What the heck is Occupational and Environmental Medicine???

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OEM doc

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As a practicing Occupational and Environmental Medicine (OEM) physician who is interested in spreading the word and helping recruit people to the specialty, I have seen a number of threads on SDN asking questions about OEM. Most of the responders aren't actually OEM docs, and much of the information is inaccurate/outdated. So I thought I'd provide a few highlights about the best specialty you've never heard of.

-What is the best place to learn more about OEM training and practice? Easy. The OEM Info Page. This is a new site created in 2024. It is very comprehensive and should answer all your questions in one place.

-Is OEM actually a real specialty? Yes. Board certification in OEM is through the American Board of Preventive Medicine, which includes OEM, the much better-known specialty of Preventive Medicine, and the even more obscure specialty of Aerospace Medicine. APBM also includes the subspecialties of addiction medicine, clinical informatics, undersea/hyperbaric medicine, and the new subspecialty of healthcare administration, leadership, and management (HALM).

-How long is OEM residency training? A total of 3 years, including an internship in any specialty and 2 years of OEM-specific training. As a bonus you also get a master's degree during OEM training, usually a Master of Public Health (MPH).

-Why should I consider OEM? Very high job satisfaction/low burnout, a surprisingly diverse range of job opportunities/practice settings, good work-life balance, the chance to impact health at the population level, interesting/challenging work, uses a wide range of skill sets, mix of clinical and administrative work in practice, and competitive pay. More on this here.

-What do OEM docs do? No simple answer to this one. Take a look at the long answer here.

-How come I have never even heard of OEM before? Since most of medicine is hospital-centric, and OEM isn't, and there are a limited number of OEM residency programs, people just don't learn about it in medical school (and often after medical school either). The specialty is just so under the radar that the word doesn't get out. And frankly, many OEM docs want to keep it that way, as it is something of a hidden gem. Since OEM seems to be quite popular among people that are familiar with it, I think the main reason is just that OEM has low visibility/awareness in the medical community and especially in medical schools.

-Is OEM in the match? Yes, OEM is in the NRMP main match for the first time in the upcoming 2025 match. For more info on this, see this video which talks about NRMP basics then delves into more specific questions about matching into OEM, which is a bit more complicated than some other specialties since most OEM programs are PGY-2 and PGY-3 only and require PGY-1 year elsewhere first.

OEM isn't for everybody, but it is worth taking a close look, at least to become familiar with what OEM is. If you don't take the time to learn a little bit about it, then you'll never know if you missed a golden opportunity for a fulfilling career path. There are many worse options...
 
I'll add that for pre-med and medical students, there is a full-time, paid summer internship program opportunity. While not specifically medical, it does introduce you to the world of occupational health and safety. Check out Occupational Health Internship Program (OHIP) for more information. It is a great opportunity for somebody that has a strong desire to go into OEM.
 
I've been getting direct messages about the match process for OEM.

Most OEM programs offer “advanced” slots that begin in the PGY-2 year. For fourth-year medical students, this means you will match into a separate PGY-1 slot at the same time. The NRMP has about a dozen specialties that use advanced matching, including OEM, anesthesia, radiology, dermatology, neurology, and others. Some OEM programs may also have “reserved” slots available, where somebody who has completed or will complete their PGY-1 year can match directly into a PGY-2 slot in the upcoming year. Check the listings on NRMP for the full list of available OEM slots. In general, fourth-year medical student applicants match into their PGY-1 prelim year and advanced PGY-2 OEM slot at the same time, giving you a complete course of training up front. Matching into OEM does NOT require you to match into a prelim year in one year, then separately apply to OEM programs the following year. This is sometimes misunderstood by applicants.

When applying to OEM or other advanced programs, you will rank the advanced OEM slots in your Primary Rank Order List (ROL). If you do not match into an advanced slot, then NRMP will continue to move down on your list until you match into a slot. You absolutely can combine ranking advanced slots with categorical slots on your primary ROL. If you match into an advanced OEM slot, NRMP will then look at the Supplemental ROL you created for that slot. This will be your list of preliminary year (PGY-1) slots. NRMP will then move down the Supplementary list until you match into a PGY-1 slot. For more on Primary and Supplementary ROLs, view the short video by NRMP here.

Loma Linda is currently the only OEM residency program that offers an integrated PGY-1 year. This option will be appealing to some. The advantage of advanced slots without integrated PGY-1 years is that you have the freedom to select the PGY-1 year of your choice, based on your preferences for training and location. Preliminary slots are available in the all the same geographic areas as the advanced OEM PGY-2 slots. Again, check the NRMP listings for the most updated information on available slots.

For those that do not initially match, the Supplemental Offer and Acceptance Program (SOAP) process offers an additional opportunity to secure a spot with a residency program that has unfilled positions. OEM programs may or may not have slots available during the SOAP. The SOAP process includes a series of offer rounds during match week. For more information on the SOAP, see SOAP | NRMP.
 
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Frequently Asked Questions About Matching Into OEM

Is it more difficult to match into an advanced spot? Not inherently. Whether a slot is categorical or advanced is independent of how competitive the program may be.

Could I potentially match into a prelim year only and not match into follow-on OEM PGY-2 training? No. Unless you accidentally rank preliminary slots on your primary rank list, this situation is not possible.

Could I potentially match into an advanced OEM slot but not match into a preliminary slot? Yes, this is possible. If you match into an advanced slot, you are committed to that slot even if you do not match into a PGY-1 slot on your Supplementary ROL. You would then be “partially unmatched” going into the SOAP. Ranking more preliminary slots on your Supplementary ROL makes this less likely, just as ranking more slots on your Primary ROL makes not matching at all less likely. If this situation happens, however, then you would need to seek a preliminary slot during the SOAP. Per NRMP, in 2024 only 86 graduating US medical school seniors did not match into a prelim year during the match, and only 5 of those did not secure a prelim slot by the end of the SOAP. So this situation seems very unlikely, but not impossible.

For more on the NRMP, it is highly recommended to watch the video about the process here.
 
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