AFOEM eBulletin – 26 July 2019
Occupational medicine. Out of time? – A member's response
Thank you, Dr Graham Wright, for an analysis of changes in work, and call for re-thinking occupational medicine in the 3 May 2019 AFOEM eBulletin
Few will have had as long and varied occupational medicine career as I have enjoyed. Employed to cover an industry in transition (the Australian waterfront), research grants in RSI, a spell in the old WorkSafe in Camperdown writing codes of safe work (involving international travel to review overseas practices), a stint in the army and defence manufacturing (Israel), hired into the heart of the semi-conductor industry (Intel, then recognised a best managed company worldwide) with responsibilities for occupational health (OH) systems from Ireland, Israel, across Europe, up to Russia and out to China. Much time in the US, but further medical registrations and times practising in the UK and across China. And much more, as projects and shorter placements. I transitioned from an office to working in complex teams, from writing scripts and referrals to producing complex reports. I can see a useful life, with much opportunity for using all my skills for prevention and promoting humane work. I have practised little in Australia since the early 90s, thank goodness from the contrasting work descriptions of my old colleagues. Few describe sitting on that three-legged stool as Ramazzini suggested.
I’m aware that every country has occupational physicians (OPs) calling for re-thinking of roles. Part is the changing nature of industries, and the move to a service economy. Old style manufacturing has declined and upskilled to automated engineer centered mostly office work. The requirement for quality and environmental permitting continues to reduce work exposures to chemicals and dusts. The unreformed sectors, such as construction, remain where the deaths and damage are done. As Graham notes, much of the remaining work has professional safety, hygiene and others doing prevention at the engineering and work system design stages. In addition, with the slow death of old industries, we have lost our natural partners for seeking better work, the unions. (In the 80’s I knew the heads of most unions, each were excited to discuss OH systems).
A further part is legislative and cost rationalisation. The UK has systems that define medical conditions as disabilities, which the employer must recognise and manage discrimination. They employ UK OPs to sort out their obligations. Israel has gone so hi-tech, and design only, traditional OH checking has near stopped. Australians are still reluctant to admit their compensation systems are uniquely huge and expensive, so we OPs get used to help manage and reduce costs, by doing injury assessments. But all the parties continuously look to 'improve' so will seek to bypass these expensive doctors. Can we OPs show better outcomes or ROI when we have been replaced?
Having described these changes, I do not think work related adverse health effects have disappeared, they have changed, and these need our attention.
I think we have been let down by some of our academic colleagues. After Ferguson, have we been too quiet in identifying current hazards and vulnerable populations? Many old industries have left unmanaged environmental hazards. Oil is applied to squeaky wheels, note the rapid response to accelerated silicosis. It is right the College promotes the health benefits of good work, but is it making enough noise about the not so good? Academics and the seniors need to identify problem areas, agitate and advocate.
I also think some work of OPs needs discouraging. I trust no one is left doing executive health checks. But useless 'pre-employment' exams have crept back, when we had advised in the 80s to manage risk. Some court work is great, (I have just had a big win in a class action following a very large oil spill, it will drive better management) but it is not an income and great care needs to go managing your bias. Between the types of work we do, does the public recognise us as 'the good guys'?
Some of the most necessary occupational medicine work is difficult to access and generates no income. We know the most vulnerable (young, poorly educated, foreign born and non English speaking background) are employed in the lowest skilled areas, by small employers, without job security, where adverse work-related health effects are most likely. Who is left to highlight these failures? Our private health systems do not pay for nor prioritise prevention.
To return to Graham’s article, our roles have changed. A survey may suggest what work we do, what numbers of members are optimal and refocus our training. But the hardest task is identifying where the new roles will be needed, and how they will provide a living.
Dr Peter Honeyman FAFOEM
I’m currently producing a benchmark comparison for the Israel Institute of Occupational Safety and Hygiene, with similar national statutory bodies (National Institute for Occupational Safety and Health, Health Safety Environment, Finland, Australia and Japan) on construction health and safety, and on minority and foreign labor.
A message from your President
Occupational physicians honoured
The 2019 Queen’s Birthday Honours List recognised the significant contribution made by two of our Fellows to occupational and environmental medicine. I extend congratulations from myself and on behalf of our Faculty to Professor Malcolm Sim, who was made a Member of the Order of Australia, AM, and Dr Chris Cunneen, who received a Medal of the Order of Australia, OAM. The full list is available on the Governor General's website.
Health Benefits of Good Work (HBGW) – Australian Signatories Steering Group (SSG) Forum in Darwin
On Friday, 21 June I was in Darwin attending the first HBGW Australian Signatories Steering Group (SSG) Forum for 2019, titled ‘Fostering Good Work, in the Territory’. The SSG is comprised of industry, unions, organisations and government bodies who are signatories to the Consensus Statement on the Health Benefits of Good Work. The SSG is the industry arm of the HBGW campaign and is essential for implementing the principles of ‘good work’ through influencing policy and workplace practices. Dr Mary Wyatt presented up-to-date evidence on the important factors that can support better return to work results. Other topics covered were from NT WorkSafe, NT Road Transport, Gallagher Bassett NT, NT Police, Fire and Emergency Services psychologist, and a successful example of promoting Indigenous employment and career pathways. The program was rich with examples of how key stakeholders are striving to maximise good work practices. These forums are a wonderful opportunity for us as occupational physicians to network with key stakeholders and demonstrate our value to industry. I strongly encourage you to attend the next Forum that will be held in Canberra in November. Details will be provided once confirmed.
AFOEM Council update
The AFOEM Council had their third meeting this year via videoconference on Tuesday, 16 July. An update on Council progress with its 2019 to 2020 workplan:
- More effective communication between AFOEM members. The College has started a pilot program to develop an online community for RACP members that contains specific member-led communities of practice. The AFOEM Health Benefits of Good Work (HBGW) Executive Group has volunteered to participate in the phase one pilot that will help evaluate the process and make recommendations.
- AFOEM Council approved the NZ AFOEM Committee’s Workplan for 2018-2020, which aligns with and supports the College goals and AFOEM Council’s initiatives. In addition, AFOEM Council approved the change of name for the New Zealand Faculty Committee to the ‘Aotearoa NZ AFOEM Committee’ to reflect the country’s bicultural foundations. This supports the Indigenous Strategic Framework, acknowledges the tangata whenua (people of the land) of Aoteaora NZ and honours Te Tiriti o Waitangi (The Treaty of Waitangi).
- AFOEM is waiting for the College Membership Survey results to be brought to the next Council meeting. The results will help inform our understanding of the ‘needs and wants’ of AFOEM members.
- AFOEM supervisors will be formally invited to attend day three of the AFOEM Annual Training Meeting (ATM) in 2020. An evaluation form will be given to attendees to complete, to assess the impact of this on the trainee experience.
- The AFOEM Education Committee continues to support and provide information on the unique nature of the AFOEM training program in the curricula renewal work.
- A reminder to everyone that AFOEM Awards are to be considered soon, so please put in nomination forms before closing dates. Please visit the RACP Foundation webpage for further information.
- AFOEM Council approved the AFOEM ‘Value Proposition and Narrative’ document, at its first meeting of 2019. The College’s Marketing and Communications Unit is finalising the AFOEM Value Proposition Marketing and Communications toolkit to help raise the Faculty’s profile. The kit will include a PowerPoint, AFOEM logos with tagline, a brochure, and a letterhead template to include the Value Paragraphs and Sentences. More information on the distribution of the toolkits will be provided once the finalised version is approved by AFOEM Council.
- The ANZSOM/AFOEM Annual Scientific Meeting in Adelaide is fast approaching. A reminder that early bird registration closes on 31 July 2019. More information about the Conference and how to register on the RACP event webpage.
- AFOEM Council does not have a trainee representative. This is a vital and important position on Council, a voice that we are missing and an opportunity for trainees to have input into our Faculty. I urge supervisors and Fellows to encourage a trainee you know to volunteer for this role to represent trainees.
Planning for RACP Congress 2020, Melbourne 4 to 6 May has started. Our Faculty is again invited to provide input into the program via an AFOEM stream planning committee.
Dr Beata M Byok
World Association for Disaster and Emergency Medicine’s biennial congress report
The World Association for Disaster and Emergency Medicine’s (WADEM) biennial congress was held in Brisbane, Australia from 7 to 10 May 2019. WADEM is an international multidisciplinary scientific congress focusing on the health aspects of disaster management and should be of interest to the occupational and environmental medicine specialty, which has a focus on prevention of diseases and injury. Since occupational and environmental medicine is a very broad speciality and has traditionally been involved in many public health issues it is appropriate that it interact more with other specialities. The WADEM Congress speakers included many medical and non-medical specialists and persons who have involvement in disaster management.
Although there is considerable experience and information on the acute management of emergencies and disasters there is a need for improvement in prevention strategies, an area where occupational physicians could contribute. Positively there has been an improvement in the emotional support provided to the disaster responders and the affected general public at the time of the incident and over the next six months. Thereafter interest tends to wane. There is evidence that support is required longer term, in many cases for as much as six years. The involvement of voluntary organisations providing services to the general community may be the most cost-effective means of providing this support.
Dr Kelvin Wooller, an occupational physician, was an invited speaker and his presentation focused on preventing disasters in persons living in isolated areas, especially those with limited or no access to the internet. Particular needs include better availability of information on hazards, skill training and communication. The recent availability of high speed satellite-based internet services was seen as a major contributor to meeting these needs.
Join the AFOEM Council as a Trainee Representative
The AFOEM Council is responsible for furthering the governance and direction of the Faculty, including its committees and working groups.
There is a vacancy on the AFOEM Council for a current trainee undertaking the Occupational and Environmental Medicine Training Program.
Responsibilities for the position:
- assist in determining AFOEM Council priorities
- assist in developing, coordinating, implementing and monitoring the activity of the AFOEM Council workplan
- respond to new and emerging issues relevant to AFOEM as they arise
- act as an authoritative source of direction and advice within the College on occupational and environmental issues.
For more information visit the expression of interest webpage
Nominations are now open for these College’s prizes acknowledging outstanding contributions and achievements made by Fellows and trainees in their respective fields:
Successful nominees are presented a medal at the RACP Congress 2020 in Melbourne and receive full Congress registration, return economy airfares and up to three nights' accommodation.
If you have a mentor or colleague you wish to recognise, now is the time to nominate them for one of these prestigious awards. Nominations must be submitted by Monday, 16 September 2019.
Full details are available on the RACP Foundation website. You may also email the RACP Foundation for enquiries.
College Gender Equity in Medicine meeting
You are invited to join your fellow members at an RACP Gender Equity in Medicine meeting on Tuesday, 20 August 2019 to showcase important gender equity initiatives and discuss the roles our College and membership can play to promote gender equity.
Spaces are limited, so please register by Thursday, 15 August to avoid disappointment.
When: Tuesday, 20 August 2019
Time: 6pm to 8pm (AEST)
Where: RACP Sydney Office
Level 19, Governor Maquarie Tower
1 Farrer Place
RACP Melbourne Office
Level 2, 417 St Kilda Road
Via teleconference – dial in details will be provided on registration.
Commencement of the Queensland notifiable dust lung disease register
In response to the emergence of occupational dust lung diseases, including coal workers’ pneumoconiosis and silicosis, changes to the Public Health Act 2005 and the Public Health Regulation 2018 provide a legislative framework for Queensland Health to establish a notifiable dust lung disease register (NDLD register).
Notifiable diseases include the following diseases caused by occupational exposure to inorganic dust:
- chronic obstructive pulmonary disease including chronic bronchitis and emphysema
- pneumoconiosis including asbestosis, coal workers’ pneumoconiosis, mixed dust pneumoconiosis and silicosis.
From 1 July 2019, Queensland medical practitioners from the following specialities are required to notify the NDLD register if they make a diagnosis of a notifiable dust lung disease:
- occupational and environmental medicine
- respiratory and sleep medicine.
These specialists will be required to notify the NDLD register about a notifiable dust lung disease within 30 days of diagnosis using the approved form. Notifications will be able to be submitted to the NDLD register via a secure portal.
For further information please visit the Queensland Health website.
AFOEM Regional Committee casual vacancies
There are various casual vacancies on AFOEM Regional Committees to be filled by way of expressions of interest.
New South Wales
- one position open for Trainee Representative of AFOEM NSW Regional Committee
- one position open for the Chair of AFOEM QLD/NT Regional Committee
- one position open for Deputy Chair of AFOEM QLD/NT Regional Committee.
- one position open for Deputy Chair of AFOEM SA Regional Committee.
- one position open for Trainee Representative of AFOEM VIC/TAS Regional Committee.
- one position open for Chair of AFOEM WA Regional Committee
- one position open for AFOEM Trainee Representative of AFOEM WA Regional Committee.
Before nominating for the role, candidates must familiarise themselves with the following documents:
To nominate, submit a completed Expression of Interest Form and your resume by email to AFOEM@racp.edu.au.
Register today for the Aotearoa New Zealand Trainees’ Day 2020. This event is developed by trainees for trainees and will be held on Saturday, 4 April 2020 at The Heritage Hotel in picturesque Queenstown.
If you are an RACP trainee, this event is for you. Whether you are a Basic or Advanced Trainee, adult medicine or paediatrics, Trainees’ Day will be inspiring and relevant for wherever you are in your training journey. Offering a variety of big picture topics and professional skills building, every NZ trainee should attend Trainees’ Day at least once during Basic Training and once during Advanced Training.
The Trainees' Day offers professional development and community building opportunities for all trainees at any stage of training. It is also supported as a recognised skills day by New Zealand District Health Boards and attendance costs are reimbursable. Earlybird registration is open now.
Trainees’ Day is an opportunity to connect with the wider trainee community, take time out to think broadly and strategically about your career, and hear practical wisdom from experienced physicians and other professionals.
Register now for the RACP Aotearoa New Zealand Trainees’ Day 2020.
For more information email the RACP New Zealand team.
A third of Australia’s population is classified as regional or remote, but since it’s such a big place it’s hard to provide comprehensive heathcare all over. As a result, chronic disease gets treated later and mortality is 1.3 times higher than it is in major cities, according to the Australian Institute of Health and Welfare.
There are only 42 per cent as many specialists per 100,000 population in regional areas as there are in major cities, but research shows that these experiences are more likely to lead to permanent careers in the country.
In this episode we visit the country town of Dubbo about six hours drive northwest of Sydney. The Dubbo Base Hospital services a catchment of 130,000 people spread across an area the size of Great Britain. While need in this area is high, Dubbo presents an example of strong clinical leadership and training across many specialties.
The Commonwealth Fund's Harkness Fellowships in Health Care Policy and Practice provide a unique opportunity for mid-career health services researchers and practitioners from Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway and the United Kingdom to spend up to 12 months in the United States, conducting original research and working with leading US health policy experts.
AMC Expressions of interest
The AMC is inviting expressions of interest from their membership for the Progress Reports Sub Committee with positions for an Aboriginal and/or Torres Strait Islander member, a Māori member, and a member experienced in medical education.
The position descriptions, expected time commitment, information about the Sub Committee and application process are detailed in the following position descriptions.
Expressions of interest close Monday, 5 August 2019.
For more information, please contact Juliana Simon, Accreditation Policy Officer at firstname.lastname@example.org or +61 2 62709752.
When: Monday, 26 August 2019, 6pm to 7pm (AEST)
Join Dr Rosalie Schultz, Associate Professor Nick Buckmaster and the Australian Digital Health Agency for an interactive panel discussion on the opportunities My Health Record has for Indigenous health, integrated care and more.
The Clinical Genomics for Physicians online course introduces physicians in Australia and New Zealand to the emerging field of clinical genomics. It aims to enable physicians to use genomics appropriately in their practice and engage with its evidence-based integration into the broader health system. It features video interviews with physicians already using genomics, interactive tools, quizzes and case studies.
The course covers:
- human genome structure and function
- genome sequencing and testing process
- applications of genomic testing in healthcare
- discussing genomic testing and results with patients and their families
- ordering a genomic test or referring to genetics services
- interpreting a genomic report
- ethical, legal and social issues.
RACP Online Learning Resources are free for RACP members and count towards Continuing Professional Development requirements.
The RACP is one of 13 leading medical colleges, societies and associations to co-badge the Australian Medical Association's Informed Financial Consent: A Collaboration Between Doctors and Patients. Other co-badged organisations include two RACP affiliated specialty societies, the Australasian Sleep Association and the Thoracic Society of Australia and New Zealand. The guide aims to empower patients to better understand medical costs, and engage in conversations with their doctors about their fees. It was launched on 23 July at Parliament House in Canberra by the Minister for Health, Hon Greg Hunt MP.
On Wednesday, 19 June 2019, an evening Ethics Committee event on ethics and high cost drugs was held at the College and webcast and recorded. Dr Narcyz Ghinea presented on current and projected pharmaceutical spending patterns and the degree to which current trends are sustainable and may contribute to low-value care. Dr Wendy Lipworth presented the results of an empirical study which examined the strategies used by Australian cancer physicians to manage dual loyalties when prescribing high cost cancer medicines, between patient advocacy and health resources stewardship. Dr Linda Sheahan FRACP provided an organisational ethics perspective on the role of Local Drug and Therapeutics Committees in overseeing the judicious use of medicines in hospitals, and decision making around drug approvals for Individual Patient Use (IPUs).
Dr Ghinea and Dr Lipworth’s presentations are now available to view online.
World Congress of Internal Medicine invitation
The World Congress of Internal Medicine will take place in Cancun, Quintana Roo, Mexico from 1 to 5 December 2020. The congress objective is to promote scientific knowledge, collegiality and friendship among internal medicine doctors from all over the world.
The main topic of the congress will be 'Present and Future of Internal Medicine'. The Mexican Organising Committee, along with the International Society of Internal Medicine (ISIM) and many other international societies are preparing an amazing scientific program with the participation of world experts and will have a variety of academic delivery formats to allow diversity in presentations and learning; these will include keynote lectures, symposia, open forums, workshops, expert discussion, scientific oral abstract presentation and more. The collaborative nature of the meeting has the intention to have a strong influence and steer the pathway of the future of internal medicine in the second quarter of this century.
In addition to the strong academic and scientific collaboration and experience, we also want you to enjoy the incomparable hospitality of Mexico. We have prepared a formidable sociocultural program that will offer the beauty of Mexico.
For more information visit the World Congress of Internal Medicine website
As a result of the application of section 59A of the Workers Compensation Act 1987, one or more of your patients may soon no longer have their claim for medical, hospital and rehabilitation expenses compensated through the workers compensation system. They may need your assistance to prepare for this change.
The date these changes come into effect will vary, with some patients ceasing entitlements from September 2019.
If you are providing treatment/services to a patient(s) affected by these changes, you should gain a clear understanding from each patient when their entitlements will cease and let them know the costs of any treatment/services provided after that date will be their responsibility.
Treatments/services provided after the cessation date will not be paid by the insurer, even when previously approved.
The State Insurance Regulatory Authority (SIRA) encourages you to tailor your approach to affected patients and work collaboratively with insurer case managers to ensure patients receive appropriate support before their entitlements end.
You might consider actions to:
- discuss and inform your patient(s) of medical and support services available to them and make referrals where appropriate. This could include through publicly-funded community, state or federal systems, or where applicable, services funded by private health insurers.
- prepare a discharge plan with your patient(s) with the goal of developing self-management strategies to promote independence from healthcare. This will assist them with longer-term management of their injury or condition.
For more information, you can read the Section 59A Information for health providers fact sheet, visit www.sira.nsw.gov.au or contact the patient’s workers compensation insurer case manager.
Expression of Interest
Check the Expressions of Interest page at any time, to find out if there are any opportunities that are of benefit to you.
Conferences and events
The Royal Australasian College of Physicians publishes notices of events and courses as a service to members. Such publication does not constitute endorsement or mandating of any such events or courses.
Joint WA ANZSOM and WA AFOEM branch meeting, 6 August, Perth
Webinar: 'Impact of Medical Assistance in Dying legislation on medical practice in Canada', 12pm NZST on 9 August
The Medico-Legal Society of Queensland's 2019 Annual Conference, 16 to 17 August 2019, Surfers Paradise
AFOEM Victoria's Kevin Sleigh Memorial Lecture, 19 August, Melbourne
ANZSOM NSW/ACT branch weekend meeting, 24 August, Orange
Australasian Society of Aerospace Medicine 'Humans In Space: Challenges for Exploration' short course, 3 to 7 September 2019, Melbourne
ANZCA 2019 Medical Education Special Interest Group meeting, 20 September, Sydney
ANZSOM Annual Scientific Meeting – 'Making it work: Practical solutions in occupational health', 27 to 30 October 3019, Adelaide
ANZCA 2019 Rural Special Interest Group meeting, 2 to 4 November, Ballarat
Supervisor Professional Development Program (SPDP) workshops
General information webpage provides an overview of our three SPDP workshops.
Online workshops webpage provides dates and information on how to register for the online SPDP workshops.
Face to face workshops provides a list of dates and registering for the face to face workshops.
Go to the events list at any time to see what other events are coming up.
View all positions vacant
AFOEM contact details
(AUS) 1300 69 7227
(NZ) 0508 69 7227
AFOEM Faculty enquiries (including Council and committees):
Lucie Perrissel-Taggart, AFOEM Executive Officer
Phone: +61 2 8076 6351
AFOEM Health Benefits of Good Work (HBGW) enquiries:
AFOEM Education and Training enquiries:
AFOEM Examination enquiries:
Examination Coordinator, Assessment and Selection Unit
AFOEM training site accreditation inquiries:
Site Accreditation Unit
AFOEM CPD enquiries: