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UEMS Section of Occupational Medicine do not have participants from all the European countries, but hope in the future to get repræsentatives from all the UEMS memberstates.
Occupational medicine in Austria
General practitioners are working as company physicians in big companies since the beginning of the 20th century. During the sixties the preventive character becomes more and more important.
1973: Austria obligates large companies to employ company physicians, the first academy of OM was founded.
2000: Every employer has the right for occupational medicine.
Science:
In the end of 19th and beginning of 20th century especially hygienic specialists did research on occupational health issues.
1969: The first chair for occupational medicine was established at the University of Vienna
1979: University Hospital of OM in Vienna, now Institute of OM as a part of University Hospital
| Inhabitants | ca. 8.000.000 |
| Employees | ca. 3.000.000 |
| Physicians in Austria | ca. 39.500 |
| Occupational physicians | ca. 1.600 |
| Specialists of occupational health | ca. 110 |
| Full time occupational physicians | ca. 300 |
| Full time specialists of occupational health | ca. 50 |
Private, companies, outsource
Companies have the possibility to employ occupational physicians, to
enter into contracts with freelance occupational physicians or
to hire an occupational health centre.
There are two possibilities in Austria to practice the occupational health profession. After three years of clinical training to become general practitioner, the doctor has to attend a 12 weeks program (360 lessions) at the academy for occupational health. Upon completion the doctor can start working as an occupational physician in companies.
The second possibility is to complete a training to become a specialist for occupational health. This lasts for six years. Four out of these six years have to be done for example in a centre for occupational health. The remaining two years have to be spent in the diverse clinical departments of a hospital.
The occupational physician has to do several examinations if employees are exposed to substances that are damaging one´s health, for which the legislation has specified the need for examinations. The occupational physicianhas to be called in cases of health protection, determining different dangers, planning of place of work and workspace, reintegration of diseased employees. The occupational physician is working closely with the safety engineers.
Training of specialists of occupational health
Scientific research
Occupational health at universities for medicine
Österreichische Gesellschaft für Arbeitsmedizin
President ÖGA: Karl Hochgatterer
Vice president: Susanne Schunder-Tatzber
Office:
Österreichische Gesellschaft für Arbeitsmedizin
Clemens-Holzmeister Straße 6, 4. Stock
1100 Wien
Austria
Email: office@gamed.at
+43 (0)681 10 650 840
Till 1968, occupational health was mostly for large companies.
In 1968 every company had to ensure itself the support of an occupational physician and this through a service for occupational health. This service could be internal or intercompany. This was the start of a big number of external services around groups of employers.
In 1996 the law on ‘Wellbeing at work’ appeared. This was the start of multidisciplinary services, with obligatory prevention advisors in safety, ergonomics, industrial hygiene and psycho-social factors. Occupational medicine in Belgium stays essentially preventive.
This was the start of fusions of services. In 2014 there are only 12 external services left that cover > 90 % of the working population of Belgium. Less than 10 % of the occupational physicians still work for internal services.
In 1996 occupational medicine became an official medical specialty with 4 years of training. Since there are few students, training became interuniversity, at least in the Flanders region. In the French region, discussion is still going on.
Total: 11.036.000 (2012)
Workforce 4.450.000
46.751 physicians (2010)
Around 1000 physicians work in occupational medicine. Since 1996, only doctors that followed the 4-year specialty can work in the field. Before it was only a one year university training. Most of the physicians are exclusively working in the specialty and they work on average 80 % of their working time.
Postgraduate training takes four years after becoming a licenced physician. Two years are mainly theoretical academic training. Two years are training on the field in a service. A number of activities have to be executed by the trainee. Besides the requirements in medical surveillance of individual workers they have to perform a number of visits on workplaces, performing risk assessments, having the basics of ergonomics and industrial hygiene, participation in committees of well being at work… The four year study is completed by a scientific thesis.
After completion of the study, the trainee can apply to be recognised as a specialist in Occupational Medicine.
Continuing Medical Education is not to be licenced by the authorities, but there is much focus on it in the specialty.
• Ability to work and sickness absence
• Ageing workforce
• Financing of the system
• Stress, burnout and all the range of psychological and psychiatric problems
We have one association of occupational physicians working in Belgium
In Dutch: BBvAG: Belgische Beroepsvereniging voor ArbeidsGeneesheren
http://www.bbvag.be/
In French: APBMT: Association Professionelle Belge des Médecins du Travail
www.apbmt.be/
We have two scientific associations:
Flanders: WVVA: Vlaamse Wetenschappelijke Vereniging voor Arbeidsgezondheidskunde
http://www.vwva.be/
French: SSSTR Societé Scientifique de Santé au Travail
www.ssstr.be
Information
Contact person:
Dr. Simon Bulterys
Interleuvenlaan 58
3001 Heverlee
Belgium
Tel. 00.32.16.39.05.00
Information is to come
ORGANISATION
According to Croatian legislation occupational health is covered by compulsory health insurance.
Information is to come
Further information (PDF)
History
Population
Physicians
Nature of Occupational Health services
Profession
Training
Tasks
Hot Topics
Association
Society of Occupational Medicine of the Czech Medical Association
Beginning: The doctor C.J.E Hornemann, was one of the first, which in 1872 investigated child labour in Danish factories. Two percent of the workers were children and several of them were under 10 years.
In 1873 the first steps taken towards the establishment of The Danish Working Environment Authority
The countries first occupational phycician was Skuli Gudjonsson, who in 1939 became the first professor of Hygiene, University of Aarhus. The focus was on lung diseases and toxicology.
In 1946 the first Department of Occupational medicine at the Rigshospitalet in Kopenhagen was established.
In 1982 the specialty was recognized and the training organized.
Total: 5.511.451
Workforce 2.800 000
19.840 physicians
65 working in the specialty (129 total) Specialists of occupational medicine
Postgraduate training takes five years after the basic training (1 year), Tree years in a hospitaldepartment of Occupational Medicine, two years in, rehabilitation, lungdiseases, neurology, dermatology). Workplace knowledge and visits on workplaces with the Danish Working Environment Authority. Theoretical training in epidemiology and statistics, professional diseases, risk assesment, industrial hygienics, heath promotion and a scientifik thesis or article.
Continuing Medical Education is not to be licenced by the authorities, but there is much focus on it in the specialty..
Dansk Selskab for Arbejds- og miljømedicin
The Danish scientific association for environmental and occupational medicine
President: Harald William Meyer
Address: Department of Occupational Medicine, Regional Hospital Vest Tlf: +45 78 43 35 00 Website: www.dasam.dk
Information is on its way
Finland’s occupational medicine activities begun to grow actively after the second world war. The ‘Labour safety act’ from 1958 stated that the employer is responsible for the health of the workers and health surveys became obligatory in hazardous workplaces. The ‘Supervision of the Labour Protection act’ in 1973 stated that workplaces with 20 or more employees must have an elected work safety committee, and workplaces with 10 workers or more have an elected work safety responsible. The ‘act on Occupational Health Services’ in 1978 finally opened the door for real preventive occupational health. The law was modified in 2001, when the maintenance of working ability became a new task for occupational health.
The specificity of occupational health in Finland is that employers can also offer curative services. More then 90 % of employers offer these services. It means that every worker uses the occupational health services almost 2 times per year. Ththis gives This gives to occupational health the possibility of reacting rapidly in case of problems, and opens the possibilities to curative and vocational rehabilitation.
The coverage of occupational health is over 90% in big work places and over 60% in small workplaces (1-9 workers).
Population: 5,4million (2010), 68% employed (09.2009) ie. 2,4 million people
Number of doctors: 19 000 (283 inhabitants/doctor)
Number of doctors specialized in occupational health: 767 at age of work, (436 women). About 2,400 doctors in total are working in the field of occupational health, including those who work part time, are on the way to specialization, or work in curative care only.
In Finland we work in multidisciplinary teams: we have 2600 nurses, 700 physiotherapists, 300 psychologists, and 800 aides.
Nature of services:
Communal health services have the obligation to provide occupational health services for the employers in the community. This guarantees the distribution of services all over the country. Communal health services tend to work together with each other, creating bigger centres. The communal system takes care of about 29% of overall occupational health services.
The employer can have its own occupational health service. The tendency now is to use private services, however in-house services still make up 26% of the services.
The employers together collectively organize 6 % of all occupational health services.
The role of private occupational health centres is growing, they take care of 39% of occupational health services.
The minimum requirement for working in occupational health for under 20 hours per week is completion of a 7 weeks’ course organized by the Institute of Occupational Health, during the two first years of practice.
All others working in the field of occupational health for over 20 hours per week must have the specialization. A trainee doctor can begin to specialize in occupational health after completion of the 2 years of common education with all medical students (after 6 years theoretical medical studies). Specialization demands 2 years of occupational health work mentored by a specialized occupational doctor nominated by the university. Additionally 1 year in hospital is required in three different specialities, followed by ½ year training at the Institute of Occupational Health, and ½ year in a practice of assessment of work ability.
200 accredited points or hours of extra training are also required.
Association: Finnish Society of Occupational Doctors
Suomen Työterveyslääkäriyhdistys ry
Kalevankatu 11 A, 00100 HELSINKI
Tel: 09 6188 5211
Fax: 09 6188 5260
stly@stly.fimnet.fi
The Finnish Society of Occupational Phycisians www.stly.fi
or contact:
Satu Vaihkonen e-mail: satu.vaihkonen@tyoterveyswellamo.fi
Kari Reijula Kari.Reijula@ttl.fi
OCCUPATIONAL HEALTH SYSTEM IN FRANCE – DR/M.D. ELISABETH ISNARD
Organisation des services de sante au travail en France – Dr. Martine Leonard
OCCUPATIONAL MEDICINE IN GREECE (update March 2023)
A. POPULATION
[Definitions: Employed are persons aged 15 years or older, who during the reference period worked, even for just one hour, for pay or profit or they were
working in the family business, or they were not at work but had a job or business from which they were temporarily absent. Unemployed are persons aged 15-74 who were without work during the reference period (they were not classified as employed), were currently available for work and were either actively seeking work in the past four weeks or had already found a job to start within the next three months. Inactive are those persons who are neither classified as employed nor as unemployed. Economically active population (labour force) are persons either
employed or unemployed. Unemployment Rate is the ratio of unemployed divided by total labour force.]
According to the Hellenic Statistical Authority (ELSTAT): the total resident population of Greece in the latest census of 2021 was 10,432,481, of which 91.6% were Greek; life expectancy at birth in 2021 was 83 years; age dependency ratio (the ratio of the number of economically non-active persons [aged 0 – 14 and 65 years and over] compared with the number of economically active persons (aged 15 – 64 years) was 57.7; total mortality rate (the number of deaths per 1,000 people) was 12.3, in December 2022; in the third quarter of 2022:, the number of persons employed amounted to 4,216,038; the number of unemployed persons amounted to 555,567; the unemployment rate for the third quarter of 2022 was 11.6%; the number of persons outside the labour force, i.e., persons who were neither working nor looking for a job, amounted to 4,276,631. In particular, persons outside the labour force under the age of 75, amounted to 3,060,938.
B. OCCUPATIONAL PHYSICIANS (OPs) AND COVERAGE OF WORKING POPULATION BY OCCUPATIONAL MEDICINE (OM) SERVICES
The large majority of the working population (estimated to be circa 80%-85%) is employed either in enterprises with less than 50 workers, or are self-employed.
The Greek occupational health and safety law pertaining to occupational health and safety (which, at least on paper, fully conforms with European Union Law) stipulates that OM services should be provided only to public and private enterprises with fifty or more workers, or workers employed in smaller enterprises who are exposed to certain noxious substances such as carcinogens and harmful biological agents. This means that only circa 15- 20 % of the employed population of 4,216,038 (i.e., only circa 0.8 million workers employed in such enterprises) must receive occupational medicine services. It is noted that, virtually, no other enterprises (i.e. none of those which are not obliged to do so by law) receive OM services.
In reality, in 2022, occupational medicine services all over Greece indiscriminately, were provided to an as yet unknown fraction of the aforementioned 0.8 million workers (a) by 159 specialists in occupational medicine [according to ELSTAT, the Greek Statistical Authority], most of whom are also members of the Hellenic Society of Occupational and Environmental Medicine [HSOEM] and registered in the “Register of Occupational Physicians” of the “Integrated Information System of the Labour Inspectorate” of the newly established (and operational since 1.2.2023) Independent Authority “Labour Inspectorate”. As these specialists have been (and still are) few (compared with those needed to offer services to all employees working in enterprises with 50 or more workers) , in certain prefectures of Greece services by them have (and still are) provided, (b) by another 374 physicians holding specialties other than occupational medicine, or holding no specialties at all (who had worked providing OM services continuously for at least seven years in private or public enterprises and organisations up until 7 May 2009, (as stipulated in Article 16, 1C of Act of Legislative Content [“Executive Order”] of 20 March 2020 (clarified in the Circular by the Secretary General of the Ministry of Labour of 23.4.2020) , which was ratified by Law 4683 of 10 April 2020 – and listed in a special and ratified formal catalogue included previously in Ministerial Decision 43323/1983 of 7 August 2018) and (c) by physicians who are employed by private “External Occupational Health Services [EOHS – “External Services for Protection and Prevention” holding specialties other than occupational medicine, or holding no specialties at all (employed by private Group Occupational Health Services [“External Protection and Preventive Services -EXYPP”], the Head of which must be a specialist in occupational medicine. The number of the latter (under “(c)”) are not officially registered at the Labour Inspectorate, hard to be estimated and thus unknown.
Physicians under “(b)” and “(c)” above legally have the job title “occupational physician”, but hold titles in various medical specialties other than occupational medicine or no specialty at all. Physicians under (b) and (c) can and are, according to existing Law in force, be recruited to work as OPs in any private or public enterprise and organization, regardless of its type, magnitude of health hazards and health risks present, or size of workforce, whilst they are also practicing their other medical specialty (and earning money in parallel practicing it) or no specialty at all. Thus, they are selected, recruited and work in posts of “occupational physicians” (following tenders for provision of occupational medicine services, which they can afford to win asking for lower remuneration than that asked by specialists in OM, as they earn their living by practicing private medicine holding specialties other than occupational medicine – or a few no specialty at all – or are paid by a private EXYPP, i.e., a private Group Occupational Health Service, by which they are employed).
This situation reflects the low appreciation and understanding of the value of occupational medicine by many employers, employees, the Government and the Greek medical establishment, as a whole. It has also been allowed to grow, because the “Regulating Authority”, i.e., none of the health labour inspectors have been (and still are) too few, to be able to inspect many enterprises (especially many small and medium size enterprises, which constitute the large majority of enterprises in Greece), they have been (and still are) not specialists in OM, and frequently, not even physicians. It is It is noted that the aforementioned physicians, can and provide OM services anywhere in Greece with low remuneration; their services are considered by specialists in OM to be, by many accounts, of lower quality and less effective that if they had been provided by specialists in OM. Many specialists in occupational medicine work on a part time and some even sessional basis, and several are underemployed. This has become apparent, by the fact that some of them also registered with the public National Health System (Service) to work as family physicians (even though they are not trained as General Practitioners, i.e. they are not specialists in General Medicine), for financial reasons.
More specialists are needed for a larger part of the working population to receive OM services. Since 2016, the number of physicians appointed as new trainees in occupational medicine (OM) has been decreasing each year, and the number of specialists in OM has been increasing very slowly.
The law does not stipulate provision of any occupational medicine services to the self-employed working population. The Law does not provide for compulsory provision of occupational medicine services by a physician or by a specialist in occupational medicine in all other private and public enterprises and organisations where less than 50 workers/staff are employed (except in certain enterprises and jobs where workers are exposed to specific high ill-health risk agents (e.g. lead. Ionising radiation). At least 85% of Greeks are either self- employed or employed in private or public enterprises and organisations. However, there are legal provisions whereby the employer is obligated to provide a healthy and safe workplace and services of a “Safety Technician” [Safety Officer} regardless of the number of employees employed by him/her.
It is noted that, according to the latest ELSTAT statistics, in 2021, in Greece, licensed practicing physicians (holding any medical specialty or no specialty) were
66,504, which entails a ratio of 637 physicians per 100,00 inhabitants, which is by far the highest number of physicians per 100,000 inhabitants among any other country in the European Union.
C. NATURE OF OCCUPATIONAL HEALTH SERVICES
Private and public enterprises and organizations receive OM services by OPs as follows:
By employing individual OPs (i.e. including them among their staff), on a whole time basis, as is the case only in very few large-size companies, or
(EXYPP), which provides occupational medicine and safety services to several enterprises.
D. PROFESSION
1.TRAINING
Specialisation training in OM fully conforms to current existing European Union Legislation. Following six years of training in a medical school and earning a degree in medicine, one becomes a qualified physician and is automatically licensed to practice. A physician, immediately after his qualification (i.e. as soon as he earns his university degree in medicine) may start specialisation training in OM, according to Greek law. This is completed after four years in training in total, which includes the following parts: A. Ministerial Decision No. 64843/2018 determined that four-year long specialisation training of physicians in occupational medicine, is to include henceforth:
A. Twelve months of academic training (which includes preparation of a dissertation, lectures, laboratory training and workplace visits) in a tertiary education establishment including the Department of Public Health Policy of the School of Public Health of the University of West Attica (up until 2019 being the “National School of Public Health”), in accordance with a curriculum and a syllabus revised and then approved by the Central Health Council [KESY]of the Ministry of Health), and then
B. Twenty eight months training in clinical specialties in training posts in State Hospitals and Health Centers, approved by the Ministry of Health. Recently, in accordance to training programs – which specify knowledge, competences and skills to be acquired by the trainees, have been determined in Ministerial Decision Γ5α/Γ.Π.οικ.37581/2022 issued on 7.6.2022 on “Training in the specialty of occupational and environmental medicine”, in: internal medicine, chest medicine [pneumology],dermatology, ophthalmology, Ear Nose Throat (ENT) medicine, orthopaedics and emergency medicine, and also cardiology, psychiatry – the latter two fields which had not been not part of the specialisation training in OM before 2018), and then
C. Eight months of practical training, of which:
six months in one or more organized occupational medicine Services in one or more State Hospitals, or in private or public enterprises or organizations (where various occupational health risks and possible ill-health effects may be present to ensure comprehensive practical training in OM) approved for this training purpose by the Ministry of Health and meeting certain criteria mentioned in the aforementioned Ministerial Decision issued on 7.6.2022, (in which for issuing a list of such enterprises and organisations is to be provided for), and two months in Centers for the Protection of from Occupational Hazards(KEPEK) and other Structures and Services of the Ministry of Labour dealing with occupational health and safety.
The above A and B parts of specialisation training may be provided in any order.
A log book for recording all training activities is to be used throughout training and completed by the trainee and signed by the trainer confirming the training. Training targets for each year of specialisation (regarding knowledge, competencies and skills to be acquired) are determined in the Ministerial Decision of 7.6.2022. Thus, i
It is difficult to know to which extent UEMS European Training Requirements [ETRs] are met, during specialisation training in OM in Greece, on account of the deficiencies outlined below.
There are no structured and approved (by an appropriate medical authority) specialization training programs for physicians during their attendance of the practical part of their specialization training in an enterprise (six months). However, trainees and their trainers must complete a logbook (the “logbook of training of specialising trainee) by recording all training activities in it. Since July 2022, in accordance with a Ministerial Decision, certain private or public enterprises and organizations (e.g. companies and hospitals) are approved for specialisation training in occupational medicine by the Ministry of Health. They must employ at least 100 staff/workers employ a specialist in occupational medicine, have an occupational medicine Service/ Department/ ”Surgery” with measurement and other equipment appropriate with respect to health surveillance of employees in relation to the type of their occupational exposures present in the workplace of the enterprise/organization in which they work. No additional accreditation or seniority is required for the trainers themselves.
The occupational physicians (OPs) in hospitals where they exist (be them specialists in occupational medicine or not), provide OM services to hospital staff only, except in one hospital, in which the OM Unit provides OM services to local enterprises too. Most of them are individual OPs, i.e. they provide an occupational medicine service without being supported my other occupational health professionals. In 2022, there were only four specialists in occupational medicine (OM), holding “director’s grade (i.e. top clinical grade) working in the Greek National Health System (Service). There are Occupational Medicine Services at few State Hospitals only. There are very few occupational medicine outpatient clinics or clinical occupational medicine Departments or Services in hospitals, providing services to employees of enterprises or to the public in general. Consequently, trainees in OM in Greece have very few opportunities chances to deal with and learn from diagnosed or suspected cases of occupational diseases, during their training.
Following the incorporation of the National School of Public Health of the Ministry of Health, as a Department of Public Health Policies, into the School of Public Health of the University of West Attica, in 2019, there is a Professor of Occupational and Environmental Health and History of Public Health, at said Department. There has never been and there is still no other Department or post of Full Professor with Occupational Medicine as a sole or complementary constituent of its title in any Medical School at a University in Greece. There is only one Associate Professor of Occupational Medicine, at the Medical School of Thessaly. There is also a Full Professor in Hygiene in a Medical School, who is also a specialist in occupational medicine at the Democritus University of Thrace. No other of academic staff holds an academic post in occupational medicine at any grade at a Medical School or academic or research institution in Greece.
There are only two postgraduate courses (MSc courses) in occupational health, which are attended also by physicians:
One (entitled “Program of Postgraduate Studies in Workplace Health”) is organized by the Medical School of the (State) Democritus University of Thrace, in
Alexandroupolis (capital city of the Thrace Region in North East Greece), and the other (entitled “Occupational and Environmental Health”) is organized by the Medical School and the Department of Political Science and Public Administration of the (State) National and Kapodistrian University of Athens. The Hellenic Institute for
Occupational Health and Safety (“EL.IN.Y.A.E.”) provides short, continuing education courses on occupational health and safety, which are also attended by physicians holding specialties other than occupational medicine.
Assessment for the acquisition of the title of specialist in occupational medicine is effected by an Examination Committee of the Ministry of Health only by an oral exam on completion of specialization training. Neither clinical, nor practical, nor written exams are conducted to that end. As allowed by law, some examiners are not specialists in occupational medicine themselves.
There is a lot of room for improvement for the specialisation training in occupational medicine (OM) in Greece. This training was somewhat improved (at least on paper), but adequately, when it was detailed in a Decision by the Minister of Health, in July 2023. However, the old model (structured in three modalities – following in an ostensibly logical order – first theoretical (12 months), [which includes mainly lectures and a few factory/enterprise visits, attendance of study days and Medical Congresses, and elements of emergency medicine] then hospital-based clinical, in hospital wards and outpatient clinics of specialties related to OM but in occupational diseases wards or OM outpatient clinics, which do not exist (28 months), and finally Ministry of Labour and Labour Inspectorate (2 months) and enterprise/hospital based (6 months) practical training – was used and built upon:
No European Training Requirements (ETRs), issued by the European Union of Medical Specialists (UEMS) in 2013 (pending to be updated) are implemented (although many training topics and elements of them are included in Greek specialisation training in occupational medicine) or targets for and summative assessment of acquired knowledge, skills and competences required at the end of each year of the four-year long training (which is not preceded, by 1-2 years of training in clinical specialties prior to the beginning of actual four-year long specialisation training, so that more time can be allocated to actual occupational medicine); practical training is provided in Services and Units of the Ministry of Labour and of the Independent Authority “Labour Inspectorate” dealing with occupational health and safety (two months), and in organised OM Services in enterprises/organisations/hospitals is too short (six months only); trainers during practical training are very few and most of them are not trained to be trainers; there are no officially approved training programs during practical training in enterprises, quality control in accredited enterprise training posts in OM is absent (although their suitability with regard to training has to be renewed annually until a definitive list of such posts is approved); the CanMEDS framework (or any other similar European framework that identifies and describes the abilities physicians require to effectively meet the health care needs of the people they serve, for that matter) is not applied as regards OM ; Entrustable Professional Activities (EPAs) are not implemented.
As from July 2022, there is a logbook to be used for recording elements of trainee’s training progress throughout the course of specialisation, but there is no assessment of trainees during or at end of the enterprise/organisation practical training; the only assessment at the theoretical training is done by confirmation of adequate attendance at lectures and tutorials in specific medical and paraclinical examinations and by way of assessment of a dissertation; the final exams include only written exams (by use of a multiple choice questionnaire) and oral exams; there is no feedback from trainees regarding the training they received.
Notably, the order of the theoretical and the clinical part of specialisation training in OM is not fixed, so that knowledge, skills, and competencies can progress gradually the new ones being built on the previous ones.
Vacancies are not advertised for posts of specialists in occupational medicine who could become trainers, so that also specialisation training in clinical OM would be provided with proper emphasis on OM aspects, and training coordinators who would be specialists in OM, and senior academic staff in Medical Schools would participate in OM specialisation training, postgraduate training, and contribute to OM undergraduate medical education. This happens because either requests for approval and funding of such posts made by Hospitals or University Departments (placing their requests for OM posts at the bottom of their list of the requested posts) are turned down by the Regional Health Authorities (YPE) of the National Health System (Service) or the General Assembly of Professors of Medical Schools respectively, or because priority requests for creation of such OM posts made by the Ministry of Health, or the Ministry of Education, funded by these Ministries, are nullified, by Hospitals by reallocating funds received for such posts to other specialties allegedly “needed more”, and by Medical Schools, by reallocating funds received for such posts to other specialties after they intentionally not electing any suitable candidate at any professorial grade.
Moreover, there is inadequate transparency, in regard of criteria with respect to selection of Training Centers. At present, there is no Committee of Occupational Medicine at the Central Health Council of the Ministry of Health to select enterprises suitable for practical training and the criteria specified by the Ministerial Decision of June 2022 for such selection are too few. No regular Quality Management within institutions providing OM specialisation training, i.e., OM Training Centres or OM Services of enterprises, in accordance with the relevant UEMS guidance, is used as a feedback instrument for quality improvement.
The aforementioned situation pertaining to specialisation training in OM, in the present economic and organisational circumstances cannot be reversed and UEMS ETRs for occupational medicine will not really be fully implemented in Greece, unless many changes propelled by strong political will and guided by expert’s advice take place simultaneously with a multisectoral holistic approach.
There is very little OM taught to undergraduate medical students. In 2021 and 2022, occupational medicine was not taught to undergraduate medical students as a separate unit course or module. In two of the smaller Schools was taught as an “elective” unit course, in the smallest School as a compulsory unit course, and in four of them only in a fragmented, deficient uncoordinated way, usually by physicians holding specialties other than occupational medicine, as part of other unit courses. The extent and quality of teaching of occupational medicine in other study unit courses is currently unknown and almost impossible to assess.
A survey (with a 100% response rate) carried out in the period April to June 2022, in all seven Greek Medical Schools, revealed that in the academic year 2021-2022, only 5.6% of Greek medical students graduating that year would have received training in occupational medicine. This may partly account for the fact that very few medical graduates (and fewer every year) choose to specialise in occupational medicine, and possibly also for the fact that very few cases of diseases are suspected to be of occupational origin by physicians holding specialties other than OM, in Greece.
respect to measures that must be taken to protect the physical and the mental health of employees.
These duties have recently been expanded as to include prevention, diagnosis, management and mitigation of psychosocial problems at work, including bullying and harassment and sexual harassment (see paragraph 11).
establish it), whenever the above is not stipulated by law. The OPs take care of the execution of medical examinations and of the measurements of hazardous agents of the working environment in conformity with specific laws
and regulations applicable in each case. The OPs assess the medical fitness of workers to work for specific posts, evaluate and register the examination results, issues certificates concerning the above assessments and
communicates them to the employer. The content of these certificates must secure medical confidentiality.
about the examination results and evaluate them.
Health Risk Book”. The OPs also keep securely the medical files of employees exposed to certain noxious (hazardous) agents. These employees must have certain medical examinations and tests in relation to their occupational exposure by law, whilst medical confidentiality must be kept at all times.
and written occupational health risks assessments of all parts of his/her enterprise.
The OP and the Safety Officer of an enterprise are obliged to collaborate between themselves and also with the Occupational Health and Safety Committee of the enterprise, where such Committee has been established.
Not all Occupational Physicians carry out all the tasks mentioned above, which are provided for by law. The extent to which their responsibilities are dispensed varies, depending on the size, prosperity, management and occupational health and safety culture of each enterprise. As primary health care is not properly and fully developed in Greece (e.g. there are not enough Family Doctors – the equivalent of “General Practitioners” in the UK), occupational physicians perform certain primary health care duties, partly substituting for family doctors. Specialists in OM, for the purpose of diagnosing (or excluding) an occupational disease, or for assessing medical fitness to work, may refer a worker for certain laboratory tests, only for the purpose of initial diagnosis (according to a very recent Ministerial Decree). By contrast, several employers expect the OP to regularly prescribe medicines and make referrals for tests, as if he were the family physician of a worker. Also, not many occupational physicians carry out written assessments of occupational health risks or initial occupational hygiene measurements. OPs do the best they can, within the limitations imposed on them by the lack of preventive culture, the scarcity of appropriate laboratory facilities, the low status of occupational medicine in relation to other medical specialties, and the current economic crisis in Greece.
There is no structured career for occupational physicians. Process protocols for use in occupational health practice by occupational physicians have very recently been introduced, following the work of a Scientific Committee of the Hellenic Society of Occupational and Environmental Health (HSOEH) and are now implemented in a few private and public enterprises and organizations. Extension of their application in enterprises all over Greece proceeds at a slow pace. There are very few nurses
collaborating with occupational physicians in private or public enterprises and organizations. There is no recognized specialty of occupational health nursing. In many enterprises secretarial, logistical and other necessary support to the work of
the OP is inadequate, or appropriate enterprise surgery premises (and also facilities and equipment) may be absent. There are still not enough laboratories for measuring or testing agents related to occupational hazards. Among the few major such laboratories is the Laboratory of the Hellenic Institute for Occupational Health and Safety (“EL.IN.Y.A.E.”). In recent years, “External (i.e. not in-house) Protection and Prevention Services” private occupational health and safety companies [EXYPP], have increased their capacities for measuring various noxious agents in the workplace.
The Ministry of Labour, Welfare, and Social Insurance on the 13th of September 2021 started operating the “ERGANI “Information System. By law No. 4808/2021, all employers must register with “ERGANI” platform (information system) and implement an electronic system of registration of working hours of their employees, which shall be real-time connected to it. Specifically, by using the Digital Employment Card, the start and end of the daily work, the duration of break, and any extra hours over the working schedule are, in real-time, registered in the ERGANI platform.
Occupational physicians (OPs) providing services to private or public enterprises and organizations also must register and use such card. Their registration ensured that henceforth no OP could be recorded as offering services to different companies or organisations at the same time, on the same day. This was also checked in the past by the employer who had to announce to the KE.P.E.K. the days of the week and the times on those days that the OP would be providing services at an enterprise, so that a Health Inspector could confirm the OPs presence in the company premises, by visiting the company himself/herself). Their registration also ensured that no OP could register himself/herself as providing occupational medicine services to companies for an inordinate number of hours in total, within a five-days long working. week (possibly allegedly working longer than seven days a week, and at night).
A drawback of OPs having to use this card is that they face being fined (“automatically” by “ERGANI”), if they are even a few minutes late in arriving at their workplace. Most OPs in Greece work on a part time or sessional basis. Consequently, on account of the digital card being used by them on checking in, their arriving a few minutes late at the firm where they provide OM services, could actually result in them having to pay a fine, regardless of the reason for being a little late (e.g., a medical or occupational health risk emergency in another firm where they had been providing services on the same day before arriving late to the next firm). This issue is being addressed with the aim of hopefully being successfully resolved soon.
On the whole, occupational physicians (OPs) contributed significantly to the effort of controlling the pandemic in the workplace, both in private and public enterprises and organizations, spearheading or collaborating in related preventive, advisory, management, educational and clinical activities. However, Greek Laws and Executive orders related to COVID-19, very rarely made reference to OPs:
For example, in Law 4722/15-92020, pertaining only to the Civil Service, concerning confirmation of grounds for obligatory remunerated leave of absence and staying at home, on an exceptionally basis, it was stipulated that, in the following document submitted and signed by the Department Head to that end “it must be confirmed and co-signed either by the Insurance Controller Physician, or the occupational physician, or any other physician available in the Department/Service in question that (a) the employee belongs to a vulnerable high risk group and that this special leave of absence is justified on grounds of limited spaciousness [at its workplace] and high density of working people in it, and (b) whether he has any other skills , on account of his work experience, which enable him to perform other duties and (c) [whether there are] working conditions securing his safety and health at work in alternative work post(s)”.
Work of OPs expanded as to cover occupational health issues being covered by all the new EC Directives, which were adopted by Greek Law: For example: a Presidential Decree (102/2020) pertaining to Biological Agents was issued to harmonise Greek National Law to EC Directives 2019/1833/EE and 2020/739/EE.
Greece had complied the European Commission Recommendation for Member States to adopt its schedule of occupational diseases (no. 2003/670/EC, of 19.9.2003), which did not include criteria for diagnosing them, by incorporating into a Presidential Decree, in which no criteria for diagnosing them are mentioned. The aforementioned Recommendation was updated (No. 2337/28.11.2022) and expanded as to recognise and include COVID-19 as an occupational disease (Annex, item 408) including criteria for diagnosing it (“COVID-19 caused by work in disease prevention, in health and social care and in domestic assistance, or, in a pandemic context, in sectors where there is an outbreak in activities in which a risk of infection has been proven”). However, Greece has not incorporated this updated Recommendation in its national Law or Regulations i.e., in its National Schedule of Occupational Diseases yet, either with or without diagnostic criteria.
Cases of occupational diseases are diagnosed by occupational physicians. However, their number is unknown, and only rarely recorded in specific epidemiologic studies to date.
Hardly any cases of diagnosed occupational diseases have been reported to date by employers (who should report them, according to law, following diagnoses by enterprise/organisation occupational physicians) to the Regional Centres for the Prevention of Occupational health and Safety Risks (“KE.P.E.K.”) which should record them, according to law, from 2009 to 2015. According to data given by the Directorate for Planning and Coordination of the Safety and Health at Work Inspectorate of the Independent Authority “Labour Inspectorate”, since 2016 the number of confirmed i.e. diagnosed, reported to and officially recorded at “KE.P.E.K” cases of occupational diseases amounted per year to 1 in 2016, 2 in 2017, 1 in 2018, 0 in 2019, 1 in 2020, 0 in 2021, 0 in 2022 (up until 14.11.2022). The employer is responsible, according to law, for reporting such cases, following diagnosis by occupational physicians. More often than not, appropriate past or current measurements and testing of noxious occupational agents are not available to enterprise OPs, to enable them to diagnose, beyond any reasonable doubt, whether a disease is occupational or not. No sufficient occupational history of patients is taken or recorded in clinical departments in hospitals. Collaboration between occupational physicians and physicians holding other specialties treating sick workers is scarce. In this connection, it is noted that most physicians have received hardly any training during their undergraduate studies.
Another contributory factor for non-diagnosis is probably that many Greek occupational physicians might not have dealt with enough cases of occupational diseases during their specialization training.
Reporting of occupational diseases (which are preventable for the most part) would reveal the financial burden imposed by them on the national insurance budget and contribute to effective and targeted planning for their prevention.
To understand the reasons why occupational diseases are underreported in Greece, the following information is necessary:
In Greece, a sickness benefit is the basic benefit provided to State insured persons who – due to physical or mental illness – are unable to work temporarily or are absent from work for more than three days.
Work accidents and occupational diseases are not covered by a separate branch of State insurance. Illness and temporary loss of working capacity come under the health insurance scheme, while invalidity and death are subject to the relevant pension insurance provisions.
As regards work accidents: Work accident: if one is a salaried employee, one comes under the e-EFKA insurance scheme (e- Unified [National] Social Security Fund) and is the victim of an accident that either took place during work or in relation to work, or while travelling to or from work, then one is entitled to the benefits in kind and in cash which are provided in the event of a work accident. In the event of a work accident, one is entitled to cash benefits and benefits in kind regardless of the length of insurance coverage. In other words, it is sufficient to have one day of insurance.
As regards occupational diseases: if one is directly insured or a pensioner and suffers from a chronic illness related to the hazards of one’s job, which occurred after a certain time period, then one is entitled to the benefits provided in the event of occupational disease. In the event of occupational disease, no minimum insurance period is required.
Benefits in kind: in the event of temporary loss of working capacity, one is entitled to the same benefits in kind (medical care, hospital care and hospitalisation) as those provided in the framework of general healthcare benefits, i.e. in benefits one is entitled for incapacity on account of any illness or kind of accident.
Benefits in cash: one is entitled to a benefit that is paid from the first day that the accident is reported; the amount is calculated in the same way as the ordinary illness benefit is calculated. The benefit is provided for the same time period as the illness benefit.
It must be pointed out that, cases of occupational diseases and work accidents, in terms of insurance benefits, their magnitude, and prerequisites for granting them, are exactly the same, in accordance with Article 34 of Mandatory Law 1846/1951 on “Social Insurance” (published in Government Gazette 179/14/A/21-6-1951), which is still in force. Occupational diseases are those which are included in the Ministerial Decision of 16.1.1979 “Updated Article 40 of Diseases Regulations of the [State] National Insurance Scheme (Organisation) – I.K.A.” (published in Government Gazette 132/B/12-21979). This Ministerial Decree is the only provision of law where the necessary criteria for diagnosing occupational diseases are stipulated. The National Schedule, in which the Schedule of Occupational Diseases, presented in the EC Recommendation regarding a Schedule of Occupational Diseases (of 2003 and – the Updated one – of 2022) has never been used in court cases or for diagnosing cases of occupational diseases or for reporting them, as it does not mention any diagnostic criteria.
Definite diagnosis of occupational diseases is pursued by workers only when they wish to claim disability pension. If they do so, a Committee of the Centre for Certifying Disability (KE.P.A.) of the National Insurance Administration [I.KA.] (as of 1.1.2017 incorporated into the Unified [National] Social Security Fund [EFKA]) examines the worker who claims it and may disagree with the diagnosis and prognosis of the enterprise OP. As regards workers compensation for occupational injury, the law of tort exists in Greece. Thus, in some circumstances employer and employee might agree on non- reporting a case of an occupational disease. This may happen when the employer benefits the worker (in certain instances, possibly also at the workers’ suggestion) by permanently and unnecessarily assigning unduly lighter or restricted duties to him after he recovers and returns to work (following absence owing to a diagnosed occupational disease, which, however is not reported to a KE.P.E.K.) as such. A worker may also consider how costly and time consuming would be for him/her to take the employer to court, to prove, in the first instance that the disease he suffers is occupational. In almost all cases, the definitive diagnosis, of an occupational disease is decided in court, following testimonies of several experts, including occupational physicians. At the same time, the employer does not appear to admit to wilful negligence or wilful misconduct, i.e. he does not risk to be shown to have been wilfully negligent in his duty to provide a healthy and safe working environment. Thus, he avoids having the case of an occupational disease taken by the worker to court claiming civil, compensatory damages (which might include claims also for mental anguish), or to be taken to a penal court for criminal negligence. Another counterincentive for the employer to report a diagnosed a case of occupational disease, diagnosed by the enterprise occupational physician, is that if it proven in court that the disease was caused on account of his wilful misconduct, he will have to pay, in accordance to law, a compensation not only to the worker who suffered from that disease, but also pay the Social Insurance Fund all the expenditure incurred by it with respect to the treatment of the worker and his absence from work (and in the event of his death owing to his being afflicted by an occupational disease, money to his relatives who are entitled to it by law).
In brief, in view of the above, the employer, almost in most instances, opts for not reporting cases of occupational diseases. Hence, occupational diseases are diagnosed as “common” diseases, i.e., not diseases caused by work.
This may, however, delay remedial, preventive measures which ought to be taken by the employer to make work healthier. In Greece, there is not a separate, specific public “Insurance Fund against Occupational Health Risk”, (into which each employer would pay in premiums, the magnitude of which would depend on his firm’s occupational health and safety risk record) which would cover health care and disability pension of workers afflicted by an occupational disease or work accident, as appropriately. Discussions to plan the creation of such a Fund have recently started at the Ministry of Labour, but it is impossible to predict whether and when they might bear fruit.
In Greece, the term “Occupational Physician” (OP) is used to signify a specialist in occupational medicine. However, it is used also as a job title for physicians who are not necessarily specialists in occupational medicine; i.e. they may be specialists in
other medical specialties providing certain OM services as best as they can. This anomaly allowed by law has been rectified for the most part by law amendment, following action taken also by the Hellenic Society of Occupational and
Environmental Health (HSOEH), but it is still partly accepted and allowed by law (even though, by and large, priority must be given by law to specialists in OM when an employer is seeking an OP):
There are no specialists in occupational medicine employed as Labour Health Inspectors and there have not been any for many years. Labour Health Inspectors are usually dentists, chemists, physicians holding specialties other than occupational medicine. Their number is still disproportionately small in relation to the one needed. It is envisaged that it may increase in the foreseeable future.
There is no legal obligation for private companies to advertise a post for an occupational physician.
The responsibilities of occupational physicians working in enterprises (either in the public or in the private sector of the economy) are provided for by law. However, it may be further specified in their contracts of work, which may vary between
enterprises. Some of these contracts, in certain private or public enterprises and organizations, may not be adequate or even appropriate for a physician, insofar as they may not promote the provision of high-quality OM services. A case in point are posts for OPs offered to the applicant who claims or accepts the lowest remuneration.
Furthermore, none of the Health Work Inspectors of the Ministry of Labour is a specialist in OM (as there is no relevant legal provision for it). These Inspectors are either physicians holding specialties other than OM, or are other health professionals, e.g. chemists. They merely attend a six months long course in occupational health and safety, before they start exercising their duties. Consequently, a paradox occurs: Whenever an enterprise OP makes a written recommendation recorded in the official register “Book of Written Recommendations by the OP” (held, according to law, in every enterprise) and the employer decides not to conform with it, the Health Work Inspector of the Ministry of Labour (as of 1.2.2023 Independent Authority “Labour Inspectorate”, established by Law 4808 of 19 June 2021) must arbitrate, even though, he is much less of an expert than the specialist in OM, who has made the recommendation to the employer.
Communicating the value of OEM, to employers, educators, workers, and physicians is inadequate. There have been hardly any Congresses on OM in Greece, and very few papers reporting on studies on OM subjects are published in medical journals or presented at Medical Congresses (as compared with the number of papers on subjects of other specialties). On a positive note, the Hellenic Society of Occupational and Environmental Medicine publishes a peer reviewed scientific
journal of occupational medicine. The [bi-partite – established by the Employers and the Employees Associations] Hellenic Institute for Occupational Health and Safety (“EL.IN.Y.A.E.”) publishes a professional journal addressed to employers, managers employees, and all occupational health and safety professionals, including occupational physicians.
There is inadequate collaboration between the Ministries of 1. Health, 2. Labour, and 3. Education, on occupational medicine and occupational health matters. There is virtually no education on issues of occupational workplace hazards and protection against them in primary and in general secondary education. The economic advantages and value of OM cannot be appreciated sufficiently by many employers during the economic crisis and the COVID-19 pandemic that followed, plaguing Greece. Generally, public opinion does not recognize that OM is a high priority, or that OPs have the same standing as physicians holding other clinical medical specialties. It is noted that OM was recognized and established as a medical specialty in Greece, in 1987.
The main issues are:
Tackling these issues is a challenge, whilst unemployment rate is at 11% and Greece has many infrastructural, manpower (e.g. currently, shortage of staff teaching OM and of Labour Health Inspectors who are specialists in OM) and economic difficulties to overcome.
Dr Theodore Bazas, MD, MSc(London), PhD, FFOM(RCP, London), DIH(Engl)
Specialist in Occupational Medicine (JCHMT, UK),
Delegate of Greece to the UEMS Section on Occupational Medicine nominated by the Panhellenic Medical Association,
Current Member (and former Vice-President) of the Hellenic Society of Occupational and Environmental Medicine,
Athens, Greece, 8 March 2023
Hungarian occupational medicine roots in ancient organisational (mine hospitals, railway physician system) and professional (M. Huszár, L. Markusovszky, J. Fodor, I. Tóth, V. Friedrich) traditions. In 1946, amid the hunger and dire humanitarian, social and financial situation that followed the WWII, physicians laid down the fundamental structures of occupational health by organising occupational medical care for workers in order to promote their health (foundation of the Hungarian Scientific Society for Occupational Health and Medicine). Hungary was the 3rd European country to ratify ILO C161. Industrial medicine that had significant curative roles was predominant in the era of state owned companies until 1994. Modernised prevention focused approach emerged after the privatisation. Occupational safety and health legislation was among the first that was harmonised with the European Union law.
Total: 9,938 thousand; active: 4,511 thousand
No. of doctors: 34,736; No. of occupational physicians 2,340
No. of doctors in occupational medical services: full-time: 951; part-time: 1,735
Accident insurance system is not introduced to occupational safety and health. Provision of occupational medical care to employees is mandatory for employers (but not for self-employed). Compliance is predominantly achieved by direct contracting with external (private, for-profit) medical services. Employers may provide the service themselves by employing the required health care professionals (internal service). Necessary material and human resources are strictly set in the legislation. Regional occupational medical centres provide second level care. The third level of the Hungarian occupational medical system is in the Occupational Health Department of the National Labour Office (formerly OMFI).
Occupational medicine is available as main specialisation after graduating at the medical faculty. It takes two years of foundation programme (emergency medicine, internal medicine, occupational medicine of various sectors) run by a university, and two years work at an accredited occupational medical service, under specialist supervision.
Occupational medicine used to be available as secondary specialisation between 1996 and 2008. Several occupational physicians acquired their specialisation that way.
Subsidiary specialisation to occupational medicine is occupational hygiene.
There is no credit system in the postgraduate training.
Specialists must participate in continuing medical education (five year cycles).
The occupational medical service is the primary consultant for employees and employers concerning health at work. Duties include: informing workers, carrying out fitness-for-job and health surveillance examinations, investigation and reporting of occupational diseases, surveillance of the working environment, giving advice on personal protective equipment, chemical safety, administering vaccination to workers, preventative care of chronically ill workers, examination of professional drivers. Furthermore, the service participates in risk identification and management, the organisation of workplace first aid, occupational rehabilitation, the setting up of the company emergency rescue plan.
Magyar Üzemegészségügyi Tudományos Társaság (MÜTT)
Hungarian Scientific Society for Occupational Health and Medicine
The Society is the only Hungarian professional association that consists solely of occupational physicians and nurses. It aims to defend the interest of occupational medicine by informing and discussing with stakeholders and decision makers, and providing networking opportunities for the membership. The annual conference is taking place in autumn.
Address:
Nagyvárad tér 2.
Budapest
H-1097
EU
Postal address:
Pf. 67.
Budapest
H-1507
EU
Telephone/fax: int+36-1-216 6942
E-mail: mutt@omfi.hu
The origins of Occupational Medicine in Italy date back to the publication of “De Morbis Artificum Diatriba”, the first comprehensive treatise on the diseases of workers written by Bernardino Ramazzini in 1700. However, the modern era of Occupational Medicine in Italy officially began on 12th October 1929 when the Italian Society of Occupational Medicine – Europe’s oldest and largest Association of this kind – was set up during the eighth national Occupational Health Congress held in Naples. Although this Society was officially founded in 1929, we should not forget that the first national Congress of Occupational Health took place in Palermo as early as 1907.
The first President of the Italian Society of Occupational Medicine was Luigi Devoto who also founded the Milan “Work Clinic” on 20th March 1910. This institution was the first clinic in the world that was specifically designed to study health and disease in the workplace.
In the 1970s, the Italian Society of Occupational Medicine changed its name to the Italian Society of Occupational Medicine and Industrial Hygiene.
Italy has a population of 59.4 million inhabitants. The active working population is about 22.7 million, comprising 56.4 % of the total population. There are approx. 330,000 doctors in Italy and approx. 10,000 occupational physicians. Currently, the Italian Society of Occupational Medicine and Industrial Hygiene has approx. 2,000 members.
In Italy, employers and companies can engage freelance occupational physicians or enter into a contract with a private occupational health centre.
In the Schools of Medicine in Italy, Occupational Medicine is taught as a separate, mandatory subject.
In order to become an occupational physician and practise this profession in Italy, medical graduates must undergo a 5-year postgraduate training course that consists of practical and theoretical training in the health care of workers, risk assessment and management, industrial hygiene, epidemiology and statistics, industrial toxicology and health promotion. At the end of this postgraduate training period, to obtain a specialization in occupational medicine, trainee physicians must present and discuss a scientific thesis.
Furthermore, in compliance with laws 502/1992 and 229/1999, occupational physicians must complete their Continuing Medical Education (Credits System) obligations in order to be enrolled on the national register of occupational physicians.
The specific tasks of the Italian Society of Occupational Medicine and Industrial Hygiene are (i) to contribute to the advancement, development and dissemination of knowledge in the field of Occupational Medicine and Industrial Hygiene, (ii) to promote, encourage, inspire and support the implementation of measures aimed at the diagnosis and prevention of occupational accidents and diseases, (iii) to contribute to informing, training and updating occupational physicians. These objectives are mainly achieved through the development, implementation and evaluation of specific guidelines and the promotion of annual training programs (Continuing Medical Education).
The Italian Society of Occupational Medicine and Industrial Hygiene (http://www.simlii.it/)
President: Prof. Francesco Saverio Violante
Contacts:
SIMLII secretariat- c/o Meneghini & Associati srl
Viale Trento, 56/f – 36100 Vicenza
Phone +39-0444-578845
Mobile +39-348-6430909
Fax +39-0444-320321
e-mail: events@meneghinieassociati.it
president of association Maija Eglite, professor, Dr. habil. med.
e-mail: Maija.Eglite@rsu.lv
Information is to come
The ALSAT (Association Luxembourgeoise de Santé au Travail) was founded in 1996 and is a member of the AMMMD (Association des médecins et médecins dentistes). Occupational health was introduced in 1994 and the occupational health services started their work in January 1995.
By law, every private company has to organize occupational health for all their employees and there are 3 possibilities to fulfill this obligation:
The public sector has a different regulation for occupational health and its own occupational health service .
Luxembourg has a population of 500 000. The active working population is approximately 320 000 in the private sector and 27 600 in the public sector. The active population is high because of a large part of workers from our neighbor countries.
Actually there are 4 in-house occupational services, 3 sector-organized services and the STM for the private sector and one service for public employees.
The law requires an occupational health physician for 5000 workers. Or actually all the services occupy only 55 occupational health physicians.
The training for occupational health physicians took place in the Universities of our Neighbor countries mostly in Belgium and Germany.
You have the possibilities to become an occupational health physician specialist (4 years training) or to ask after a specific program requiring 450 hours training over 2 years including at least 2 months of practical training in an occupational health service for an authorization to work as an occupational health physician.
In 2012 the Ministry of Health has initiated an audit of occupational health where the following hot topics were issued
Association luxembourgeoise de santé au travail a.s.b.l (ALSAT)
President : Marc Jacoby
Vice president : Nicole Majery
Office :
Rue de Vianden, 29
L-2680 Luxembourg
Information is to come
History
1659 – The mining industry physician – ”Berg Medicus”
1893 – First legislation for workers’ protection. Focus on child labour.
1910 – and onwards – increasing concern in social factors, working conditions and health
1946- Outpatient clinic at the National Hospital in Norway. Organized by the Norwegian Labour Inspection Authority.
1960s and onwards- Out-patient clinic at the National Institute of Occupational Health (STAMI)
1978- Department of Occupational Medicine at the Regional Hospital in Telemark, localised in a primary industrial area.
1990-1995- Departments of Occupational Medicine established at six regional hospitals in Norway
1917: Industrial physician promotes preventive health care
1943: 40 OHS in factories
1945: OHS organised in cooperation between Medical association, Trade Unions and
Employers organisation.
1977: New Working Environment Act.
1979: OHS 3.300 enterprises with 450.000 employees covered by OHS.
1990: New Act defining enterprises that should have compulsory OHS.
2010: Extension of the Act of 1990.
2010: Compulsory approval for all OHS
Occupational Health Personnel both employed by the individual company and in independent enterprises offering OHS.
5,0 million
Workforce approx. 2,5 mill.
Nearly 28.000 in total
447 members of the combined Association and Society of Occupational Medicine
281 approved specialists of Occupational Medicine
Postgraduate training of Occupational Medicine Specialists lasts five years. At least one year in OHS or in a Department of Occupational Medicine. Comprehensive program of supervision and theoretical training is mandatory.
No compulsory program for continuing medical education.
Health Prevention based on Knowledge of Occupational Medicine in a Global Perspective
Strengthen the education in Occupational Medicine at the Universities
Strengthen Occupational Medicine – improve the physicians’ position in OHS
OCCUPATIONAL MEDICINE IN POLAND
History
Polish Society of Occupational Medicine (PTMP) was set up in 1969 and it gathers about 2000 members, mainly physicians specialized in occupational medicine. It is supported regionally by a group structure arranged in geographical regions. The main goals of the Society are:
Main data
Poland has a population of 38.5 million people of which 24.2 million are in the working age (15-64). The active working population is approx. 16 million people.
From a legal point of view, the main stakeholders for health and safety at work in Poland are:
According to the Polish legislation, every employment must be preceded by the performance of a compulsory medical examination. Following such an examination, a certified physician issues a certificate, which states whether or not there are any contraindications for one to perform work at a particular post. This rule applies to all workers and workplaces, irrespective of the working conditions. The costs of medical examinations are borne by the employers.
There are approx. 6700 physicians entitled to perform employees’ periodical health screening in Poland. Only 48,4% of them are physicians specialized in occupational medicine.
Some of them work in joined occupational medicine services and some of them as self-employed occupational medicine physicians. They can also work in an in-house company service.
Profession
There is a 5-year postgraduate training for occupational medicine physicians (3-year elementary module – common for various specializations and 2-year specialist training). One becomes a specialist in occupational medicine after passing a national exam.
Contact details
Polskie Towarzystwo Medycyny Pracy
ul. sw. Teresy od Dzieciatka Jezus 8
91-348 Lodz, Poland
Occupational Health in Portugal
By the late decade of the century due to social and political events, the first laws regarding conditions at work are published (minimum age, working time, restricted activities)
After the fall of the monarchy in 1910, the new republican regime enacted laws that defined the criteria for repairing work-related diseases and accidents. Up to world war two, private enterprises created their own systems that in some cases also provided assistance for work related accidents by building their own hospitals.
In 1950 a joint Commission of the International Labour Organization and of the World Health Organization establishes the definition of Occupational Health.
In April of 1962 a decree, based upon Recommendation 112 of the ILO, establishes the obligation of Occupational Health Services in the enterprises with the risk of silicosis. A year later a post-graduation course in Occupational Health begins at the Instituto Superior de Higiene (nowadays Instituto Nacional de Saúde – National Institute of Health – INSA) Dr. Ricardo Jorge.
By January of 1967 further decrees are published that enlarge the scope of the Occupational Health Services that are to cover industries that present risks of work-related diseases, but its effectiveness is still limited to those that employ over 200 workers. However its basic concepts remain at the core of the present day regulations.
In 1974, the path for adhesion to the EEC was opened and following it in 1986, the Directives begin to be adopted including the ones that regulate this field
The extension to all fields of activity, apart from the Armed Forces, Polices and Civil Protection Services, is established in 1991 through the adoption of Directive 89/391/EEC.
In 2009 a new Law has been enacted, which includes the adoption of several Directives. In this Law it is specified that the Occupational Health physician must have a graduation in this area and be registered in the respective College of the Portuguese Medical Association (Ordem dos Médicos). It is also recognized as legal practitioners in this field those doctors that fulfil some criteria specified in the law, but actually either they are about to cease its activities due to ageing or its practice is limited to the duration of its post-graduation process.
The College of Occupational Health was established in 1978 and currently has around 900 members.
After the creation of the National Health Service, post-graduation in the different specialities have mainly been provided through internships of 4 or 5 years. Although the proposal for an internship in Occupational Health has already been delivered to the proper authorities in early 2008 to replace the current transitional plan, unfortunately this is still the process that was adopted in 2002.
Further information. Document from dr Pedro Reis
Total 10.341.330 (as of 31 Dec 2015)
Workforce 5 182.000 (as of 1st T 2017)
50.927 medical doctors
1014 specialists in Occupational Medicine
Occupational Health Services are mainly provided either by internal (civil services or major enterprises) or external (outsource) services. Although the law also admits the possibility of common services, this form of provision is seldom exploited
The internship requires practical and theoretical modules, distributed through 4 years, in a major Hospital with an OHS, as well as specialized organisms that deals with Occupational Health, in particular Labour Inspectorates (ACT) and the one in charge for the recognition of OD (DPRP-ISS). A final exam concludes the evaluation process.
CONTINOUS MEDICAL EDUCATION:
No credit system has been implemented as the Portuguese Medical Association defends a method of evaluation based upon Careers with a continuous process throughout the active life of medical doctors.
Colégio de Medicina do Trabalho – Ordem dos Médicos
Rua Delfim Maia, 405, 4200-256 Porto
TLF: (351) 225070180
FAX: (351) 225070179
TM: (351) 935570107
antonio.pinheiro@nortemedico.pt
Ferreira Leal, MD – President of the College
TM: (351) 961748197
Pedro Gustavo Reis, MD – Representative in UEMS
TM. (351) 965 059 968
Presentation from The Portuguese Medical Association at the meeting i Lisboa october 2009
History
Organisation
Population : Republic of Ireland 4.2 Million /Northern Ireland 1.8 Million (Faculty is all Ireland)
Workforce: 1,8 mill
Doctors : 8,000 Republic of Ireland
Occ Physicians :86 full-time Occupational Physicians, app. 250 part time non specialists GPs with an interest in Occupational Medicine
Three Bodies :
Nature of Occupational Health Services
Roughly 50% of Full Time Occupational Physicians are in the public sector and 50% are in the private sector. Large public sector organisations like the Civil Service, Health Service, Police (“Garda Siochana”) , Postal Service and Transport Service have inhouse ocupational halth services. Private sector organisations have either inhouse or outsourced occupational health services.
There are also approximately 25-30 doctors employed by the Department of Social Protection who work in disability assessment medicine.
Periodic medicals for all workers (like in France etc) are not a feature of Irish Occupational Health Services. Periodic health surveillance for noise exposure / hand-arm vibration etc & immunisation against biological hazards are required on a statutory basis.
Professional Training
Hot Topics
New Medical Practitioners Act requires all doctors to undergo compulsory CME and Audit, 360 degree feedback may be introduced at a later date. Doctors who are not involved in specialist training or who are not on a specialist registrar are required to “align” themselves with a specialist training body who will provide non-specialist competance assurance for their area(s) of work. This will be a major body of work for the Faculty going foward with limited financial and doctor resources, all of whom are unpaid “volunteers”.
Weblinks
www.rcpi.ie/Faculties/Pages/FacultyofOccupationalMedicine.aspx
During 1963 and 1967 the Dispensaries of occupational medicine were founded to take preventive and active heath care for all the workers in Slovenia.
On 9th September 1971 the Clinical Institute of Occupational Medicine in Ljubljana was founded.
POPULATION OF SLOVENIA
NATURE OF OCCUPATIONAL HEALTH SERVICES
TASKS
HOT TOPICS
Total: 5 412 254
Active: 2 056 656
All: 20578 Specialists of occupational medicine: 127
Non governmental health facilities
Private practice
Public health centres (advice and state health inspection)
Postgraduate training for a doctors is possible in 4 specialization/subspecialization:
Continuing Medical Education is required to be licensed by the Slovak Medical Chamber.
HOT TOPICS
Occupational health-prevention of professional and work related diseases, health promotion
Professional diseases
Occupational Health Services
TASKS
Slovenská spolocnos‘ pracovného lekárstva SLS – SLOVAK ASSOCIATION OF OCCUPATIONAL MEDICINE
Address:
Rastislavova str. 43
04190 Košice
Slovakia
Contact person: marek.varga@upjs.sk
HISTORY
1900 First law legislating work accidents. This law originated the development of a treatment and compensation system for workers.
1955 Occupational Medicine officially recognised as a medical specialty.
1956 Spanish Society of Occupational Health and Safety at Work founded as a federation of regional societies.
1989 Access to 3 year formal training in OM through national examination.
2005 Four year Specialist Training Scheme in Occupational Medicine established.
ORGANISATION
Total population: 46.072.834
Active population: 23.122.300
Registered doctors: 219.031 (476 doctors / 100.000 inhabitants)
Occupational Physicians: 10.500 doctors with title of specialist in OM (5.500 doctors actually working in OM (estimated))
NATURE OF OCCUPATIONAL HEALTH SERVICES
Outsourced OHS: most medium and small sized enterprises (a very high number of private companies in Spain are medium or small) and many large companies.
TRAINING
TASKS / TASK DISTRIBUTION
– Communication between the two systems of social security (occupational and not occupational) and the preventive system (OHS).
– Occupational diseases.
– Changes in legislation.
– Concern about the position and the future of the specialty.
ASSOCIATION AND WEBLINKS
SOCIEDAD ESPAÑOLA DE MEDICINA Y SEGURIDAD DEL TRABAJO (SEMST)
Spanish Society of Medicine and Safety at Work is a federation of 12 regional societies with an autonomous regional scope and a total of over 3000 professionals associated.
Address: C/ Santa Isabel, 51. 28012 Madrid. Tel 91 792 13 65. (Fax 91 500 20 75)
Website: http://www.semst.org
President: Pilar Niño Garcia
SOCIETAT CATALANA DE SALUT LABORAL (SCSL)
Catalan Society of Occupational Health is the biggest of the 12 regional societies with 800 professionals associated.
Address: Carrer Major de Can Caralleu 1-7. 08017 Barcelona. Tel: 93 203 27 97 (Fax: 93 203 14 85)
Website:http://webs.academia.cat/
President: Elisabeth Purtí Pujals
Contact person: Mari Cruz Rodríguez Jareño (scsl@academia.cat )
Information is to come
History
The legal regulation for occupational health goes back as far as to 1864, as the first Swiss “Kanton”, Glarus, put the “Fabrikgesetz” into force, it limited the daily maximum working time to 12h maximum. 1878 Switzerland introduced a common federal legislation on matters of working time and liability of the employer in case of an work accident or an occupational disease. After the first world war, the law about diseases and accidents was introduced and a federal insurance fund was created which was competent for industrial working places.
There have been chairs for Occupational Medicine at several universities in the second half of the last century (Geneva, Lausanne, Zürich) with some brilliant and international connected leaders, Prof. Etienne Grandjean for example. But it Occupational Medicine was only a sub-specialty until 1996, the year when Switzerland adopted a legislation, which adopted most of the legislation of the European Union in Occ. Health and Safety for Switzerland.
Organization
The society of occupational medicine was founded in 1984 and has today about 200 members, half of them specialists. The society is one of the over 70 Medical Associations which form together with the individual members the Swiss Medical Association FMH.
Population: 8,1 Mio, 23,3% with a non-Swiss passport
Number of doctors (without dentists): 31858 (in 2012)
Specialists in OM: 142 (including non active colleagues)
most of them work in medical organizations which give service to more than one company or in institutions (insurance, university of LS). There is a growing number of Occ. Physicians who work full or part time as freelancers in Occupational Medicine.
Nature of service
Employers are obliged to seek professional advice if the have special risks in their organization. Professional advice may com from a technical safety person, an industrial hygienist or an occupational physician. The ideal would be a multidisciplinary team, but this is mostly not the case, so safety experts dominate the business.
There is no obligation for continuous service, for example depending on the risk classification of the company or the headcount or both. Only a very limited number of companies (pharmacy, railway, chemistry) have their own medical service. There has been a tendency for outsourcing in the 90ies and at the start of the century.
Profession
The postgraduate training in OM needs 2½ years training in medicine outside OM and 2½ years training at an recognized postgraduate post. Ever since there has been a limited number of training possibilities, which means a challenge to the society to seek for ways to increase these. To complete the training, a theoretical course in OM must be completed and there is a final exam to be passed, organized by the society.
The Swiss institute for medical training and continuous education has set guidelines for all specialist’s training programs.
E-Logbook, Mini-CEX and DOPS are getting more and more important and are being introduced the coming years.
Professional tasks (depending of the post)
OM Society Website: http://sgarm-ssmt.ch/ (in German and French)
by: Klaus Stadtmüller 10/2013
Prevention – Insurance – Rehabilitation SUVA, Klaus Stadtmueller
OCCUPATIONAL MEDICINE IN UNITED KINGDOM
There are two main bodies for Occupational Medicine in UK:
The Faculty of Occupational Medicine was set up in 1978 to provide a professional and academic body of doctors empowered to develop and maintain high standards of training, competence and professional integrity in occupational medicine. Its objectives are to:
○ act as an authoritative body for consultation in matters of education and public interest concerning occupational medicine
○ promote for the public benefit the advancement of education and knowledge in the field of occupational medicine
○ develop and maintain for the public benefit the good practice of occupational medicine, providing for the protection of people at work by ensuring the highest professional standards of competence and ethical integrity.
The Faculty is a registered charity. Its policies and general direction are determined by the Board, which is elected by the membership. It is supported by committees, working groups and including regional forums. It is also responsible for the publication of Occupational and Environmental Medicine.
The Society is also a registered charity and was founded in 1935 as the Association of Industrial Medical Officers; it changed its name to the Society of Occupational Medicine in 1965. It provides education and support to its members through a national and regional programme of continuing medical education and a quality assured appraisal scheme in support of the requirements for medical revalidation in the UK. It has 1800 members and is open to doctors outside of UK with an interest in occupational medicine as well as nationally. Membership includes general practitioners as well as occupational physicians. It is supported regionally by a group structure arranged in geographical regions.
It has a board, which is elected by the membership determining policies and strategic direct with both national and regional membership.
The Society is concerned with:
○ the protection of the health of people in the workplace
○ the prevention of occupational injuries and disease
○ related environmental issues
SOM is a forum for its membership and aims to stimulate interest, research and education in Occupational Medicine. It has wide-ranging contacts with government departments and professional bodies and responds with the Society’s view to consultative documents and topics of interest and concern affecting the speciality.
POPULATION
According to the National Statistical Authority, the Office for National Statistics, the total population of the UK in 2016 was 65.64 million.
The total working population (the “labour force”) aged 15-64 years, in 2013 was 41.67 million. The official unemployed population in 2013 was 1.36 million.
The current (2019) state pension age, the age at which many people retire, is currently 65 years for men and for women is gradually increasing from 60 to 65 years of age.
The employment rate for older people has increased considerably since 1992 and is now around 7.5% of the total working population as shown in the graph below:
Employment rate for people in the UK aged 65+, March to May 1992 to May to July 2016
MANPOWER OF OCCUPATIONAL PHYSICIANS (OPs)
In 2018, the total number of all licensed physicians was 242,433, with practicing specialists in OM (SOM) or competent in OM (by way of training) 571 (General Medical Council)
There are no official figures but it is believed that the unemployment rate amongst occupational physicians is 0% (Nerys Williams personal communication)
Management of work-related health risks relies on H&S legislation in this country and compliance with it. It is the duty holders statutory responsibility to manage the risks to health caused by/made worse by work. UK has not adopted ILO convention and there is no legal requirement for the provision of occupational health services (OHS) to people who work, unless health surveillance is statutorily required. The law does not stipulate provision of any occupational medicine services to the self- employed working population.
The most recent HSE survey of Occupational Health Provision at Work (1993), suggested that 8% of private sector companies used some form of occupational health support, with manufacturing having the highest usage (14%). However, over two thirds of large employers had access compared to 5% of employers with less than 25 employees. A more recent report of Occupational Health Provision within the NHS (1998) suggested that over 99% of the 425 Trusts in England and Wales had access to occupational health support. Forty per cent were using in-house services, 48% purchasing services from other Trusts and 4% from private sector sources.”
(http://www.hse.gov.uk/research/crr_pdf/2002/crr02445.pdf)
PROFESSIONAL TRAINING AND ASSESSMENT OF SPECIALISTS IN OM
1.SPECIALISATION TRAINING
Specialisation training in OM fully conforms to current existing European Union Legislation EU Directive 2005/36/EU. A physician who has earned a University degree in medicine, after 2 years (3 years for general practice) spent in “basic” specialisation training) may start (“higher”) specialisation training in OM, according to law. This is completed after another four years in training in total, and including following the “Specialist training curriculum for occupational medicine” (FOM, 2017) in a GMC-approved training programme.
The curriculum describes the competencies to be attained by the end of specialists training and the assessment strategy. The requirements include:
Note – The curriculum is currently under review. This review has been mandated by the UK General Medical Council who approve the curriculum and assessments.
ASSESSMENT/EXAMS IN SPECIALISATION TRAINING
Assessment for the acquisition of the title of specialist in occupational medicine is effected, at the training stages specified above by :
Assessment of an MSc Dissertation or equivalent study on an occupational medicine before the end of their final year of training. Oral examinations (vivas) are not conducted as they are not held to be a valid and consistent form of assessment.
Examiners are selected (and trained) as follows:
Examiner selection is via an examiner application and approvals process
Examiner training is via an examiner training session (which is held regularly), examiner auditing and for the clinical exam – a day “shadowing” examiners undertaking OSPE examinations.
Examiners are licensed doctors with at least 2 years experience who have a professional
obligation to keep up-to-date (through continuing professional development (CPD), as part of revalidation).
Examinations are conducted as follows:
Membership of the Faculty of Occupational Medicine part 1 exam – multiple choice paper (single best answer)
Membership of the Faculty of Occupational Medicine part 2 exam – written papers [multiple choice paper questions- single best answer and a modified-essay question paper and OSPE exam [“clinical stations” – 4 on the “short circuit” and 2 on the “long circuit” plus 1 photographic/ occupational hygiene “station”]
Feedback is given:
1 with regards to.training: by trainee supervision and feedback, including an annual review of competence progression (ARCP)
2.Examinations: by results letter (and by response if an initial inquiry/ appeal is raised)
TRAINING DEFICIENCIES REGARDING:
There are small numbers of OM speciality trainees and one of the biggest challenges has been to develop intelligence about the numbers of occupational health professionals currently in practice and to predict future requirements (Reference: The Council for Work and Health (2016). Planning the future: Implications for occupational health; delivery and training).
Occupational medicine is a small speciality and is “shrinking in size and ageing” (Reference: General Medical Council (2018). The state of medical education and practice in the UK. www.gmc-uk.org ).
The Faculty of Occupational Medicine is seeking both:
As part of this latter aim, the Faculty is supporting a project to provide a competency framework and easily accessible and flexible teaching resources in occupational health to medical schools (Reference: Resources for Medical Schools and Medical Students www.fom.ac.uk) .
The Faculty of Occupational Medicine manages specialty training in occupational medicine with the National School of Occupational Health. This includes:
Setting the Part 1 MFOM and Part 2 MFOM examinations and assessments for Specialty Registrars
Approval at end of training and recommendation for specialist registration
Ensuring specialty training in occupational medicine is kept up-to-date with current and best practice
OM PRACTICE
(d) Are occupational health and occupational health risk and protection subjects incorporated into other stages of vocational and general education? No.
(a) Assessing health effects of work, i.e. diagnosing occupational diseases, and exacerbation of non-occupational diseases by occupational factors, (b) performing (or coordinating, or contributing to, or definitively interpreting the results of) occupational health risk assessments in large enterprises, ii. in circumstances where work “exposures” are complex or potentially very unhealthy, and iii. when insuring an enterprise (i.e. the employer) against OH risk (c) assessing and ultimately and definitively give an expert opinion on working people medical fitness to work in circumstances where work “exposures” are complex or potentially very unhealthy or requiring special physical or mental health characteristics, and ii. on return to work after “serious” illness or injury, (where work might possibly affect work performance or health), (d) designing, coordinating, assessing and interpreting the results of occupational epidemiologic studies (such as intervention studies, operational studies to reveal occupational health effects, studies to reveal new occupational health hazards), (e) interpret the sickness absence rates values and patterns, at an enterprise, (f) identifying priorities in annual occupational action plan at an enterprise, (g) contributing to major accidents preparedness and to provision of emergency health care in circumstances arising from major or specific health hazards, (h) having advisory responsibilities, participating in health and safety at work committees work, communicating the value of OM to management and workers, (i) performing workers health surveillance/preventive medical examinations, (k) collaborating with other OH professionals, (l) examining employees on entry to the pension fund of the enterprise .]
DIFFICULTIES AND DEFICIENCIES IN OCCUPATIONAL MEDICINE PRACTICE
STRUCTURAL, ORGANISATIONAL AND OPERATIONAL DEFICIENCIES
ISSUES RELATED TO DIAGNOSING AND REPORTING CASES OF OCCUPATIONAL DISEASES AND MEDICAL FITNESS TO WORK
IS THERE A NATIONAL LIST OF OCCUPATIONAL DISEASES? Yes.
ARE SPECIALISTS IN OM PARTIPATING AS MEMBERS OF WORK RELATED DISABILITY ASSESSMENT PANELS? Yes but not always
IS MEDICAL FITNESS TO WORK ULTIMATELY DECIDED IN COURT BY A JUDGE? /No
None
Undertaken by Society and Faculty of Occupational Medicine and other bodies such as the Council for Work and Health
ARE OPs MEMBERS OF STAFF OF AN ENTERPRISE? Variable. Some are and some are not
HAVE A CONTRACT AS SELF EMPLOYED? Some do
ARE EMPLOYEES OF GROUP OCCUPATIONAL HEALTH COMPANIES? Some are
www.som.org.uk and www.facoccmed.ac.uk
Contact Details
| Society of Occupational Medicine
2 St Andrews Place, Marylebone, London NW1 4LB Web address: www.som.org.uk Tel: 0203 9104531 | Faculty of Occupational Medicine
2 Lovibond Lane, Greenwich, London SE10 9FY Wed address: www.fom.ac.uk Tel: 020 7242 8698 |
Dr. Nerys Williams,
updated feb 2021
Fifth European Assessment in Occupational Medicine
21. October 2024
Domus Medica Europaea, Brussel
8th Croatian congress on occupational medcine with international participation entitled "Occupational Medicine – Coping with the Future
7. November 2024 - 10. November 2024
