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.
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
|Physicians in Austria||
|Specialists of occupational health||
|Full time occupational physicians||
|Full time specialists of occupational health||
NATURE OF OCCUPATIONAL HEALTH SERVICES
Private, companies, outsource
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
Occupational health at universities for medicine
Österreichische Gesellschaft für Arbeitsmedizin
Arbeitsmedizinischer Dienst Linz
T 0043 732 781560-0
Arbeitsmedizin in Österreich VDDWAKTUEL Ausgabe ok tober 2010
F 0043 732 784594
Occupational medicine in Belgium
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.
Population of Belgium
Total: 11.036.000 (2012)
Physicians in Belgium
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
- Collaborating in multidisciplinary prevention
- Medical exams
- Risk assessment
- Work place visits
- Counselling to the employers and employees
- Participation in the dialogue of the social partners
- Research in Occupational Health
- Diagnosis of Occupational Diseases
We have one association of occupational physicians working in Belgium
In Dutch: BBvAG: Belgische Beroepsvereniging voor ArbeidsGeneesheren
In French: APBMT: Association Professionelle Belge des Médecins du Travail
We have two scientific associations:
Flanders: WVVA: Vlaamse Wetenschappelijke Vereniging voor Arbeidsgezondheidskunde
French: SSSTR Societé Scientifique de Santé au Travail
Dr. Simon Bulterys
Information is to come
- 168 full time specialists in Occupational Medicine registered by Health Manpower Registry
- Coverage about 80% of the employed population
- Total population 4,28 million
- Total workforce 1,8 million (employed 1,4 million)
According to Croatian legislation occupational health is covered by compulsory health insurance.
Information is to come
Further information (PDF)
Nature of Occupational Health services
Society of Occupational Medicine of the Czech Medical Association
Occupational medicine in Denmark
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.
Population of Denmark
Workforce 2.800 000
Physicians in Denmark
65 working in the specialty (129 total) Specialists of occupational medicine
Nature of Occupational Health Services
- Public health care (Hospitals)
- Very few in private companies (5-6)
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..
- Diagnosis of Occupational Diseases
- Risk assesment
- Councelling to the employers and employees.
- Research in preventing Occupational disease
- Work related metal diseases
- Ability to work and sickness absence
- Professional diseases
Information is on its way
Occupational Health in Finland
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.
- Prevention and Diagnosis of occupational diseases
- Workplace visits and Risk Assessments
- Counseling to the employers and employees
- Preventive and curative health care of employees, especially related to their work ability
- Prevention and early treatment of mental diseases.
- Sickness absence
- Curative care in occupational health
Association: Finnish Society of Occupational Doctors
Suomen Työterveyslääkäriyhdistys ry
Kalevankatu 11 A, 00100 HELSINKI
Tel: 09 6188 5211
Fax: 09 6188 5260
The Finnish Society of Occupational Phycisians www.stly.fi
OCCUPATIONAL MEDICINE IN GREECE (update JULY 2016)
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.
POPULATION (in 2011)
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
NATURE OF OCCUPATIONAL HEALTH SERVICES
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).
TASKS / TASK DISTRIBUTION
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.
4. HOT TOPICS
- discrepancies between national OSH legislation and the everyday practice
- ethics and independence of occupational medicine on micro and macro levels (finance, politics)
- occupational health for non-organised workers (self-employed)
- aging workforce
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.
Nagyvárad tér 2.
Telephone/fax: int+36-1-216 6942
Occupational Medicine in Italy
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.
Occupational Health Services
- Public Health Care Centres;
- Private Occupational Health Centres;
- Private practice.
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).
- Ability to work and sickness absence;
- Alcoholism and drug addiction and work;
- Atypical jobs and work shift;
- Biological and environmental monitoring;
- Biological risk;
- First aid in the workplaces;
- Health surveillance;
- Musculoskeletal disorders;
- Noise and vibrations;
- Non-ionizing radiation and optic radiation;
- Occupational skin diseases;
- Risk assessment and management;
- Toxicology of organic compounds and metals;
- Transport workers;
- Working hours and sleep disorders;
- Working with VDUs;
- Work-related mental illness;
- Work-related stress.
The Italian Society of Occupational Medicine and Industrial Hygiene (http://www.simlii.it/)
President: Prof. Francesco Saverio Violante
SIMLII secretariat- c/o Meneghini & Associati srl
Viale Trento, 56/f – 36100 Vicenza
Occupational Medicine in Latvia
physicians work in private sector (private medical centres);
15 occupational physicians are working in Occupational medicine center of University Hospital.
362 family doctors have the Certificate of occupational physician and are working part time job in occupational medicine;
president of association Maija Eglite, professor, Dr. habil. med.
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:
- Have an in-house occupational health service ( possible for companies with more than 3000 workers)
- Create an occupational health service for a sector of activities
- Affiliate to the Service the Santé au Travail Multisectoriel (STM) which is a public occupational health service created by law and financed by the companies, asking for his service
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.
- Clinical examinations (pre- employment, risk related health survey, on employers or workers demand, after sickness absence over 6 weeks, employees during pregnancy, for rehabilitation )
- Risk assessment
- Prevention at work
In 2012 the Ministry of Health has initiated an audit of occupational health where the following hot topics were issued
- Lack of occupational health physicians
- Multidisciplinary staff in occupational health
- Mental health issues
- Occupational health in SME’s
- Promotion of collaboration with stakeholders
Association luxembourgeoise de santé au travail a.s.b.l (ALSAT)
President : Marc Jacoby
Vice president : Nicole Majery
Rue de Vianden, 29
Information is to come
One of our main tasks is to develop evidence based practice guidelines in occupational health. In addition to this, NVAB is also involved in the development and implementation of multidisciplinary clinical guidelines for the integration of work-related aspects. Another important issue in NVAB’s quality policy is medical audit. Development and organization of medical audits is a key activity of NVAB’s Centre of Excellence.
- lack of independent position due to priority on the management of absence behaviour
- Too little time spent on prevention
- Companies find other programmes to improve health (without OP)
Occupational Medicine in Norway
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
Nature of occupational Medicine in Norway
Occupational Medicine in Hospitals
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
Occupational Health Services (OHS)
1917: Industrial physician promotes preventive health care
1943: 40 OHS in factories
1945: OHS organised in cooperation between Medical association, Trade Unions and
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.
Population in Norway
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.
- Risk assessment at the workplace
- Counselling to the employers and the employees
- Individual health screening
- Cooperation Agreement regarding a More Inclusive Working Life
- Diagnosis of occupational diseases
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
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:
- enhancement of the scientific basis of occupational medicine and harmful effects of work environment
- co-participation in creating employees’ health prophylaxis strategies
- development of the Society members’ professional and scientific qualifications
- co-participation in designing of the postgraduate training in occupational medicine programs
- development and implementation of evidence-based clinical practice guidelines.
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:
- Ministry of Labour and Social Affairs responsible for issues related to occupational safety and hygiene (including the transposition of the majority of the EU OSH directives).
- The Ministry of Health responsible for issues related to occupational health (medicine) and the monitoring of the occupational medicine service.
- The State Labour Inspection plays a significant surveillance role by checking whether or not the employers fulfil their OSH obligations. The Inspection also conducts awareness-raising campaigns on OSH.
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.
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.
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
POPULATION OF PORTUGAL
Total 10.341.330 (as of 31 Dec 2015)
Workforce 5 182.000 (as of 1st T 2017)
PHYSICIANS IN PORTUGAL(2016)
50.927 medical doctors
1014 specialists in Occupational Medicine
NATURE OF OCCUPATIONAL HEALTH SERVICES
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
Ferreira Leal, MD – President of the College
TM: (351) 961748197
Pedro Gustavo Reis, MD – Representative in UEMS
TM. (351) 965 059 968
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 :
- Faculty of Occupational Medicine (All Ireland& International)
- Irish Society of Occupational Medicine (Republic of Ireland)
- Northern Ireland Society of Occupational Medicine (Northern Ireland)
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.
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”.
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
- Private practice
- Public health care centres
- Postgraduate training takes four years (active health care of workers, epidemiology and statistics, professional diseases, risk assesment, industrial hygienics, heath promotion)
- Continuing Medical Education is required to be licenced by the Medical Chamber of Slovenia.
- Preventive assesments of employees as required by the legislation
- Risk assesment
- Councelling to the employers
- Ability to work and sickness absence
- Professional diseases
- Changes of legislation
OCCUPATIONAL MEDICINE IN SLOVAKIA
- 1932 – first outdoor patient department and few years later clinical department in Prague, Czechoslovakia – prof. Dr. J. Teisinger
- 1949 outdoor patient department and clinical department in Bratislava – prof. Dr. M.Nosáľ
- 1951 – outdoor patient department in Martin, 1956 – clinical department in Martin – Dr. B.Geryk
- 1952 – outdoor patient department in Košice, 1960 – clinical department in Košice – assoc. Prof. Dr. B.Gomboš
- 1953 – Research Institute of Occupational Hygiene and Occupational Diseses in Bratislava – Dr. I Klucik
POPULATION OF SLOVAKIA
Total: 5 412 254
Active: 2 056 656
ACTIVE PHYSICIANS IN SLOVAKIA
All: 20578 Specialists of occupational medicine: 127
NATURE OF OCCUPATIONAL HEALTH SERVICES
Non governmental health facilities
Public health centres (advice and state health inspection)
Postgraduate training for a doctors is possible in 4 specialization/subspecialization:
- Occupational Medicine (specialization – 4 years study) after basic specialization in Internal medicine, or GP, or Hygiene and Epidemiology subspecializations:
- Clinical Occupational Medicine and Clinical Toxicology (subspecialization – 3 years study)
- Preventive Occupational Medicine and Toxicology (subspecialization – 3 years study)
- Occupational Health Services (subspecialization – 2 years study)
Continuing Medical Education is required to be licensed by the Slovak Medical Chamber.
Occupational health-prevention of professional and work related diseases, health promotion
- One time compensation: awarding points scale depends up to disease (240 – 8000 points)
- 1point = 2% of average earns in Slovakia (2010: 1p.=14,89€)
- plus monthly accident pension
Occupational Health Services
- changes of legislation
- tasks in team of OHS
- Occupational health risk assessment
- Preventive examinations of employees – evaluation of work ability
- Advising to employers and emploees
- Health education
- Evaluation of health status of emploees in relation to the changing work conditions
- Diagnostics ,notification and prophylaxis of occupational diseses
Slovenská spolocnos‘ pracovného lekárstva SLS – SLOVAK ASSOCIATION OF OCCUPATIONAL MEDICINE
Rastislavova str. 43
Contact person: firstname.lastname@example.org
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.
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.
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)
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)
President: Elisabeth Purtí Pujals
Contact person: Mari Cruz Rodríguez Jareño (email@example.com )
Information is to come
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.
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.
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)
- Workplace visits and risk evaluation
- Counseling employers and employees and their associations
- Prevention of professional diseases and work associated health problems
- Ergonomic problems
- Work-force with special needs or special regulations (under 18, night workers)
- Back-to-work, re-integration
- Insurance medicine and labor inspection
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
- The Society of Occupational Medicine.
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.
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:
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.”
PROFESSIONAL TRAINING AND ASSESSMENT OF SPECIALISTS IN OM
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:
- Membership of the Faculty of Occupational Medicine part 1 exam
- Membership of the Faculty of Occupational Medicine part 2 exam
- To complete a dissertation (or equivalent)
- To complete the work-based assessments/supervised learning events required for Annual Review of Competence Progression (ARCP)
- To complete annual reviews (ARCP)
- To receive the Certificate of Completion of Training and be entered by the UK General Medical Council onto the Specialist Register.
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 multiple choice questionnaire (at the end of the third year of specialist training, by examiners*)
- Assessment at Clinical exams (at the end of the years 4-6 of speciality training, by examiners*)
- Completion by candidates and assessment by a review panel (ARCP panel) of individual electronic platform (or work journal) of work performed, continually every 12 months.
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)
- Examiners: by audit and a written report and/or discussion.
- DIFFICULTIES AND DEFICIENCIES IN SPECIALISATION TRAINING
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 ).
- SHORT SUMMARY OF UNDERGRADUATE TRAINING OF MEDICAL SUDENTS IN OM
The Faculty of Occupational Medicine is seeking both:
- to encourage medical undergraduates to consider occupational medicine as a career
- and also to extend awareness of health and work issues to general practice and all medical specialties.
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) .
- SHORT SUMMARY OF TRAINING AND ASSESSMENT REGARDING OTHER POSTGRADUATE AND CONTINUING EDUCATION TRAINING IN OM
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
- FRAMEWORK OF OH PRACTICE
- Occupational health in the UK involves multidisciplinary teams including occupational health nurses, ergonomists, physiotherapists, occupational therapists, psychologists, safety officers and occupational health technicians working with occupational physicians.
- Do physicians during their specialisation training in specialties other than OM receive any training in OM? Generally no but some specialities such as respiratory medicine and dermatology offer opportunities to develop specific expertise in work related conditions.
- Are there laboratory facilities relevant to occupational medicine practice? Yes.
(d) Are occupational health and occupational health risk and protection subjects incorporated into other stages of vocational and general education? No.
- MAIN DUTIES/TASKS OF OCCUPATIONAL PHYSICIANS (OPs) ACCORDING TO LAW
(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
- DEFICIENCIES IN LEGISLATION AND ITS ENFORCEMENT
- COMMUNICATION ISSUES. ADVOCACY FOR OM
Undertaken by Society and Faculty of Occupational Medicine and other bodies such as the Council for Work and Health
- WHO PAYS THE SALARY/REMUNERATION OF OCCUPATIONAL PHYSICIAN (OP)? the employer
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
- PRIORITIES/ MOST CONTENTIOUS ISSUES REGARDING OM AS VIEWED BY OCCUPATIONAL PHYSICIANS? No objective data available
- NAMES AND CONTACT DETAILS & WEBLINKS OF NATIONAL SOCIETY OF OCCUPATIONAL MEDICINE AND OTHER RELATED INSTITUTIONS
www.som.org.uk and www.facoccmed.ac.uk
|Society of Occupational Medicine
2 St Andrews Place,
Web address: www.som.org.uk
Tel: 0203 9104531
|Faculty of Occupational Medicine
2 Lovibond Lane,
Wed address: www.fom.ac.uk
Tel: 020 7242 8698
Dr. Nerys Williams,
updated feb 2021