Incorporating environmental medicine into training programs in occupational medicine

Demand is increasing rapidly for medical evaluation and management of individuals and groups exposed to chemical, physical, and biologic hazards in the non-workplace environment. Because general physicians are ill prepared to respond and no existing specialty has obvious expertise, occupational physicians who have some relevant background could have a central role to play in filling these perceived needs. However, incorporation of environmental medicine into the specialty will require reexamination of our skills and training. The focus of this essay is to explore aspects of environmental medicine practice that demand expansion of the current repertoire of skills. Based on these, we propose modifications of training that could facilitate such expansion without sacrifice of the core principles of traditional occupational medicine.