301 - The Crisis of Training in Occupational and Environmental Medicine

In July 2025, there will be 19 accredited civilian Occupational and Environmental Medicine (OEM) residency programs in the USA, a steady decline from a high of 40 programs 30 years ago. The number of new diplomates board certified in OEM reached a 7-year low of 63 in 2023. Despite published assessments that training was failing to meet workforce needs from the very beginning, remarkably little has changed in the approach to OEM residency education. The proposed solutions over the past 40 years have consistently included calls for increased funding for the existing training model and efforts to raise awareness of OEM among the applicant pool for residency programs, neither of which has ever been implemented on a wide scale. An in-depth examination of OEM training today informed by the results of an annual survey completed by all OEM program directors together with an analysis of its history over more than 50 years, points to numerous fundamental challenges in the existing approach to training. There is an urgent need for substantial reform, guided by evidence from the experience of the USA and other countries, to ensure the sustainability of the field as a distinct specialty.