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Occupational medicine: Making it work for you


If you find yourself working longer hours for less money, these physician-entrepreneurs have a suggestion: Start an occupational medicine practice. Here's how they did it.

If you find yourself working longer hours for less money, we have a suggestion: Start an occupational medicine practice.

After graduating from family medicine residency, we opened a primary care practice in Roxboro, North Carolina. We were the typical family medicine physicians and not only owned our own practice, but also served on hospital committees, had admission privileges, and even served as medical examiners for the county. We soon expanded and added the first-ever urgent care center in Roxboro and incorporated an electronic health record system into our office in 2002.

Business was booming, and we were busy. By all of the standard measures, we had developed the ideal family practice. The practice thrived, but we were suffering. Between the family practice, urgent care center, and on-call and hospital work, we routinely worked 60- to 70-hour weeks. Our income was on par with other family practitioners, until we looked at it from an hourly rate perspective. That's when we realized that we were stressed, overworked, underpaid, and had no idea how to make it better. Then occupational medicine discovered us. A nurse at a local power plant stopped by and asked for help with some fire department physicals. With no training in this type of physical and little experience in areas such as audiometry and spirometry, we told her we were sorry we could not help her and sent her away. Fortunately for us, she was persistent and returned a couple of weeks later and asked again. This time we agreed to help, and it turned out to be the defining moment in our careers.

Fire department physicals are reimbursed at about four times the rate of a routine family practice patient visit, and no follow-up care or insurance billing is required. We simply sent an invoice to the company at the end of the month and received payment in less than 30 days. The best part was that each physical took no more time than a routine family practice visit would. Realizing the potential to increase our cash-based income, we began to look at how to maximize our return on time by adding more occupational medicine to our practice.

To accomplish this, it helped to get creative with scheduling. Because appointments for occupational medicine exams were made ahead of time, we would perform these physicals on certain days of the week or during a particular time of day.

Primary care physicians (PCPs) already are trained to perform the medical exam component but usually lack the business and marketing expertise to be successful. Those areas were where we encountered the biggest learning curve that we had to overcome.


We decided on a two-pronged strategy to first capitalize on our existing occupational medicine offerings and then to expand our reach. As is the case with many PCPs, we already offered some basic occupational medical services, such as truck driver, work, and workers' compensation physicals. We had always looked at these services as little more than an additional convenience for our family medicine patients. Seeing the potential, we changed our thinking and began to focus on refining and marketing these services.

To develop a successful occupational medicine business, our first challenge was to educate ourselves and our staff. We accomplished this task by attending courses from the Centers for Disease Control and Prevention's National Institute for Occupational Safety and Health and the Council for Accreditation in Occupational Hearing Conservation to learn about spirometry and audiometry, which are integral to most companies' occupational medical programs. The American Osteopathic College of Occupational and Preventive Medicine also offers a three-part basic course on occupational medicine, which can lead to a certificate of added qualifications in occupational medicine for osteopathic physicians. Finally, the American College of Occupational and Environmental Medicine offers a Foundations of Occupational Medicine course. We found that it was also important to learn about the needs and wants local companies had, and how other providers they had used did or did not meet them. We met with local plant managers and industrial safety coordinators and made it a point to take a plant tour of every company they worked with. Only then were we able to develop a medically sound program around the needs of each individual company.


Once we had a firm grasp on what we needed to do and how, we put our occupational medicine program together. The first step was to brand the program separately from our family practice.


One of the chief complaints we heard was that companies felt that most providers did not prioritize occupational medicine. We wanted to change this perception, so we developed a stand-alone occupational medical program with its own Web page, brochures, business cards, and phone number. We designated one person in our office as the occupational medicine coordinator. We also standardized communication between our practice and our clients, and prioritized our occupational medicine clients to ensure that we were staffed to accommodate their needs without long waits behind our family medicine patients.


The program was good, and our clients were happy. Many of them had been using multiple providers for occupational medical services but consolidated their business with us. The next step was to expand our business by marketing our occupational medical services.

Every city has companies that must meet government mandates that ensure the health and safety of their employees. We just had to identify them. We gathered our brochures and contacted local industries. Our strategy was to arrange plant tours, which would give us an "in" to learn about the plant and ask about the company's current occupational medical provider. Few were satisfied with their current providers, and most were willing to give us a chance. Most companies were surprised that a physician would take the time to show an interest in their practices and procedures.


Our practice not only became busier; it also became more efficient. Occupational medicine visits paid about two times what we were being paid for a family medicine patient encounter. We billed for occupational medical services outside of workers' compensation using a simple computer spreadsheet, which eliminated billing costs.

Our income from occupational medical services steadily grew as we expanded and refined our services. With the extra income, we were able to hire one, then two midlevel providers to see work-in patients. Doing so helped us cut our overall hours, allowed us to spend more time with our primary care patients, and made our days much less stressful. The additional help also gave us time to discuss marketing ideas and build our business. Our work week was cut back to 35 hours, with an increase in income.

Together, we now own SiteMed and perform on-site physicals for companies throughout the southeastern United States. Recently, we started a small group seminar series to teach other PCPs how to implement creative strategies to add occupational medicine to their practices. Our goal is to be the mentors we wished we would have had when we started our occupational medical practice. We often talk about the money and time we would have saved if someone had helped us along the way.

Fernandez and Walker founded SiteMed, an occupational medical company that delivers on-site wellness and medical services to businesses throughout the southeastern United States, after years of blending occupational medicine with their practice. Send your feedback to medec@advanstar.comAlso engage at http://www.twitter.com/MedEconomics and http://www.facebook.com/MedicalEconomics.

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