EM Fellowships- Occ Med and Sports

[miacomet]

Has anyone done fellowship in Occupational Medicine or Sports Medicine, bonus points for mid to late career?

Would love any thoughts or info or experiences

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[RustedFox]

Is this the part where I make the obligatory sports medicine joke, then concede that "yeah, I'm minimizing it; it was a joke guys, a joke" ?

 

[Rekt]

Has anyone done fellowship in Occupational Medicine or Sports Medicine, bonus points for mid to late career?

Would love any thoughts or info or experiences

I’ve worked with docs that left and did occ med without any fellowship. Doubt it’s necessary.

 

[DeadCactus]

Occ Med is a 2 year pathway if you don't already have an MPH. Probably don't need the BC to find work in the field but you probably won't be competitive for the better gigs.

 

[miacomet]

Occ Med is a 2 year pathway if you don't already have an MPH. Probably don't need the BC to find work in the field but you probably won't be competitive for the better gigs.

Better gigs being academia or ???

 

[DeadCactus]

Better gigs being academia or ???

I'm purely an outside observer but it seems like there are some desirable medicolegal, leadership, government, and industry jobs/contracts that people aim for. Maybe it's all smoke, I don't know. I'd reach out to some of the programs and ask for alumni contact information if you're really interested.

 

[BreadXray]

I'm an Occ Med doc visiting the forum. I can offer some thoughts for attendings thinking about making a switch.

There are 2 main types of pure Occ Med jobs out there:

1. Occupational medicine staff physician - Worker's Comp (think urgent care for work injuries with some patient continuity), employee preplacement exams, surveillance exams (Asbestos, Lead, etc.).
2. Occupational health director - A mix of clinical and administrative work (primarily developing and reviewing protocols). At large enough places, you will be fully non-clinical; at very small places, you may be almost fully clinical.

Number 1 is the job that anyone boarded in any specialty can get. Number 2 is the job that strongly prefers occ med board certification, especially at medical centers, government positions, and corporations.

Then there are some less-common paths people take in the occ med world:

1. Academic OEM - These are the departments that will do environmental exposure consults and treatment as well as research.
2. EHS/Occ Med consulting - These are people who developed an industrial niche and now work to provide EHS and Occ Med services for clients (often large corporations).
3. Government agency work - Federal OSHA and NIOSH are obvious fits as well as their state counterparts.
4. IMEs (independent medical exams) - If you can get a good referral base from insurance companies, you can make a decent chunk of money in this route.
5. MROs (medical review officer) - A lot of the Occ Med positions require you be an MRO, so some people are then able to just do MRO work full time.

Numbers 1-3 are exclusive to occ med trained folks. Number 4 by its nature will be heavily limited to occ med-boarded folks or subspecialists in other fields. Number 5 can be done by anyone.

A lot of people make a full career working in Occ Med with board certification in other fields. If you decide you want to get board certified in Occ Med, you could choose to enter a full-time residency/fellowship, but you also have two additional options which would allow you to continue working as an attending and thus would be much less onerous from a financial standpoint:

• Enter what is essentially a part-time residency at some programs through the "Complementary Pathway" of the ABMP. Not every residency offers this, so you would need to specifically reach out to programs and ask if they offer that option and how it would work for you.
• The University of Pennsylvania offers an "External Track" where you need to find someone at work to mentor you and you go to Philadelphia periodically for some didactic training. This is somewhat of a similar setup to executive MBAs.

Do note that if you go down one of these routes, you may have to get an MPH on your own.

If you are interested in pursuing formal training, I've written more about the process here: A brief introduction to Occupational Medicine Residency

Finally, if you do want to go into occ med, you need to be ok with making $240,000-$260,000 per year for M-F 9-5 (no nights, weekends, or holidays). If you go into the less common paths that are more entrepreneurial (consulting, IMEs, MRO work), you could make a lot more working a lot less, though.

 

[bravotwozero]

Thanks for that informative post @BreadXray, and welcome to the forum! Please keep coming back and posting more!

 

[Frazier]

I'm an Occ Med doc visiting the forum. I can offer some thoughts for attendings thinking about making a switch.

There are 2 main types of pure Occ Med jobs out there:

1. Occupational medicine staff physician - Worker's Comp (think urgent care for work injuries with some patient continuity), employee preplacement exams, surveillance exams (Asbestos, Lead, etc.).
2. Occupational health director - A mix of clinical and administrative work (primarily developing and reviewing protocols). At large enough places, you will be fully non-clinical; at very small places, you may be almost fully clinical.

Number 1 is the job that anyone boarded in any specialty can get. Number 2 is the job that strongly prefers occ med board certification, especially at medical centers, government positions, and corporations.

Then there are some less-common paths people take in the occ med world:

1. Academic OEM - These are the departments that will do environmental exposure consults and treatment as well as research.
2. EHS/Occ Med consulting - These are people who developed an industrial niche and now work to provide EHS and Occ Med services for clients (often large corporations).
3. Government agency work - Federal OSHA and NIOSH are obvious fits as well as their state counterparts.
4. IMEs (independent medical exams) - If you can get a good referral base from insurance companies, you can make a decent chunk of money in this route.
5. MROs (medical review officer) - A lot of the Occ Med positions require you be an MRO, so some people are then able to just do MRO work full time.

Numbers 1-3 are exclusive to occ med trained folks. Number 4 by its nature will be heavily limited to occ med-boarded folks or subspecialists in other fields. Number 5 can be done by anyone.

A lot of people make a full career working in Occ Med with board certification in other fields. If you decide you want to get board certified in Occ Med, you could choose to enter a full-time residency/fellowship, but you also have two additional options which would allow you to continue working as an attending and thus would be much less onerous from a financial standpoint:

• Enter what is essentially a part-time residency at some programs through the "Complementary Pathway" of the ABMP. Not every residency offers this, so you would need to specifically reach out to programs and ask if they offer that option and how it would work for you.
• The University of Pennsylvania offers an "External Track" where you need to find someone at work to mentor you and you go to Philadelphia periodically for some didactic training. This is somewhat of a similar setup to executive MBAs.

Do note that if you go down one of these routes, you may have to get an MPH on your own.

If you are interested in pursuing formal training, I've written more about the process here: A brief introduction to Occupational Medicine Residency

Finally, if you do want to go into occ med, you need to be ok with making $240,000-$260,000 per year for M-F 9-5 (no nights, weekends, or holidays). If you go into the less common paths that are more entrepreneurial (consulting, IMEs, MRO work), you could make a lot more working a lot less, though.

Great post. Thanks for the info!

 

[OEM doc]

OEM is a paradox in that people who do OEM generally really love it. Job satisfaction is really high. But OEM residency programs haven't been getting a large number of applications. OEM offers interesting work, high quality of life, great hours, and competitive pay. The issue seems to be that OEM is just really obscure and people don't hear about it. When they do, the specialty tends to be quite appealing.

There is a new website started in 2024 which has the singular goal of helping inform non-OEM docs and medical students about the key points of OEM training and practice. Highly recommend to check it out at The OEM Information Page if you have any interest in OEM. Better do it now because when the word really gets out, this specialty could become very competitive in a hurry.

 

[miacomet]

OEM is a paradox in that people who do OEM generally really love it. Job satisfaction is really high. But OEM residency programs haven't been getting a large number of applications. OEM offers interesting work, high quality of life, great hours, and competitive pay. The issue seems to be that OEM is just really obscure and people don't hear about it. When they do, the specialty tends to be quite appealing.

There is a new website started in 2024 which has the singular goal of helping inform non-OEM docs and medical students about the key points of OEM training and practice. Highly recommend to check it out at The OEM Information Page if you have any interest in OEM. Better do it now because when the word really gets out, this specialty could become very competitive in a hurry.

It's also a two year fellowship, which is a tougher sell. But everyone does seem to love it.

 

[cyanide12345678]

Occupational medicine fellowship is not necessary. The largest player in this space is concentra. They own 90% of the occupational medicine market.

I have been to a recruiting event with them and have gone as far as receiving a job offer. No fellowship needed. They train you and they like ER doctors.

The problem is they pay around 250k - Monday to Friday, 40 hours a week. And you’re usually seeing 20-30 patients a day, if not more.

The reality is - I’ll work 9 days in EM a month starting this year and make 330k. And most likely I’ll see 1/4tg the total number of patients for a higher compensation.

One of the physicians at the recruiting dinner by the way was an ER physician who left EM after 20 years. So yes, late career physicians are welcome as well.

 

[Apollyon]

40 hours/week, not day! Unless you're one of the Beatles!

 

[cyanide12345678]

40 hours/week, not day! Unless you're one of the Beatles!

haha yes yes. Fixed it.

 

[Prehealth1011]

Occupational medicine fellowship is not necessary. The largest player in this space is concentra. They own 90% of the occupational medicine market.

I have been to a recruiting event with them and have gone as far as receiving a job offer. No fellowship needed. They train you and they like ER doctors.

The problem is they pay around 250k - Monday to Friday, 40 hours a week. And you’re usually seeing 20-30 patients a day, if not more.

The reality is - I’ll work 9 days in EM a month starting this year and make 330k. And most likely I’ll see 1/4tg the total number of patients for a higher compensation.

One of the physicians at the recruiting dinner by the way was an ER physician who left EM after 20 years. So yes, late career physicians are welcome as well.

Interesting. Why do the occupational medicine residency then? I guess that’s just for people straight out of medical school.

 

[BreadXray]

Occupational medicine fellowship is not necessary. The largest player in this space is concentra. They own 90% of the occupational medicine market.

I have been to a recruiting event with them and have gone as far as receiving a job offer. No fellowship needed. They train you and they like ER doctors.

Interesting. Why do the occupational medicine residency then? I guess that’s just for people straight out of medical school.

Occ med board certification is not needed for regular clinical practice, but it is more or less needed if you want to do other stuff in the field. I'll quote the start of my comment above:

There are 2 main types of pure Occ Med jobs out there:

1. Occupational medicine staff physician - Worker's Comp (think urgent care for work injuries with some patient continuity), employee preplacement exams, surveillance exams (Asbestos, Lead, etc.).
2. Occupational health director - A mix of clinical and administrative work (primarily developing and reviewing protocols). At large enough places, you will be fully non-clinical; at very small places, you may be almost fully clinical.

Number 1 is the job that anyone boarded in any specialty can get. Number 2 is the job that strongly prefers occ med board certification, especially at medical centers, government positions, and corporations.

 

[cyanide12345678]

Interesting. Why do the occupational medicine residency then? I guess that’s just for people straight out of medical school.

You shouldn’t? It’s for people who have no understanding of finance and opportunity cost.

100% unnecessary fellowship. Literally concentra has almost the entire market and they will happily hire you without a fellowship.

 

[throway134]

You shouldn’t? It’s for people who have no understanding of finance and opportunity cost.

100% unnecessary fellowship. Literally concentra has almost the entire market and they will happily hire you without a fellowship.

This seems a little simplistic. I completely agree pursuing any fellowship for "more education" is idiotic, it should be a goal directed decision with a clear reason for doing it.

I'm not in occ med, but hospice and palliative is similar on the hospice side: you don't need a fellowship to do hospice medicine.

Fellowship is one year, so lower opportunity cost than occ med. Benefits include heavy exposure to regional standard practices and hopefully some good education, but that's variable based on fellowship. Other benefit is some future proofing (more and more places require board cert over time, it's a very new board from <10 years ago).

Cost is ~$200,000 lost pretax income which may balloon into a million or so by retirement.

You also have the option of palliative jobs from hpm if you do fellowship, which are very hard to get otherwise.

I know people without board/fellowship who are excellent hospice docs because they got good mentorship, continued their own education, and worked hard at it. I also know people who just took a hospice job with no training, and generally suck at it. It's not so different from EM that way: I've met old school fm/im people that grandfathered into EM and are ok to good. I've also met a LOT of people like that who just suck at it.

Do you like to work in the ED with someone who team health/insert garbage CMG taught how to do EM? After all, CMGs have like 90% of market share and they can train you up.

Not everything in life is about the shortest path to the most wealth. Agree you shouldn't let anyone take advantage of you, and wealth will make a lot of things easier. No need to be a dick about it without understanding someone's reasoning.

 

[DeadCactus]

Interesting. Why do the occupational medicine residency then? I guess that’s just for people straight out of medical school.

Specifically so you don't end up working for Concerta for $250k.

 

[AlmostAnMD]

Specifically so you don't end up working for Concerta for $250k.

I was gonna jump on the Concerta train but quickly realized it's less acute but same level of admin bs nonsense for less money.

 

[HemorrhagicShock]

I was gonna jump on the Concerta train but quickly realized it's less acute but same level of admin bs nonsense for less money.

30 patients a day for $250k, 40 hours per week, W2 pay, tons of admin/corporate headache

The only way this works as a physician is if you have no other option

I can't even imagine an older end-of-career type doc doing this since that seems like somewhat of a brisk pace

 

[Kryptocoin]

30 patients a day for $250k, 40 hours per week, W2 pay, tons of admin/corporate headache

The only way this works as a physician is if you have no other option

I can't even imagine an older end-of-career type doc doing this since that seems like somewhat of a brisk pace

It's like jumping from the pot to the fire.

I can work 6 shifts a month, with 3wks off/month, seeing less pts/shift and *still* make the same amount of money.

 

[AlmostAnMD]

It's like jumping from the pot to the fire.

I can work 6 shifts a month, with 3wks off/month, seeing less pts/shift and *still* make the same amount of money.

I dunno man


I used to have this mentality

But then I was just annoyed/pissed off 9 days a month instead of 13 when I went part time.

I thought all 40 hour a week jobs were gonna suck my life. Instead as I work from home out of 8 hours I do maybe 2-3 hours and hit the gym/play games for minimal pay cut and paid vacation.

A lot of us did em for so long you forget jobs that are 5 days a week outside of the er (or concentra nonsense) can actually be rather chill. Not busting my ass or sprinting all day at all.

 

[Kryptocoin]

I dunno man


I used to have this mentality

But then I was just annoyed/pissed off 9 days a month instead of 13 when I went part time.

I thought all 40 hour a week jobs were gonna suck my life. Instead as I work from home out of 8 hours I do maybe 2-3 hours and hit the gym/play games for minimal pay cut and paid vacation.

A lot of us did em for so long you forget jobs that are 5 days a week outside of the er (or concentra nonsense) can actually be rather chill. Not busting my ass or sprinting all day at all.

I get it.

But I'd rather retire from clinical medicine altogether instead working 9-5, seeing 30pts per day for 5 days and making 250k.

9-5 working in nonclinical jobs (pharma, hospital admin, biotech etc) will be much more cush and a better deal.

 

[HemorrhagicShock]

I dunno man


I used to have this mentality

But then I was just annoyed/pissed off 9 days a month instead of 13 when I went part time.

I thought all 40 hour a week jobs were gonna suck my life. Instead as I work from home out of 8 hours I do maybe 2-3 hours and hit the gym/play games for minimal pay cut and paid vacation.

A lot of us did em for so long you forget jobs that are 5 days a week outside of the er (or concentra nonsense) can actually be rather chill. Not busting my ass or sprinting all day at all.

How did you land a remote job? I've been trying for a while now and it seems like there's nothing out there for a physician.

 

[AlmostAnMD]

How did you land a remote job? I've been trying for a while now and it seems like there's nothing out there for a physician.

I think there's another recent topic when I discussed this in depth you can dig through/my posting history, not much to add to it. I'm basically an air traffic controller for the hospital system. I log in, review cases, have a fairly sizeable RN UM staff that refers gray area cases to me and make IP vs obs decisions. Some other admin work.

It's definitely not the grind EM was. Honestly I could do this work til I'm 90/blind and deaf. You also learn a lot about hospital medicine which overall would probably make me a stronger clinician if I still cared/local EM environment wasn't poisonous. Throw in a few random insurance p2p which are painless.

Dunno what the future holds with AI entering the picture but hoping to hit FIRE over the next 5 years regardless, sitting on a liquid mil in investments and I need that to grow grow grow. So long term dunno, feels like a job robots will take.

Same way birdstrike broke down the pain doors. Side gig, side gig, (prior auth contractor, medical necessity, concentra-level BS) build CV, apply like mad. Finally found a system willing to interview and fully train.

Having an ACPA-C certificate is helpful if you're interested. You can go to the conference in april and do it in person and network for jobs or just take it online at your own expense.

My stress levels have dropped 99%. Great path for anyone else burned out but still wanna make decent 300ish money

 

[WhatJobDoIPick]

The one thing I notice about these alternatives for those of us in the pit, is that there's a pretty small "pull" factor.

Like who is actually interested in UM, sleep med, or occ med?

At the end of the day, my time is my time, and id rather make more to work less hours with the occasional win in the ED.

 

[AlmostAnMD]

The one thing I notice about these alternatives for those of us in the pit, is that there's a pretty small "pull" factor.

Like who is actually interested in UM, sleep med, or occ med?

At the end of the day, my time is my time, and id rather make more to work less hours with the occasional win in the ED.

I'll answer

My pull was no nights, weekends, home for dinner every night and no call

The lifestyle became so important saving myself became more important than patients

 

[WhatJobDoIPick]

I'll answer

My pull was no nights, weekends, home for dinner every night and no call

The lifestyle became so important saving myself became more important than patients

Yeah that makes sense. Do you mind sharing your pay and how many hours/year you work?

 

[AlmostAnMD]

Yeah that makes sense. Do you mind sharing your pay and how many hours/year you work?

Without specifics it was a 25% pay cut from full time er work. But for a 99% reduction in stress and 100% improvement in quality of life absolutely worth it. Keep in mind i came from, and I've posted about this before, an egregiously abusive SDG which burned me out of the er forever. So my capacity to tolerate er and motivation to seek alternatives is different than most here.

It's a full time regular person job dude. 40 hrs a week. But wfh with downtime that comprises half of that probably. So getting to the gym more, daily naps, eating better, losing weight, overall just happier with life. My adrenaline days are behind me.

 

[DeadCactus]

The one thing I notice about these alternatives for those of us in the pit, is that there's a pretty small "pull" factor.

Like who is actually interested in UM, sleep med, or occ med?

At the end of the day, my time is my time, and id rather make more to work less hours with the occasional win in the ED.

I think the pull would be stronger if EM didn't live in such a bubble of abuse. Patients who are not angry, drunk, and/or violent. Patients who are genuinely grateful or at the very least you actually did something concrete to benefit. Something new to learn after stagnating in the ED. Working with a consistent team that isn't constantly turning over due to burn-and-churn. Low stress. No nights or weekends. Holidays off. Being able to just call in sick. Real vacation, not just squishing your days off together.

To your last point, I think EM really overestimates how much more time off we get. Jobs are so variable it's hard to really compare but between vacation, holidays, CME time, and sick days I'd bet typical EM physicians lose more time to recovering from night shifts than these other specialties lose to extra time at work.

I still like EM, but I think we need a realistic perspective on the relative benefits other specialties enjoy.

 

[HemorrhagicShock]

I think the pull would be stronger if EM didn't live in such a bubble of abuse. Patients who are not angry, drunk, and/or violent. Patients who are genuinely grateful or at the very least you actually did something concrete to benefit. Something new to learn after stagnating in the ED. Working with a consistent team that isn't constantly turning over due to burn-and-churn. Low stress. No nights or weekends. Holidays off. Being able to just call in sick. Real vacation, not just squishing your days off together.

To your last point, I think EM really overestimates how much more time off we get. Jobs are so variable it's hard to really compare but between vacation, holidays, CME time, and sick days I'd bet typical EM physicians lose more time to recovering from night shifts than these other specialties lose to extra time at work.

I still like EM, but I think we need a realistic perspective on the relative benefits other specialties enjoy.

This is completely correct.

The cabal of ER docs who have accepted (or even "like") the specialty's downsides have necessarily had to rework reality within their brains.

"I only work 12 days a month" means nothing when that involves a circadian switch, more than half of those being swing shifts, and then the only day shifts being on 2 out of 4 of those weekends.

Nothing about this is a "lifestyle" that works once you have a family, or just want to live within a healthy context.

 

[WhatJobDoIPick]

This is completely correct.

The cabal of ER docs who have accepted (or even "like") the specialty's downsides have necessarily had to rework reality within their brains.

"I only work 12 days a month" means nothing when that involves a circadian switch, more than half of those being swing shifts, and then the only day shifts being on 2 out of 4 of those weekends.

Nothing about this is a "lifestyle" that works once you have a family, or just want to live within a healthy context.

Oh I completely agree. I just think there's not enough "pull" for me to work an extra 6-7 days a month for less money.

I don't particularly enjoy night shifts, but I'm able to shift back pretty easily within a day after a block of em.

 

[HemorrhagicShock]

Oh I completely agree. I just think there's not enough "pull" for me to work an extra 6-7 days a month for less money.

I don't particularly enjoy night shifts, but I'm able to shift back pretty easily within a day after a block of em.

Yea that's completely fair, and this is where the idiosyncrasies of the individual EM job come into play.

There are absolutely ER jobs that I would immediately sign up for right now if I had the opportunity. For example I hear all these wonderful situations in Florida where ER docs can sit in an FSED and see like 8 patients per shift, and clean up to the tune of $3k per shift or something absurd like that. Florida seems like God's country for EM.

I hear similar gigs in the midwest in all sorts of trash-tier places I would never want to live.

But where I am in metropolitan CA, you couldn't find any low acuity low volume ED without driving at least 3-4 hours, and that's simply not a way to sustain a career unless I want to live part-time in said areas, which completely defeats the purpose (for me). I never want to work high-acuity high-volume EM ever again, and because of that decision I'm screwed.

As such I now need to find another use for my MD and license, which is proving extremely difficult if my main priority is to remain in this geography.

And here's what blows my mind about it: There are sick people many sick people around me. I have a valuable skill that can help heal said sick people.

Yet somehow, this gets lost in the weeds with the amazingly beauracratic, political, and regulatory mess that is our healthcare system.

I am now tapping friends in various tech and financial industries to make a full career pivot. Thinking about signing up for a coding boot camp too. Even if it doesn't lead to anything, at least I can learn another skill. It's been fun being "retired" and just learning/reading/trading everyday.

 

[RustedFox]

There are absolutely ER jobs that I would immediately sign up for right now if I had the opportunity. For example I hear all these wonderful situations in Florida where ER docs can sit in an FSED and see like 8 patients per shift, and clean up to the tune of $3k per shift or something absurd like that. Florida seems like God's country for EM.

That's precisely what I'm doing right now while putting the pins on the map for my final exit strategy.

$253 per hour for 12 hour FSED nightshifts, 7pm-7am. $3036/shift. Oh, and there's often bonuses to fill the holes in the schedule.
I sleep for at least a few hours every night.
I might actually "work" for 5 hours. The rest is spent... strategically - either grabbing Z's or doing the thing I need to do.

 

[HemorrhagicShock]

That's precisely what I'm doing right now while putting the pins on the map for my final exit strategy.

$253 per hour for 12 hour FSED nightshifts, 7pm-7am. $3036/shift. Oh, and there's often bonuses to fill the holes in the schedule.
I sleep for at least a few hours every night.
I might actually "work" for 5 hours. The rest is spent... strategically - either grabbing Z's or doing the thing I need to do.

I wish with all my heart that I could have this in CA

I wouldn't have left EM so early if I did

Unfortunately, this kind of practice environment simply doesn't exist in any CA emergency department (if anybody has evidence to the contrary, please DM and tell your director I'd be down for some shifts)

 

[miacomet]

I wish with all my heart that I could have this in CA

I wouldn't have left EM so early if I did

Unfortunately, this kind of practice environment simply doesn't exist in any CA emergency department (if anybody has evidence to the contrary, please DM and tell your director I'd be down for some shifts)

California blows. One place quoted me $180 for nights while the nurses are making $120 for days with patient caps. Are you ****ing kidding me?

 

[AlmostAnMD]

California blows. One place quoted me $180 for nights while the nurses are making $120 for days with patient caps. Are you ****ing kidding me?

They're not kidding at all. They do that, and quote those numbers, because idiots are desperate enough to live there to feed off whatever scraps they are offered. An entire community revolting and refusing to work there would immediately jack up prices.

But someone will always cave.

 

[dozitgetchahi]

They're not kidding at all. They do that, and quote those numbers, because idiots are desperate enough to live there to feed off whatever scraps they are offered. An entire community revolting and refusing to work there would immediately jack up prices.

But someone will always cave.

One of the many reasons that I absolutely refuse to live (or work) in CA.

Beautiful place, but my goodness the work environment is horrific and not worth it at all.

 

[EthylMethylMan]

Has anyone done fellowship in Occupational Medicine or Sports Medicine, bonus points for mid to late career?

Would love any thoughts or info or experiences

Hyperbaric is a great option. Lifestyle is way better than EM. Money is pretty good too; after RVUs, I make about as much as an emergency medicine physician in my area, though I do work at a very busy HBO center. I’m fellowship-trained, so I’m biased towards that pathway. I strongly believe it gives you superior training overall, and especially for the more critical cases like ICU carbon monoxide and gas embolism patients. But you can become a good practitioner with the forty-hour course as well.

Edit: Also, fellowship is only one year.

 

[OEM doc]

Occupational medicine fellowship is not necessary. The largest player in this space is concentra. They own 90% of the occupational medicine market.

I have been to a recruiting event with them and have gone as far as receiving a job offer. No fellowship needed. They train you and they like ER doctors.

The problem is they pay around 250k - Monday to Friday, 40 hours a week. And you’re usually seeing 20-30 patients a day, if not more.

The reality is - I’ll work 9 days in EM a month starting this year and make 330k. And most likely I’ll see 1/4tg the total number of patients for a higher compensation.

One of the physicians at the recruiting dinner by the way was an ER physician who left EM after 20 years. So yes, late career physicians are welcome as well.

This is simple supply and demand. There are a lot more Occupational and Environmental Medicine (OEM) jobs out there than there are board-certified OEM physicians. So they will take whoever they can to fill these kinds of jobs. Just like how in some rural areas, ERs are heavily staffed by non-EM trained physicians. Not because they wouldn't prefer EM-trained docs, but because there aren't enough EM-trained docs that they can hire into those positions.

Concentra jobs are possibly the lowest-level OEM positions out there. There is a reason why they would offer you a position right away despite having no OEM experience or training. Don't assume that the reason is because OEM training is a waste of time. OEM-trained physicians typically won't take these jobs, unless it is a higher-level leadership position in the organization or maybe if they are right out of residency and looking to build up some clinical OEM experience on their CV.

You also note that the Concentra jobs pay about $250k. The average OEM physician makes about $320k per Doximity's 2024 Compensation Report. Corporate medical directors can make far more. But you won't get hired for that kind of position without OEM board-certification and probably ample experience working in OEM as well. More on compensation in OEM here.

Yes, OEM training isn't necessary to get a job working in OEM, just as EM training isn't necessary to get some ER jobs. If you are content to work at Concentra for $250k, then go for it. But there are very valid reasons why OEM training offers a good value. Work-life balance is excellent, job satisfaction is high, and the work is typically interesting. See more reasons here. But as you might expect, the best OEM jobs are generally going to be filled by those with OEM training and experience.

For an interview with an OEM-trained physician who switched over after starting in EM, go here. He offers some additional perspective on the value of OEM training.