Occupational medicine and the general practitioner.

A substantial amount of occupational medicine is practised by primary care physicians and this applies throughout the world. In the UK, if we assume that 1 in 10 primary care physicians may have some attachment or interest then there may be as many as 3200 general practitioners (GPs) practising occupational medicine, even if this is simply an arrangement to see employees from a local company if they have health issues. This may be an underestimate and we know that all primary care physicians see work-related health problems on a daily basis. However, this introduction to occupational medicine has been a vital feeder to the speciality in the past and many full-time occupational physicians have had previous careers as GPs, often lasting many years, before they were prompted to make the change. The majority of the working population do not have access to occupational health at a time when there are well-publicized government targets for achieving health in the workplace [1]. The current shortage of specialists and the shortfall of those in training in the speciality suggest a strong need for more GPs either to start practising or to convert to full-time occupational medicine. Moreover, it is believed that there are a vast number of companies, particularly smaller and medium-sized enterprises (SMEs), who are crying out for occupational medicine advice. However currently, only one in seven SMEs have access to an occupational physician [2]. The new GP contract of April 2004 allowed GPs to opt out of 'out of hours' care and this may give GPs the opportunity to take on some or more occupational medicine work. Conversely, there may be more incentive for GPs to concentrate on aspects of the new contract, such as the quality and outcome framework, which could be financially very rewarding. Many converts from primary care are attracted by the unique facets of occupational health; this really is a speciality outside the more typical special interest within the health service and, uniquely, usually it is not at all within the National Health Service. This, in itself, is attractive as doctors discover the opportunity to operate in a real and very different world outside the normal medical boundaries. Specific advantages and differences include having more time with patients, operating in different physical environments and working with non-medical people, such as personnel and production managers, insurance specialists and lawyers. However, there also exist substantial differences between occupational medicine …