The changing role of the occupational physician in the private sector: the Canadian experience

The role of the occupational physician in the private sector is changing. Fewer large corporations maintain medical departments following the 'downsizing' trend of the late 1980's and early 1990's and those that do have extensively redefined the duties of the corporate medical director, often extending these duties to include responsibility for environmental health. Occupational medical services for employees previously covered by in-house services are now often provided by outsourcing. The private practice of occupational medicine has become the major growth area of the specialty in both the US and Canada. These trends have been driven primarily by economic imperatives and new management philosophies; the trend may have gone too far and a 'rightsizing' correction may be in progress. However, it is not clear that corporations in general are deriving the greatest value they can from their physicians or that the current generation of senior managers is utilizing its health professionals as effectively as they might. This is in part because the training, qualifications and capabilities of occupational physicians are not well understood. At least as important, however, is persistent confusion over desirable and appropriate roles that obscures the potential contribution of the medical professional within a management structure. We suggest that the greatest value in occupational medical services may be in the anticipation of risk related to health issues and the flexibility this gives the organization to manage the problem.