Across the healthcare industry, an acknowledged overdue emphasis has been placed on diversity, equity, and inclusion (DEI).

From the origin of this specialty, occupational and environmental medicine (OEM) has championed diverse and underrepresented (URM) workers' illnesses and injuries, says Robert Goldberg, MD, FACOEM, of San Francisco.

"Immigrants have often done the most dangerous work, with the highest exposures, going back 130 years," says Goldberg. "Other medical specialties are in some ways disparate newcomers to this, but we have always recognized that people of diverse backgrounds don't appear in clinical studies as often and have poorer outcomes when they respond differently to treatments, medications, and the lack of diversity within the ranks of physicians in general."

Goldberg, an occupational medicine specialist and consultant, is past president of the American College of Occupational and Environmental Medicine (ACOEM) as well as of the Western Occupational and Environmental Medical Association (WOEMA), where he's a member of the Justice, Equity, Diversity, and Inclusion (JEDI) Committee. The organization's member states are California, Nevada, Hawaii, Utah, and Arizona.

Every Worker Deserves Health

"Diversity in OEM seems to be improving, when I look around the room," says WOEMA's president and JEDI committee co-chair Rupali Das, MD, MPH, FACOEM, of San Francisco. "I do think there are aspects of the field that are not diverse, but that lack has more to do with the way society is.

"For example, in private industry, we have OEM physicians not just in clinical practice, but they are CMOs at hospitals and corporations, they work for insurance companies, for government, and for public health," says Das, also clinical professor of medicine at the University of California, San Francisco. "OEM physicians also work for corporations that could do more to increase funding available to promote diversity."

DEI may be inherent in the field of OEM, she says, but it doesn't always play out for the patients those physicians treat. "People who live near freeways, or who live in houses where old lead-based paint is chipping off, are taken care of by professionals in our specialty," says Das. "In farmworker health and immigrant health, naturally, when we advocate for those patients, we are advocating for DEI."

"Every worker in the United States is entitled to a safe and healthful workplace," adds Goldberg. "And every family is entitled to have a safe place to live that isn't polluted by environmental or occupational hazards, or chemical, biological, or other physical hazards. Every family deserves to have members go to work and come home every day as healthy as everyone else in this country. If they get hurt or become ill, they deserve to have the same kind of medical care."

The equation is pretty simple but so powerful, he says. "Healthy workers and healthy families equal healthy communities that are good places for people to grow and develop the next generation.

"When people are hurt or ill less frequently, and when access to good medical care returns them to health, we become a healthier and more productive society, and the GDP [gross domestic product] grows in a healthier way," he says.

See Physicians Who Look Like 'Me'

Because many OEM practitioners are not considered as highly paid as in some other specialties, it may make the field of OEM jobs seem less attractive, less competitive, so high-achieving medical students may not go into it, Das says.

"OEM can suffer from lack of exposure, so when physicians from diverse populations don't know about it, they don't know to apply to it as their specialty," she says. "We're not trying to keep it a secret."

In fact, just the opposite is transpiring. Renewed efforts at WOEMA, and a new JEDI program at ACOEM, go far to enlighten and educate those groups' members, says Goldberg. "But a lot of OEM care is provided by urgent care clinics, family physicians, orthopedists, and other surgeons," so they may not have the same exposure to DEI.

He thinks WOEMA is probably "the most diverse medical society I can imagine, where diversity has been very organic, but now is more intentional.

"With our leadership development, committee chairs, officers, and board, we want to make this look like the rest of society in California, if not the West," Goldberg says. "That way, younger physicians who come into the field from other specialties can see people who look like themselves."

DEI demands attention among physicians, who face discrimination at work, Das says. "They don't talk about it, because physicians aren't supposed to."

Identify Existing Barriers to Change

"This is something we should have done long ago, as an association," says Jill Rosenthal, MD, MPH, FACOEM, and the new chair of ACOEM's JEDI Committee, which held its inaugural meeting on Oct. 27, 2022. She's the organization's treasurer, and a member of its board, as well as a member of both the Florida Association of Occupational and Environmental Medicine, and the Central States Occupational and Environmental Medicine Association.

She's also a WOEMA member and says the work of her JEDI group at ACOEM is being modeled with a nod to WOEMA's JEDI initiatives, as well as those of other medical societies nationwide.

Rosenthal is proud that the six medical professionals on the ACOEM JEDI Committee are of different genders and sexual orientations, ages, races, religions, and stages of their professional practices.

"We want to make sure everybody feels like they belong, that they have a voice within the college," says Rosenthal. "Our membership is diverse-including on all of our different committees-so we want that population to be considered at conferences, in emails that go to the membership, and in recognition of certain holidays or months."

She hopes members will think about whether there are existing barriers to implementing change, then assess them and fix them. A member of the Jewish faith, she subscribes to the principle of "tikkun olam," or "heal the world."

"The impact of the JEDI Committee at ACOEM allows us to develop ways to support our culturally diverse patient population and we all have to think about that," Rosenthal says.

Self-reflection allows people, and medical professionals, to reflect upon unconscious biases: "We all have them," she says. "We can't allow them to impact the care we give patients-the way we do our work-or how we interact with each other."

Patient Trust Yields Better Outcomes

"It's very important to have OEM medical providers, and providers in general, who come from backgrounds similar to the patients we take care of-in our case, injured workers," says Das.

"Studies have shown that patients do better when providers speak the same language and are of similar backgrounds-otherwise they might misunderstand something about lifestyle or language. We are public health practitioners, and DEI issues are critical to public health."

Just as younger physicians can be supported by more experienced physicians with similar cultural attributes, patients benefit, too.

"If you're a minority worker, even if you get to a good place for healthcare, it doesn't mean the physician looks like you," says Goldberg. "When a doctor looks like you or me, there's an automatic connection that's made. When that doctor doesn't, cultural differences surface in language and background cues."

When patients feel more comfortable with a physician, they're more likely to engage and be trusting, and to accept medical advice, he says. "Being more adherent to medical direction should lead to a faster, more complete recovery-and that gets people back to work and supports families."

What OEM Can Do for DEI

Before change can really be made, more information is needed, says Das. "You can't change what you can't measure so we must measure diversity in OEM, of those in practice and in residency and training. Academic institutions need to consider not only 'Can we offer that candidate a spot?' but also how to improve diversity of our own faculties. In academic institutions, where people tend to stay a long time, there seems to be a greater lack of diversity."

UConn Health's OEM department developed a diversity and inclusion questionnaire that asks for voluntary participation to "assist our effort to attract a more diverse applicant pool for open faculty positions."

It asks questions, including "Have you experienced any challenges regarding your race, sex, and ethnicity when working with faculty, colleagues, and other mentors here at UConn?" and "Has your program directly emphasized the importance of diversity and inclusion for residents/fellows?" and "Please describe your expectations with respect to the kind of support you need for your career advancement."

"Equal treatment doesn't end up producing equity," says Goldberg. "If you start from a disadvantaged place, you don't have as many opportunities. We need equity so outcomes start to look the same, for whomever you are, no matter what community you come from. We can make extra efforts for underrepresented physicians, medical students, and undergrads. If we nurture that sense of equity, we can better focus on attracting people into the OEM specialty."

Das suggests that when considering promotions within OEM faculty, diversity should also be a factor and not only the number of publications by a faculty member.

She was a co-author on a September 2022 study in the Journal of Occupational and Environmental Medicine that aimed to evaluate the presence of DEI among 24 accredited OEM residency program websites and found a lack of same among resident and faculty photos and bios. Having more, the authors determined, would "help attract more diverse applicant pools."

Rosenthal's thoughts about her new ACOEM Jedi Committee could well relate to the expanding and fruitful efforts of DEI within OEM in general: "We want to plant a seed and have it tended to forever more-to see it grow and just blossom."