Western Occupational & Environmental Medical Association
Leading Occupational & Environmental Medicine

e-Newsletter – February 2011

Welcome to WOEMA’s e-newsletter. After over 50 years, gone is WOEMA’sprinted newsletter for this new electronic format. WOEMA is committed to providing on-going communications to members while reducing its carbon footprint by eliminating paper usage. WOEMA members receive the newsletter via email every other month with contents appearing on this website. It includes links to pertinent information. — Peter Swann, MD, FAAFP, Newsletter Editor 


• Job-Hunting 101
• News You Can Use from the Literature
• WOEMA Board Pledges its support for New CA Public Protection & Physician Health Program
• 2011 Legislative / Advocacy Agenda
• News and Events

Physician Job-Hunting 101 – A Primer
by Peter Swann, MD, FAAFP

It has been said that we are currently living through the hardest economic times since the great depression. Bank failures, unemployment and mortgage foreclosures are but a few of the signs of widespread difficulties. During such times many businesses face choppy, uncertain waters that necessitate employee layoffs and terminations. The business of medicine is no exception. When difficult times strike, physicians may find themselves looking for new positions just like anyone else. Complicating this situation for occupational medicine physicians may be the simple fact that they have been in their positions or practice for long periods of time and their job searching skills may be rusty. What follows are some quick tips and resources that you may find helpful if faced with such a situation.

1. Update your CV. Recruiters often recommend including sections for:

• Personal Information
• Education – generally undergraduate, graduate, post-graduate and CME credits, with dates and degrees granted
• Licensure and Certification
• Work Experience – include all dates and account for any gaps in employment, starting with the most recent and working backwards
• Research – Listings should be in a standard MLA format
• Professional memberships
• Publications
• References – Usually available upon request or a small listing complete with name and telephone number

a. See a sample physician CV
b. A template for CV creation

2. Visit on-line job boards that have postings for occupational medicine. Many of these will allow you to set up an account, post one or more anonymous CVs, set up customized searches that will e-mail postings that fit your search when they happen, and other features. Some of the best ones (all these have listings for occupational medicine) include:

a. The WOEMA Job Bank
b. The ACOEM Job Board
c. MD Jobsite
d. The Physician Depot

3. Consider contacting a recruiter. Recruiters are typically paid by the organization acquiring the physician so there is no cost to you. There are 2 main types of recruiters. Retained recruiters are paid regardless of whether or not they place a candidate physician. Contingency recruiters, on the other hand, are paid only if they successfully locate and place a candidate physician. When working with a recruiter it is always helpful to know whether or not they are being paid on retainer or by contingency. Retained recruiters typically will only show you to one candidate at a time as they are paid regardless of whether you are selected. Contingency recruiters, however, are motivated to show you to many organizations at the same time as they only get paid if you are selected. In short, both have their pros and cons. There are large national search firms with size and scope such as Merritt Hawkins and Jackson and Coker and smaller boutique firms. One small firm that deserves special mention is Medlock Consulting, headed by Nyla Medlock. They have placed a lot of occupational medicine physicians and get very high marks from our colleagues who have interacted with them.

4. Lastly, consider reading a book titled: “Rites of Passage at $100,000 to $1 Million+…Your Insider’s Lifetime Guide to Executive Job-Changing and Faster Career Progress by John Lucht. Although the book’s target audience is really business executives, most of the chapters are informative and valuable to physicians seeking new positions. That is especially true if the position you are seeking is non-clinical. In short, if the title of the position you are looking for is Medical Director, Chief Medical Officer, VP, etc., Mr. Lucht’s book is mandatory reading.

5. Good hunting!

Peter Swann MD FAAFP is a member of the WOEMA Board of Directors and he recently accepted the position of Associate Medical Directorat WorkCare Inc. He can be reached at: pswannmd@gmail.com

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News You Can Use from the Literature
by Constantine J. Gean, MD, MS, MBA, FACOEM


A useful review of the latest journal articles of interest to the field of occupational medicine.

Aerobic exercise training that gets sedentary adults, aged 60 to 80 years, up and walking for 40 minutes 3 times a week has been shown to increase the size of the hippocampus and improve memory after 1 year, per a randomized clinical trial of 60 adults who at baseline got 30 minutes or less of physical activity per week given a course of aerobic training using brisk walking. 60 sedentary adult controls were randomized to stretching and toning exercises. Spatial memory tests and MRIs were collected before the intervention, after 6 mo., and after the completion of the program. At the end of 1 year, participants in the aerobic exercise training group increased the volume of the left hippocampus by 2.12% and the right hippocampus by 1.97% (effectively reversing age-related loss in volume by 1 to 2 y), whereas the control group actually displayed a 1.40% and 1.43% decline in the left and right hippocampus, respectively. Increased hippocampal volume is associated with greater serum levels of BDNF, a mediator of neurogenesis in the dentate gyrus. Proc Natl Acad Sci U S A. 2011 Jan 31. [Read Here]

14%-62% of pet owners allow dogs and cats on their beds and documented health risks from this includes infections with MRSA, parasites (hookworms, roundworms, Giardia), Chagas disease, Cat-Scratch disease, Pasteurella spp., plague, rabies, staphylococcus intermedius and a wide range of other zoonotic pathogen infections, per a CDC monograph entitled Zoonoses in the Bedroom. J Emerg. Inf. Dis. Volume 17, Number 2-February 2011. [Read Here]

Use of Hemoglobin A1c alone, in the range of 5.5 to <6.5%, would identify a population with risks for diabetes ( = 32.4%) and CVD (=11.4%) comparable to adults meeting the 2003 ADA prediabetes definition-whose risks of incident type 2 DM (over 7.5 years) and cardiovascular dis. (CVD) (over 10 years) were 33.5% and 10.7%, respectively. Using cross-sectional data from the 2005-2006 Nat’l. Health and Nutrition Exam. Survey, the Am. Diabetes Assoc. (ADA) proposed the use of hemoglobin A1c as a strategy of testing in clinical settings to identify greater numbers of adults at high risk of developing type 2 diabetes and CVD. Am J Prey Med. 2011 Jan;40(1):11-7. [Read Here]

Individuals over 60 y/o who increased their leisure-time physical activity had 34% lower mortality ([HR=0.66), and those who were continually active had 45% lower mortality (HR=0.55), compared with people who were continually sedentary from 2001 to 2003, per a prospective follow-up study of 2,732 individuals (valid even for those with obesity or functional limitations). Am J Prev Med. 2011 Jan;40(1):39-46. [Read Here]

The 7th edition of the USDA dietary guidelines for healthy eating were released 1/31/11 and include 23 key recommendations for Americans. Last updated in 2005, the new guidelines recommend limiting sodium to 1500 mg in about half the US population. Consumption of saturated fats, dietary cholesterol, trans fatty acids, solid fats, added sugars, and refined grains should all be limited. Research on eating patterns (including vegetarian) is incorporated for the first time, healthy eating patterns limit sodium, solid fats, added sugars, and refined grains and emphasizes nutrient-dense foods and beverages (e.g., vegetables, fruits, whole grains, fat-free or low-fat milk and milk products, seafood, lean meats and poultry, eggs, beans and peas, and nuts and seeds). [Read Here]

50% of articles did not provide accurate financial disclosure for physician-authors who received $1 million or more as paid consultants from orthopedic device companies funding a study, based on the examination of 2007 physician payment information from 5 orthopedic device companies Of the 41 individuals receiving $1 million or more in 2007, 32 had published articles relating to orthopedics between January 1, 2008, and January 15, 2009. The accuracy of disclosures did not vary with the strength of journals’ disclosure policies. Arch Intern Med.2011; 171: 81-86. [Read Here]

For level-specific lumbar impingement diagnosis, likelihood ratios (LRs) of ≥5.0 were observed for anterior thigh sensation at L2; femoral stretch test (FST) at L3; patellar reflex testing, medial ankle sensation, or crossed FST at L4; and hip abductor strength at L5 -(LR=13, 5.7, 7.7, ∞,13 and 11, respectively), per a cross-sectional study with prospective recruitment. From this likelihood ratios (LRs) were calculated to assess the ability of individual tests and test combinations to predict impingement. LRs ≥5.0 indicate moderate to large changes from pre-test probability of nerve root impingement to post-test probability. [Read Here]

Lachman test appears to have the greatest sensitivity (approximately 80%) for detecting an ACL tear, per an article summarizing the epidemiology and risk factors for ACL injuries which outlines physical exam findings that would indicate when an early referral to an Orthopedic Surgeon is indicated. Conservative/Non-surgical care is a consideration when: 1) No knee giving way; 2) No damage to other tissues (e.g., collateral ligaments, meniscus); 3) knee has full or nearly-full ROM; 4) quadriceps muscles maintain good strength. 80,000 to 100,000 ACL repair surgeries are performed annually in the US. Amer Fam Physician. 2010;82(8): pp917-922. [Read Here]

Disc degeneration did not differ between twins who reported previous back injury and their uninjured co-twins, per MRI assessment of disc degeneration between 37 male monozygotic twin pairs with discordant exposures to recalled previous injury/trauma to the lumbar spine (structured interviews). Disc degeneration was assessed using quantitative measures of disc height and disc signal intensity. Disc height averaged 0.3 mm higher in the injured twin, and was on average 0.05% higher at the level of the greatest co-twin difference. There was no evidence that greater period since injury resulted in greater twin differences in disc degeneration. Authors conclude that back injury based on patient report is not an important predictor of future disc degeneration. Spine (Phila Pa 1976). 2010 Oct 1;35(21):1925-9 [Read Here]

Quadrivalent HPV vaccine prevents HPV infection in men with an observed efficacy of 90.4% (in a per-protocol population), and 60.2% (in an intention-to-treat population), against lesions related to HPV-6, 11, 16, or 18, per a randomized, placebo-controlled, double-blind trial of 4,065 healthy males 16 to 26 years of age, from 18 countries. (In per-protocol, subjects received all three vaccinations and were negative for HPV enrollment; in intention-to-treat, subjects received vaccine or placebo, regardless of baseline HPV status.) N Engl J Med. 2011 Feb 3;364(5):401-411. [Read Here]

The CDC’s Advisory Committee on Immunization Practices (ACIP) approved the Adult Immunization Schedule for 2011, with some highlights including recommendations that all persons at least 6 months old, including all adults, should receive seasonal influenza vaccine (if least 65 y/o may use high-dose vaccine); Tdap vaccine for persons at least 65 y/o in close contact with an infant younger than 12 months; quadrivalent or bivalent human papillomavirus vaccine vaccine is recommended for girls and women. Other information is also included. Ann Intern Med,, 1 February 2011,Volume 154(3), 168. [Read Here]

Diagnostic imaging is indicated for patients with low back pain only if they have severe progressive neurologic impairments or signs or symptoms indicating a serious or specific underlying condition, or if they are candidates for invasive interventions, per recommendations from a systematic review and meta-analysis of the Clinical Guidelines Committee of the ACP. Authors conclude routine imaging for low back pain with radiography or advanced imaging methods, such as computed tomography (CT) scanning or magnetic resonance imaging (MRI), does not provide clinically meaningful benefits on outcomes regarding pain, function, quality of life, or mental health. Ann Intern Med. 2011;154:181-189.[Read Here]

The King-Devick (K-D) test is an accurate and reliable method for rapid sideline screening for concussion in athletes with head trauma, per pre- and postfight testing of 39 boxers and mixed martial arts fighters. Scores correlated well with postfight Military Acute Concussion Evaluation (‘MACE’, a more comprehensive but longer test) scores. The K-D test measures the speed of rapid number naming (reading aloud single-digit numbers from 3 test cards), and captures impairment of eye movements, attention, language, and other correlates of suboptimal brain function. Neurology. 2011 Feb 2. [Read Here]

The US Food and Drug Administration (FDA) has approved vilazodone tablets (Viibryd, Clinical Data, Inc) for the treatment of major depressive disorder (MDD) in adults. Vilazodone is the first approved drug that is both a combination selective serotonin reuptake inhibitor (SSRI) and a partial agonist of serotonergic (5HT1A) receptors. Marketing firm Clinical Data notes the mechanism of action “is not fully understood but is thought to be related to its enhancement of serotonergic activity in the CNS through selective inhibition of serotonin reuptake”.  [Read Here]

Researchers have grown vessels using human cells for the first time. They used the vessels to create a fistula to mimic hemodialysis setups. Mechanical properties were similar to native human blood vessels. Vascular grafts were engineered using human allogeneic or canine smooth muscle cells grown on a tubular polyglycolic acid scaffold. Science Translational Medicine Vol. 3, Issue 68, p. 68ra9.  [Read Here] [return to top]

WOEMA Board Pledges Support for New CA Public Protection & Physician Health Program 
by Walt Newman, MD

To our California physician-colleagues:

We have often been admonished “Physician, heal thyself.” I never really understood the meaning of this, so a bit of reading was in order.

In researching “Physician heal thyself”, I was surprised to learn that this is a Biblical quote, from the Book of Luke. It has withstood the test of the millennia.

The concept of “physicians healing themselves” can be difficult to understand, but suggests to me that physicians, while often being able to help the sick, when sick themselves, are no better placed than anyone else.

A similar bit of wisdom came from my Grandmother: “The cobbler has no shoes.” Grandma warns us that perhaps cobblers are too poor or too busy to attend to their own footwear.

The question before us now is “Shall we remain shoeless cobblers or can we again be physicians healing ourselves?”

In 2007, the Medical Board of California eliminated the 27-year-old California Diversion Program, making California one of a very few states without any central physician health program. The remedy for physician impairment currently lies in judicial proceedings only – through the California Deputy Attorneys-General.

A new strategy for Physician healing has begun in California – through the “California Patient Protection and Physician Health” or “CPPPH.”

This will be a full scale program promoting physician wellness and addressing and preventing impairment. A group of stakeholders including the California Medical Association (CMA), California Society of Addiction Medicine (CSAM), California Hospital Association (CHA), Kaiser, and many other groups have joined hands to make CPPPH a reality.

The CPPPH goal is to be funded by physician license fees and by the physicians utilizing its services. But it needs our enthusiasm and financial support to get it off the ground.

CPPPH is in its infancy and I am proud to announce that your WOEMA board has committed $2,000 of WOEMA’s budget to get the ball rolling.

Additionally, several WOEMA Board members have joined in making personal pledges to get CPPH started.

Will you join us in this pioneering effort? You may read more about CPPPH at http://cppph.org/and send a donation made payable to CPPPH) with the attached form CPPPH contribution form to:

California Public Protection and Physician Health, Inc.
Attn:  Lisa Folberg
1201 J Street, Suite 200
Sacramento, CA 95814

CPPPH, Inc. is a non-profit organization and donations are 100% deductible as charitable contributions. EIN: # 27-3452546

WOEMA as an organization is committed to physician wellness, and to the ancient command of “Physician heal thyself.”

Thank you for your consideration of this vital issue. — Walt Newman, MD

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2011 Legislative / Advocacy Agenda is Set

The WOEMA Legislative Affairs Committee has the active participation of about 15 members, under the leadership of our two vigorous co-Chairs, Drs. Scott Levy and Paul Papanek, and with designated legislative “liaisons” from each of WOEMA’s five member states. Of note, WOEMA continues to be the only ACOEM Component with a paid lobbyist on staff, and we believe that the decision by the WOEMA Board five years ago to retain the advocacy services of Mr. Don Schinske has been of pivotal importance in increasing WOEMA’s footprint in the legislative and advocacy arena.

The basic task of the Legislative Affairs Committee is to track new bills and new regulations related to Occupational and Environmental Medicine in our five member states. To this end, the Committee schedules detailed teleconferences on a quarterly basis, to review bills of importance, and to plan coordinated advocacy with other interested groups, especially the state Medical Associations and various state agencies.

To further WOEMA’s goals, the Legislative Committee has developed specific active collaboration with two state medical associations — the Arizona Medical Association (ArMA), where Dr. Robert Orford is this year’s ArMA President, and with the California Medical Association (CMA), where Dr. Levy serves as WOEMA’s representative at the CMA House of Delegates and earned the post of Secretary of CMA’s Specialty Delegation, and where Dr. Steve Schumann has served as our representative at the Council on Legislation and the Workers’ Compensation Technical Advisory Committee. This liaison work is both challenging and rewarding, and WOEMA is always seeking new volunteers to help represent our interests at other medical societies.

Moving to specific accomplishments — in the past year, WOEMA is proud to have helped catalyze a decision by Cal-OSHA to form an Advisory Committee to revise the General Industry Lead Standard. We have long known that the Lead Standard is outdated and fails to offer sufficient protection to lead-exposed workers. Over the past two years, the members of the Legislative Committee have had frequent contact with the Cal-OSHA Administrative Director and other staff, and have brokered many fruitful conversations between staff within the California Department of Public Health (CDPH) and other stakeholders in the area of occupational lead exposure, including the California Occupational Health Nurses and industry stakeholders. Through our efforts, coupled with creative initiatives from both CDPH and Cal-OSHA, we now developed the proposed fundamentals of a much improved and long-overdue Lead Standard. The first meeting of the Cal-OSHA Advisory Committee is set for later this month (February, 2011), with a roughly six-month timetable to bring new proposed regulatory language to the Cal-OSHA Standards Board. We are optimistic that a revised California Standard would trigger similar action on the national stage with Federal OSHA.

The intricacies and oddities of the California Workers’ Compensation system are a frequent topic of discussion within the Legislative Committee. In nearly every one of the past 15 years, the California Division of Workers’ Compensation (DWC) has proposed new and often complex regulations, which the Legislative Committee continues to track. Over the past year, we have submitted detailed comments on an almost monthly basis on such topics as:

– the California Workers’ Compensation fee schedule (OMFS), which sadly continues to be among the lowest in the nation;

– the proposed shift to an RBRVS methodology for workers’ comp billing-a step which is likely to rationalize payment among various specialties and improve the rates for primary care practice, but which has occasionally been challenged by other physician groups;

– electronic billing and reporting, a topic on which DWC is finally poised to implement regulations, several years after a legislative mandate to do so.

– compounded medications and food packs, an area of sporadic but increasing billing abuses in the past few years; and

– orthopedic office supplies and other durable medical equipment (DME) dispensed as part of workers’ compensation medical care.

In the past year, the Legislative Committee has developed closer working relationships with staff of the California Commission on Health and Safety in Workers’ Compensation (CHSWC), and has provided detailed input on a recent CHSWC proposal related to medical liens. CHSWC recently responded by inviting WOEMA volunteers to serve on expert panels for new research studies funded by CHSWC on the subject of medical quality in the workers’ compensation arena.

The Legislative Committee typically schedules meetings with key staff in the California Department of Industrial Relations, either in Sacramento or Oakland, two or three times a year, and schedules visits with members of the California legislature on an ad hoc basis.

Recently, a subgroup of the Legislative Committee began a policy review of recent decisions by the California Department of Pesticide Regulation to license the sale and use of the agricultural fumigant Methyl Iodide within California. A report by this working group is expected by mid-2011.

During 2010, in an effort to be more pro-active and focused, the Committee launched a new undertaking – the preparation of a “WOEMA Advocacy/ Legislative Agenda,” comprising a set of twelve general advocacy goals for WOEMA. By mid-year last year, we had distributed copies of the Advocacy Agenda widely in our five state capitols, and also shared the document with the ACOEM Public Policy Committee and with the ACOEM House of Delegates as a model for advocacy by other Components. Our Advocacy Agenda proved to be a useful “calling card” in visits to state officials, and in conversations with political candidates who were seeking cooperation from WOEMA in their campaigns.

At the beginning of 2011, the Legislative Committee revised and expanded the WOEMA Advocacy Agenda, in collaboration with several other stakeholders, including the California Medical Association, insurers, representatives from the community of Occupational Health Nurses, and various academic leaders within the NIOSH ERC’s (Education and Research Centers). Once again, we will again distribute the Advocacy Agenda widely during the year. [Advocacy/Legislative Agenda]

As in past years, members of the Legislative Committee meet informally every Friday by teleconference, from 7:45 am to 8:15 am. New members are warmly welcomed to join us, and help with the important work of shaping public policy in the field of Occupational and Environmental Health.

Finally, the leaders of the Legislative Committee are proud to assert that our hard work, sometimes frustrating but always engaging, has helped to greatly expand WOEMA’s footprint in the field of Occupational and Environmental Health. This work is vital for us. Helping to shape legislative and regulatory policy showcases WOEMA’s medical leadership on medical quality in our field, and has a direct bearing on our members’ practices and on the health and safety of the American workplace.

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News and Events:


– Next WOEMA CME Webinar is on the topic of: “Visual Ergonomics” by Jeffrey Anshel onThursday, April 21, 2011 at 12N PST. Watch your e-mail for registration notification.

– Congratulations to WOEMA member Constantine Gean, MD, MS, MBA, FACOEM who has been elected to the ACOEM Board of Directors.

– American Occupational Health Conference (AOHC) will be held in Washington D.C. at the Grand Hyatt on March 26-29, 2011.

– The University of San Francsico’s (UCSF) Occupational and Environmental Medicine Update and Construction Industry: Old and Emerging Occupational Hazards Course is fromMarch 17 – 19 at the Holiday Inn Golden Gate, San Francsico. The course offers both an OEM Update and a one day session on construction industry hazards. This course, presented by the Division of Occupational and Environmental Medicine in the Department of Medicine at the University of California, San Francisco, is designed to provide occupational health professionals with a review of clinical toxicology, epidemiology, and the evaluation of occupational and environmental diseases and injuries. The curriculum will also include a substantial component focused on issues specifically pertinent to the health of construction workers

– The Western Occupational Health Conference (WOHC) will be held at the Bellagio Hotel in Las Vegas, September 8-10, 2011.