A transplant to Boston from Brazil, my patient worked as a hairdresser but had developed painful rashes on her hands that peeled and cracked, making it impossible to do her job.
I diagnosed her with an allergy to para-phenylenediamine, an ingredient in certain styling products she used at the salon. Her skin recovered as she avoided this chemical. A careful medical evaluation had healed her hands and allowed her to maintain her livelihood, her self-sufficiency, and the social connections with colleagues and clients that sustained her.
Wherever you work — an office, a factory, a construction site, or a big rig — conditions on the job can greatly affect your health. That’s why I went into the field of occupational and environmental medicine, or OEM: It’s a specialty that focuses on supporting both management and labor to keep workplaces and communities healthy.
But it’s a specialty in danger.
Occupational physicians care for more than 100,000 workers each day and are used by more than 95% of Fortune 500 companies. We advise managers and their employees on issues ranging from chemical exposures to workplace hazards to infection control to mental health. We evaluate worksites and provide clinical care to both prevent and treat occupation-linked diseases and injuries.
Emergency medicine is grappling with a surprising problem: The prospect of too many physicians
Yet the number of practicing OEM physicians is on the decline due to a quirk in how the federal government funds medical training.
Without congressional action, our numbers are likely to continue dwindling, endangering worker health.
The issue lies in how doctors-in-training are paid. Nearly all medical residencies in the United States are funded by the Centers for Medicare and Medicaid Services, but OEM’s unique patient population — primarily working-aged people who do not qualify for Medicaid — means that the field’s residency slots are not funded by CMS. Instead, these training organizations survive on meager and inconsistent support from the National Institute for Occupational Safety and Health and a hodgepodge of other local and private funding sources.
As a result, each year OEM training programs across the nation are unable to train enough doctors to care for America’s workforce. There are just 1,440 board-certified OEM physicians in the country — to serve 161 million American workers.
The value of OEM-trained physicians to an organization scales beyond one-on-one clinical encounters. The union at one of my clients’ worksites demanded the company pay to test everyone for mycotoxins after someone found mold in the vents. We held a townhall discussion to listen to their concerns, offered free medical evaluations, educated the community about this harmless type of mold, and implemented healthy building strategies. Both labor and management were satisfied.
At the OEM Residency Program at Harvard’s T.H. Chan School of Public Health, I encountered the stark reality of insufficient funding. In 2024, my graduating class had only six new OEM physicians. If the field received funding similar to other medical specialties, the program could supply twice as many doctors each year to meet the nation’s needs.
The same story is playing out at every OEM residency program around the country. In 2023, training institutions had the capacity to take in 187 OEM residents, but only 115 of those slots were funded — meaning 40% of training opportunities sat empty.
The average age of OEM physicians in the U.S. is 63. Yet more than half of training sites have closed in recent years, which jeopardizes OEM’s ability to build back in the future. The U.S. funds only one-third as many positions now as we did a generation ago.
Fix the rural physician shortage by expanding support for resident training
We are losing an invaluable national resource — the U.S. does not have enough occ docs to replace my retiring mentors. On a practical level, the next military commander still needs the doc who can treat his missile-loaders’ shoulders injuries and then convince their shop supervisor to invest in hoisting equipment. The next storm-ravaged community still needs the doc who teaches volunteers cleaning up after a devastating hurricane how to protect themselves from hazardous materials in construction debris. The factory town still needs the doc who approaches workers’ compensation as an opportunity to prevent needless disability.
Fortunately, there is a clear and obvious solution: Congress can appropriate funding to fill the gap. This is not unprecedented. In fact, Congress already provides a line-item budget to fund training programs for pediatric medicine, another critical specialty that does not receive traditional CMS funding.
Adopting this approach would be a game-changer for American workers and employers. And it would not be all that costly.
The American College of Occupational and Environmental Medicine estimates that fully funding training would require just $16 million a year in additional funding. That is a miniscule sliver of the $18 billion that CMS spends annually to train America’s other doctors, especially per capita.
Investing in a sufficient corps of OEM doctors would pay dividends not just for workers but for American taxpayers. Unhealthy workers are a drag on the economy — and add costs to taxpayer-funded programs like Medicare and Social Security Disability.
Indeed, the National Safety Council estimated the total cost of work injuries at $167 billion per year, including wage and productivity losses, medical expenses, and administrative costs. OEM doctors reduce these losses by preventing and addressing health risks before they become serious issues.
A robust cadre of occupational and environmental physicians will help not only the American economy, but also the American public — because workers aren’t just workers. They are parents, neighbors, citizens. And they bring their health, or lack thereof, back to their families and communities.
Matthew Hamm, M.D., M.P.H., a former Air Force flight surgeon, is chairman of the national OEM Pipeline Task Force and medical director at Occupational and Environmental Health Network.
