Position of occupational medicine specialists is troubling

While increasing subspecialisation in medicine has been the focus of critical commentary, the benefits of general specialisation are long established and undisputed. 

The ability to hone one’s craft through years of specialist training and continuing professional development – and direct patient care – means that patients and healthcare systems have access to the latest knowledge and skills across the spectrum of medicine (although a glaring caveat in the Irish context is lack of timely patient access to this expertise). 

However, the skills and knowledge of occupational medicine specialists in Ireland appear to be significantly under-appreciated by health leadership. 

In the first instance, higher specialist trainees in occupational medicine complete a training programme at a level comparable to other specialties, but, unlike their peers, they are not recognised as consultants in the HSE. 

This undoubtedly impacts upon the attractiveness and growth of the role and the general standing of occupational medicine specialists in some healthcare settings in Ireland. How does this translate in practice? 

As reported in this edition of the Medical Independent, an expert group in the RCPI Faculty of Occupational Medicine, in late 2021, considered certain Covid-19 control measures outlined in HSE guidance at the time as inadequate in maximising staff safety and inconsistent with the employer’s duty of care to their staff. The specialists specifically examined HSE guidance on masking for healthcare workers and strongly advised the wearing of FFP2 masks for staff working in clinical areas where Covid-19 cases may present or arise at all times, as part of a hierarchy of control measures (and higher-grade respirators for close contact with known Covid-positive patients). 

These views were provided in the context of a predicted imminent surge in Covid-19 cases and were communicated to the HSE. 

There was a subsequent change in guidance in favour of recommending wider use of FFP2 masks, but this has since been downgraded. This newspaper understands that several occupational medicine specialists have internally expressed concern about HSE guidance and control measures throughout the pandemic. 

Several specialties have vital contributions to make to infection prevention and control guidance – particularly in a pandemic. Criticism of the guidance is not meant as a challenge to the integrity, skills, and knowledge of the authors, who have had to weigh-up existing and newly emerging evidence on a daily basis. 

However, occupational medicine brings a different – and important – set of skills, knowledge, and considerations (including on health and safety law), which should be better reflected in the construction of guidance and final iterations. 

As the Faculty of Occupational Medicine webpage states, occupational medicine physicians combine their knowledge of science with an understanding of legal issues surrounding workplace safety. 

It should be of concern to healthcare workers – and their unions – that medical specialists with expertise on the interface of work and health have such misgivings about the HSE approach.