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Occupational medicine physician Robert Nathan Clapp discusses his article, “Why you should take a closer look at occupational and environmental medicine.” Addressing the pervasive issue of physician burnout, Robert introduces occupational and environmental medicine (OEM) — a specialty under preventive medicine — as a compelling but often overlooked field boasting high job satisfaction and low burnout. He notes that despite its appeal, only about 20 percent of OEM residents knew about the specialty before finishing medical school, leading many to transition later in their careers. Robert explains that OEM focuses on preventing, diagnosing, and treating workplace and environmental injuries and illnesses, uniquely blending clinical care with public health principles. Key advantages drawing physicians to OEM include extremely diverse career paths (ranging from 100 percent clinical to 100 percent non-clinical in various settings like corporations, government, and academics), excellent work-life balance with minimal call or weekend work, a focus on functional outcomes rather than volume metrics, competitive salaries, and high demand. Furthermore, residency training is accessible (often two years, or even one year for those with prior GME) and includes a master of public health (MPH) degree, with prior specialty experience often being highly valued. Actionable takeaways encourage physicians feeling dissatisfied or burnt out, as well as medical students, to explore OEM as a pathway to a more sustainable and rewarding medical career.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Robert Nathan Clapp. He’s an occupational medicine physician. Today’s KevinMD article is “Why you should take a closer look at occupational and environmental medicine.” Nate, welcome to the show.

Robert Nathan Clapp: Thanks, Kevin. I appreciate it.

Kevin Pho: Let’s start by briefly sharing your story and journey.

Robert Nathan Clapp: OK. I was originally a family medicine physician in the Navy for about 14 years. I did a mix of what we call operational medicine, working as a flight surgeon, taking care of helicopter squadrons for both Navy and Marine Corps, doing international deployments and stationed abroad as well as based across the nation.

And then over time, I really enjoyed more the care of the workforce, and military medicine is very much that. And so I desired to switch to occupational medicine, which is worker health across all industries. I ended up getting out of the Navy and doing a residency at the University of California, San Francisco.

I got exposed to a wide variety of industries, and that evoked more of the passion of why I switched over, and it made it very rewarding. I found at points in my career as a family physician, I got tired at times of certain things. Hypertension, diabetes, all of that is really important.

But at times it gets monotonous and can be boring. And also just the pull from different aspects of clinic, hospital, ER, OB—all those factors were making it hard to feel fulfilled and sustained, which is one reason I switched.

That’s what got me and a number of my colleagues at ACOM, which is the American College of Occupational and Environmental Medicine. They’re working on trying to recruit more physicians into the occupational medicine sector.

And it’s an area that a lot of people don’t know about. And it’s often thought of as just workers’ compensation care, but it is environmental medicine, climate change. It includes keeping people in the hospital safe and healthy. It is travel medicine. It is a wide variety of aspects, and there’s a niche for everyone.

So, for me it was a second career, and that’s actually true for a lot of physicians who do occupational medicine. They wanted a change in their career, whether it was because they wanted to tailor their care to certain populations, or there was some burnout, a combination of both, or they just didn’t know about it earlier on.

And found out about it later in life. And so the purpose of the article was to try and let people know about this specialty and the pros and cons of it. There are a lot of pros, and I think it’s a great solution to some of the burnout that we can experience, especially in primary care.

But other specialties will dabble in occupational medicine factors as well.

Kevin Pho: Why do you think occupational medicine is relatively unknown despite the satisfaction rates among those in the profession?

Robert Nathan Clapp: I think part of it is it’s only thought of as workers’ compensation from a lot of sectors, and that’s not true.

We also do employee health and surveillance of medical programs for noise, so hearing issues, exposure to certain chemicals. And then for things like firefighters and drivers, we’re very much involved in keeping them healthy and making sure they’re safe to do their job.

Other reasons are the funding system sources for residencies in the U.S. are not traditional Medicare, Medicaid funding. It’s a bunch of grants from NIOSH educational grants and other sources of funding, and it can fluctuate at times. And so funding, I think, plays a role.

So a lot of people don’t get exposure to these types of rotations in medical school or residency. And if you’re not somewhere near an occupational, a workers’ compensation clinic, or employee health clinic, you may not get a chance to ever see what that’s involved. And also some of the jobs are corporate.

So you’re working as a medical director for some company, whether it’s in the U.S. or outside or spread across the world.

Kevin Pho: Now, are the majority of occupational medicine physicians taking that on as a second career? Do you get a lot of new graduates going into occupational medicine?

Robert Nathan Clapp: I think it’s somewhere around 50-50. At least when I was switching over—I got out of the Navy and switched to occupational medicine in 2018—I think it was a little more than 50 percent were from a prior career. But there are a number of people who were doing it as their first and only training just because they had an opportunity to see what’s involved and there may be something that speaks to them.

And if you’re working with someone who really enjoys taking care of employees and gets excited about the different hazards and taking care of certain sectors of industry, that’s going to resonate with them and get them interested.

Kevin Pho: What is the day-to-day like as an occupational medicine physician?

And granted, I know that there are a lot of different tracks as you previously mentioned. In your day-to-day, what’s it typically like?

Robert Nathan Clapp: I work at a large multi-facility medical group. And I do mostly workers’ compensation, but I do take care of the hospital employees as well as doing pre-employment physicals and surveillance for some of the employers out in town.

But most of what I do is workers’ compensation. And I work in an area that has a wide variety of industries, from agriculture to construction, lots of law enforcement, correctional facilities, first responders. A whole host of fabrication, office workers, education systems—a pretty wide range compared to some of the other cities that may have a much narrower focus.

So for me, it’s exciting because there are so many different types of injuries that you can see. A lot of training in occupational medicine will let you do some site visits to different factories, work sites. And you get to see the hazards, and sometimes once you’ve seen one pattern, when a patient is speaking to you about how they got hurt, you have some familiarity and you can fine-tune it and really understand how they got hurt, which makes a big difference. But we get a range of polytrauma from amputations to multiple rib fractures, lung disease, skin disorders.

So I’m still getting to use a lot of the educational skills I developed as a family physician. And I’ve built on more of the musculoskeletal than I was using before, as well as some of the trauma that, even in the Navy, I’m seeing stuff here that is challenging, so it’s great.

Kevin Pho: Now, do you have the same administrative bureaucracy that typical primary care physicians would have a focus on? Metrics, performance, RVUs, productivity? What’s that like in the occupational medicine world?

Robert Nathan Clapp: There are going to be some similarities and there are going to be some differences. Patient satisfaction plays a role, but some workers come in who are being seen under workers’ compensation, and they’re not going to be satisfied. And you do your best to control that. Some of the things that we follow are timelines of getting your reports done and processed for the insurance adjuster.

We do impairment reports for when we’re wrapping up a claim and measuring how much injury their body sustained on a permanent basis, and if they need permanent restrictions for life, and deadlines for those.

And then we still follow a lot of the HEDIS measures for our facility. Our low back pain guidelines for X-rays still hold true; for instance, Choosing Wisely principles still apply.

We have the ability to help our patients complete their preventive screenings when their primary care physician has badgered them and they’re not making progress.

I can say, “This is important. I was great on this in the past, and it’s important to me because it’s important to your health.” So I can help speak for and be an advocate for their primary care. And so I help their physician look good, help the patient get good routine primary care, as well as the facility.

Immunization rates are also relevant.

I think the main bureaucratic complaint that people will have is the paperwork for workers’ compensation. There will be some similarities to pre-authorizations for your requests.

So there are guidelines about when we can and cannot request consults. Imaging has to meet the standard of care or have a good justification for why you’re requesting it early or with this particular patient.

But that’s typical of any medical career, but we get a lot of requests for response from the insurance adjuster, or the adjuster is getting a complaint or a question from the employer, and then they’re relaying it back to us. And we’re trying to advocate—under HIPAA, we’re still advocating for the patient or to help answer what may be a concern.

Kevin Pho: Now, for those who transitioned to occupational medicine as a second career, are most previously family physicians?

Robert Nathan Clapp: No, there’s a wide range. I think the majority are going to be primary care: internal medicine, family medicine. There are a number of pediatricians that switch over to do some level of occupational, and they often will go into environmental medicine.

Addressing issues like asthma and pollution, which is really relevant to the health of children. But there’s also a lot of people that do occupational medicine as orthopedists, cardiologists, pulmonologists. There are some OB-GYNs that will dabble in it as well for reproductive health and its interaction with the workplace or environmental contaminants.

So there’s a pretty wide variety, and once in a while you’ll see some dermatologists who really get into the occupational realm as well.

Kevin Pho: Differentiate between the occupational and the environmental aspects of the specialty. Does one typically focus more on one aspect? You, for instance: what’s your proportion between the occupational and the environmental aspects of your specialty?

Robert Nathan Clapp: I think for most clinics that are doing workers’ compensation care, the majority of it is going to be the occupational or worker health realm. Some clinics, depending on if they’re near a research center or they have close connections with pulmonologists that also treat asthma, COPD, and air pollution, they may naturally have a stronger association with that. And they’re kind of like a gateway to pulmonologists.

Some of the environmental medicine work is done with pulmonologists. So I think there’s a small chunk where they really only do environmental medicine. But for most occupational clinics, I would say that the majority is going to be industrial or work site injury. But I work in Central California, and so forest fires and agriculture, all that plays a role in air quality.

And so I do some of it, but not as much as other places may do, where there’s more of a robust research that some of the academic facilities will do.

Kevin Pho: Now, if a physician is interested in transitioning to occupational medicine, what exactly would that entail?

Robert Nathan Clapp: There are different paths. You don’t have to do a second residency in occupational medicine to do it. But you do want to learn, have some exposure to someone who knows your state laws, because every state is going to vary on their workers’ compensation laws. And you don’t want to get in trouble by violating laws ignorantly.

But there are a number of people who start working at a workers’ compensation clinic, and they were not formally trained in occupational medicine. But they required some training and mentoring by people who do workers’ compensation.

So there’s that route. There’s a lot that are just like me that did a previous residency or some people who start a residency and then realize, “This isn’t what I want to do.” And often they’ll find out about occupational medicine and switch over and then they’ll actually do a formal residency. Every occupational medicine residency, which falls under the American Board of Preventive Medicine, requires a Master of Public Health.

And so, because you’re doing a lot of public health, preventive medicine, and population health and biostatistics for what you’re justifying, especially if you’re managing an industry, you’re using the biostatistics pretty regularly for population health for different industries.

Kevin Pho: Now, for those medical students who may be listening to you now, what kind of traits should they have? What type of questions should they ask themselves to see whether occupational medicine is right for them?

Robert Nathan Clapp: I think the biggest thing, if you ask most occupational physicians, is: do you care about worker health?

And don’t take that negatively. I mean, it helps for that to be a passion. Or does some sector of industry or population really excite you? So people that really care about agricultural workers or peace officers, law enforcement, first responders—sometimes that’s what drives them.

Others are heavy in the tech industry, and they build relationships and start learning about the hazards, whether chemical or even ergonomic hazards, from those sectors, and that’s what gets them excited. So if you like a wide variety of things similar to family medicine, I think occupational medicine fits that because—and it depends on where you work—but I get to do a lot of eye injuries, wound care, wound repair, fracture management, post-operative management, chronic health conditions.

So you have a pretty wide range of types of conditions you can be treating and managing along with your specialists. And that will vary based on where you live and what industries are nearby. It also depends on where you work and which insurance companies will use your clinic for the care of their employees.

That plays a role. But I think for medical students, if you’re interested in worker health, that’s a great start. Or if you’re passionate about a particular population, there’s a niche for you in occupational medicine.

Kevin Pho: We’re talking with Nate Clapp. He’s an occupational medicine physician. Today’s KevinMD article is “Why you should take a closer look at occupational and environmental medicine.” Nate, share some take-home messages that you want to leave with the KevinMD audience.

Robert Nathan Clapp: I think the first one addresses one of the concerns that people have when they’re doing workers’ compensation: how do they say no to patients?

How do they give workers appropriate restrictions, fight the battle of requested time off? I think if you stick with your clinical experience, your knowledge of anatomy and physiology, pathogenesis of the disease process, and expected timeline of recovery, and you hold to that, you can guide them to the appropriate transition back to their maximal improvement.

And when they don’t meet that, often that’s a sign that you’re no longer dealing with that actual injury. There’s something else going on. And that probably isn’t the realm of what you should be doing.

As you practice that and you get used to generating restrictions and being specific based on evidence-based medicine, I think it gets easier to properly protect patients from further injury, let them heal, and then get them back to full function both in and out of work.

So that’s one of the joys that I have. And I think the other take-home message is:

Regardless of what you’re passionate about, there is probably a place for you in our sector.

And if you are late in your career and something’s dissatisfying you to a degree that you’re really unhappy with medicine, a number of people felt that way and they have found a place for themselves that makes them thrive in occupational medicine.

And it renews their vigor and their zest for care of the workforce and their patients.

Kevin Pho: Nate, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.

Robert Nathan Clapp: Thank you, Kevin. I appreciate it.