always been the case in the past, but as the healthcare system evolves, forming collaborations with all healthcare professionals and fields, occupational health will be essential. Occupational health has and will continue to have a vital role for years to come. Employers will continue to have a role in healthcare, no matter what healthcare system is in place, as they clearly will need to recognize the role health has on productivity and to use that knowledge to remain competitive within the global economy. Twenty years from now I see a stronger collaboration between occupational health and business leaders and pulling employees into that realm of decision-making.
Q. What do you think is going to drive that?
Ms. Pepler: The cost of healthcare. We are in a prime location within the work. We are right there to see the work people are doing, what their challenges are, what their exposures are. We have face-to-face contact with workers on a daily basis and that provides an opportunity to OHNS to have an impact on promoting wellness choices as well.
Q. What do you believe is the greatest obstacle to obtaining the vision that you just described? In other words, what can occupational health professionals do to address and overcome these obstacles?
Ms. Pepler: I believe we (the occupational health professionals) need to collaborate more and speak with a larger voice so that we are heard. Often, the physicians, industrial hygienists, ergonomics, nurses in varying groups speak and many times say the same thing but are not heard together. I believe we would be a mighty force by collectively working together on common health solutions through some sort of alliance or consortium.
Q. Why are so many voices speaking from so many different platforms?
Ms. Pepler: Groups get focused on what their group is all about, though they are starting to break down those walls and more collaboration and partnerships are developing.
Q. Speaking for AAOHN, what do you envision as your members’ primary role in the occupational health community moving forward?
Ms. Pepler: Our vision for our members is to be a vital part of their organization’s management of workers, inclusive of health, productivity, and engagement. We want them to voice their health knowledge and expertise to improve individual worker and worker family health while improving the organizational health of the business or entity in which they work. The OHN is the leader in health and well-being initiatives and education. They have the knowledge and expertise to influence a safe and healthful work environment as well as initiate activities to assist individual workers and their families in becoming and staying healthy.
Q. Do you see the number of occupational health nurses increasing or actually decreasing?
Ms. Pepler: Increasing.
Q. How do you envision occupational health nurses fostering wellness and preventive medicine?
Ms. Pepler: Occupational health nurses are in a unique position to help foster wellness and preventive health. They see first-hand the work activities workers are performing. Growing partnerships with business leaders continue to become stronger, allowing for discussion affecting the work environment, employee health and safety programs. Wellness promotion is becoming more of a focal point for business leaders. Occupational health nurses are promoting wellness activities, health screenings, and educational offerings. Influences in employee health benefits are emerging, which is leading to more preventative activities. This leads to better health and wellness outcomes. It’s smart business because employees are attracted to work environments that engage employees, provide a work-life balance and make them feel valued.
Q. Dr. Auerbach, speaking for ACOEM, what do you envision as your members’ primary role in the occupational health community moving forward?
Dr. Auerbach: Increasingly the delivery of occupational health is a team effort. Members of our organization must continue and expand working with the other professions.
Q. What precipitates that, in your opinion?
Dr. Auerbach: There are changes in the delivery model. We have various arrangements within a given employee-employer relationship. We have many delivery models that lack immediate access to the occupational physician. We need a system that facilitates such referrals, and once a referral is made, the occupational physician needs to be working with other members of the team.
Q. Dr. Crawford, speaking for the NAOHP, what do you envision as your members’ primary role in the occupational health community moving forward?
Dr. Crawford: The NAOHP is in a unique position to have positive effects and a positive role. Our membership is unique because we have nurses, physicians, and practice administrators as members. You need to combine excellence in practice management with excellence in caregiving and coordinate all of the different components. The NAOHP is uniquely positioned to help facilitate that.
Q. In what way are they or could they be doing to facilitate that?
Dr. Crawford: The NAOHP gives those in the occupational health treatment delivery system a voice. More importantly, it allows interaction between the different parties involved. Our national conferences are so exciting because there are doctors, practice administrators, nurses, and marketing people all sitting in the audience from all over the country. Those potentially divergent points of view get to be shared; that’s what the NAOHP allows.
Q. Dr. Auerbach, as president of ACOEM, you have an opportunity to foster change within the world of occupational health. What changes would you like to see at ACOEM during your tenure?
Dr. Auerbach: I would like to move the ball forward on the issue of funding for training because that is the major barrier to the profession at this point. One of my roles is to get into a conversation that improves our funding stream for training. I personally want to see occupational health involved in the care organization system in the medical home and to have a voice in the meaningful use of health information systems. Another objective is to continue our work on reducing opiate abuse.
Q. Dr. Crawford, as president of the NAOHP, what changes would you like to see during your tenure?
Dr. Crawford: Occupational medicine fellowship programs throughout the country prepare qualified physicians. They are trained in epidemiology and come out strong in those fields. We need to develop a program where fellowship training incorporates more of the “bread and butter” occupational medicine typical of the type of medicine that we’re practicing where we’re seeing not only inhalations and exposures but musculoskeletal cases. The preponderance of injuries evaluated in most clinics are musculoskeletal, and I don’t believe that graduates of the fellowship are well-trained in musculoskeletal medicine. If fellowship programs integrate rotations in this aspect of care, it would result in better exposure to musculoskeletal injuries, and this would enhance the delivery of care to injured workers, reduce referrals, and contain costs.
Q. Ms. Pepler, what changes would you like to see happen at AAOHN during your tenure?
Ms. Pepler: Our organization continues to grow membership. We have become financially secure. We have guided members towards becoming health leaders as well as advocates in their profession with colleagues as well as others outside of our field’s practices. We will continue to become stronger in our pursuit of this path. Our membership’s business opportunities are expanding globally. We will continue to strengthen our educational opportunities; with the modalities and the use of more technology, stay on the leading edge of the profession.
Q. Dr. Auerbach, given occupational health’s potential and paucity of practitioners, leadership skills become critically important. What do you think constitutes real leadership in your sector?
Dr. Auerbach: Physicians need to change their mindset to recognize that they are a part of a team; that’s a leadership skill that we really need to foster in our practitioners. We need to extend the reach of occupational medicine well beyond the relatively small numbers of residency trained providers we have for experienced occupational physicians who have learned through clinical practice.
Q. What word would you use to describe the most outstanding physician leader in occupational medicine?
Dr. Auerbach: Plays well in the sandbox.
Q. Dr. Crawford, what do you think constitutes real leadership? Dr. Crawford: The phrase I would use is ability to integrate. Patient care and running a business need to be integrated. If you could combine clinical, nursing and business administration with strong political representation we can foster change in occupational health. For example, the NAOHP maintains a continuous dialogue with both ACOEM and the AAOHN to work collaboratively for the benefit of all aspects of the practices.
Q. Ms. Pepler, what do you think constitutes real leadership in occupational health nursing? Ms. Pepler: Leadership is critical to any success and that’s why AAOHN is creating a leadership institute to promote the skills and knowledge needed to run an organization and have the ability to become even stronger leaders. Leaders need to be visionary and have the ability to drive the change needed to reach the vision. We also feel that self-confidence, occupational health expertise, communication skills, the ability to influence others, and the ability to collaborate are hallmarks of leaders.
Q. What word or phrase comes to mind when you think of the true occupational health nurse leader? Ms. Pepler: Someone who is strategic in their thinking. Someone with a willingness to be a part of the change, and not only just to be out in front but also jump in when necessary.
Q. What final words of advice would you have for the people who will be reading the transcript of this roundtable discussion? Dr. Auerbach: Recognize that occupational providers, whatever their training, have a unique skill and ability to deliver care in an arena that definitely needs those skills. Recognize that there are challenges being brought by the changes in the healthcare system and continue to work on the political side to make sure those skills are brought to benefit the worker.
Dr. Crawford: A thank you (to all in the field) for keeping the country’s workers healthy so we can remain a productive and prosperous nation. We are always looking to do better but I think we do a pretty good job of keeping people productive, identifying problems and treating our workers appropriately to get them back to work.
Ms. Pepler: It’s not one person or one group that creates the change; it is everyone collectively. Occupational health won’t just be a small entity. We can really impact what is happening globally as well.
