a, their younger training years when they're still trying to figure out what to do, to the point where many of us are today, having found OEM, applied, trained, practiced, and then out there making a difference in the world. But that pipeline has been going down for many years, and we think that there was some potential to better understand some of the phenomenon that could then drive policy change. Rather than a pure curiosity talk, I think that you'll find a lot of things that we did directly applicable and, to take it a step further, have already been implemented in the recent months. We'll talk about some of that in today's session. And as my last point of context, I wanted to share that the subsequent talk in this room, also on the OEM pipeline, very different approach to the same type of problems, will be here as well. So we'll go get a break, come on back if you like, and we'll talk much more about, in that talk, the implementation of policy and how that will change the field. Standard overview slide, a little background on OEM training for anybody who's not intimately familiar with the current state and structure. The research question, specifically, what we found, what that implies for policy. The way that we did this study, and I hope that you find it entertaining, at least, if not very inspiring, is to hear, in the words of prospective applicants to OEM, their own thoughts, feelings, and ways they make their decisions. This group's never been studied before. No one's asked, in any fashion, this group or these questions. And they have direct implication to how we run training of our specialty, which is the future of this college and the field. Oh, yeah, there's the disclaimer slide from NIOSH. Thank you for the money. I had to put that in there, okay. So here's the problem. I want to use a few illustrative quotes. I apologize. I was not able to use audio recordings, so it was not approved, nor would it really be confidential. But we have the candid thoughts from a ton of folks, and here's some examples. You would need, kind of need, to have quite a bit of context and background to be able to understand OEM. By the way, all these people were considering OEM, but hadn't trained or matched or anything. So these are our customers, if you will, potential clients to come into our field. One said, I want to get involved, and I feel like I haven't been able to. Ouch. That's a friction point. It definitely hasn't been advertised widely, if it does exist. We exist. But if they don't perceive that we exist, how are we reaching them? How should we be reaching them? Not just in theory. I think you guys will be excited when we start talking about some of the policies. I think it's just more of a mature residency in that a lot of the residents already have practice experience. You know, I had 12 years in the Air Force, some private work prior to residency. I get it. That's a lot of our paths. They're circuitous. They're nonlinear. That's part of the fun of this. That's part of what drives our culture. But how do they feel about it? Maybe a little bit different than you'd think. The gray tsunami, I think, as we were talking about it last year in this forum, the average age is now 63, highest average age for any medical specialty, average, 63. The tsunami is coming. These are the board certs. Little peak in the 90s. A few corporate donors that didn't last. And it's been declining. This data stops in 2020. Last it was published, but we got the numbers. They're quite a bit worse. Year after year, decade after decade, generation after generation. Why is that? Gosh, it's really complicated. We're going to get more to more of that in our next presentation. But for this one, very specifically to ask those guys, from the perspective of the residents, what do they think about this? Man, your specialty isn't even funded. In fact, about 45% in recent years, 45% of ACGME approved positions, which are still not yet what the workforce is demanding to be hiring us, which is easily more than double that from an economic standpoint, but even just the ACGME approved level, 45% on average are not being funded or filled. And with almost no exception, when we talk about positions being unfilled in ACMED training programs, it's because they're unfunded. There's no money, can't take you on board. Otherwise, the infrastructure's there. Here's some recent data. Just got 2024. It's back from ERES. We do not have 100 applicants per year. I understand that ERES isn't the only pathway, but it's far and away the majority. And when you compare this to any other specialty, or even the past of OEM, and we've never been big, this is a mere fraction. We've had 20 programs closed since 2020, and I'll tell you, as we speak, three more programs are closing. ACOM estimated a few years ago that we're going to lose 1,600 OCDocs in less than a decade. That's more than this whole conference. Just to put it in perspective. NIOSH did an estimate a few years prior to that and actually estimated only 1,400 total practicing OCDocs in the countries. In other words, we're looking at a full replacement in less than a decade of our specialty. Hopefully, you know, showing the three different ways of painting the picture all solidifies the same phenomenon of why we need to tackle this problem. It's not just us sitting around here talking to each other. We need to go outside of OCMED and figure out why they're not coming, why the dollars aren't coming, why the people aren't coming, why the structure's not working. Last overview slide here, and then we're going to dive into the research question. There are overall 23 residency spots, residency programs. These are including the ones that are pending closure, by the way. We'll be down to 20 in a few months. More are closing. More have been closing. This has been going on for two generations, at least. All programs, in case you're wondering, every one of them is a two-year program, at least under their registration. You need a separate PGY-1. Typically, program directors want more applicants. They want more qualified applicants, more numbers of applicants. They'll take an increased quantity and quality any way we can deliver it to them. It's approximately a third, a third, and a third of who comes into our field. This is what makes it really unique. Even General PregMed doesn't quite have these numbers, and we're talking about those securities pathways. A third come more or less straight through an internship, which is kind of the minimum quickest pathway to come in. Many people have some additional PGY training, some independent practice experience. Many of them are board-eligible or certified in other fields, typically medicine, internal medicine, family medicine. There are a few folks that come in in advanced standing. What that means is that you can actually come in, like, as a second-year OCMED resident that has a PGY-3 under certain circumstances, lots of military folks, some people through the complementary pathway, like an industry-funded one-year training program. We are really diverse, which is cool, and it's also very confusing, is what we found, and that's a huge theme we're going to talk about. The application systems are numerous, and again, we think of that as, oh, that's cool. Let's hear what they think of it. The match, if you've noticed on it recently, I knew there used to be letters. I found literature back to the 50s describing how this stuff occurred before any algorithm-based ranked matching, and we're doing it like our grandparents would have done it. It's manual, to say the least. What do they think about it? This question's never been answered. We will hear in their words. I think that's the most fun part of this. Okay, we can't graduate enough folks, can't fill job demand. We need to fix stuff. Existing literature. There's lots of surveys out there on us. There's been plenary sessions. There's been, you know, lots of research on graduates of OEM programs, current trainees of OEM programs, but recall the perspective of a person that changes, and here's a fundamental assumption. Why are we even studying prospective applicants to ACHMED? Because that's who we're making our sales pitch to, not just one-on-one, but as we design our systems of marketing and recruitment. How is it going? Not well. And we're not going to fix it by doing an echo chamber in this room amongst folks that are already sold on OEM, already trained in OEM. We'll reach out to them. Generally, we knew that visibility was very low. There's informal exposure at best, whereas you had a friend, for example, that had heard something, and then you go to an internet forum. Is this how we want to be visible to the rest of the medical and general population? Typically because of this lack of information and other reasons for mentorship and exposure opportunities, they're unprepared for OEM training to come into it. Think of it, a person going into neurosurgery is exquisitely aware of what they're getting into. OEM? We'll hear their stories. Funding is a mess. It's not CMS like almost every other specialty. It's inconsistent. It's variable between programs. It fluctuates over time, and it leads to a lot of uncertainty for us in the field, certainly for the program directors and even the applicants. Funding is the primary determinant. If you got, you know, if I just handed you a blank check, yeah, you could graduate an extra resident this year. Typically it is the most immediate limiting factor. So what we don't know is how attractive is OEM? Not to us. I love it. You love it, too, probably. What do they think? And there's a range of responses on that, and why do they think that? But overall, our goal is to increase the number and preparedness of applicants into the training pipeline for OEM. So it took many, many months to boil it down to one question, and this is really what we're going after. What influences those factors, OEM trainees' application decisions? The rest is pretty much history. If they like OEM enough to apply, we're set. But getting up to that point is a real struggle, and we're going to learn why by hearing their voices. The prior studies typically were quantitative, by the way. We're going to hear about the research methods here in a minute, but novel problem, novel methods. This is not a cross-sectional survey, and there's a lot of data out that, thank you, Dr. McKenzie, and many others throughout the training pipeline and beyond through ACOM and many other institutions that have been asking this question with different techniques, different populations. And those answers have not been yielding fruitful results. Ours are different. And we have reached those results, and we'll continue to grow, and we're going to talk about that at the end. Specifically, one thing we did not go into, in case you were hoping to hear from today just to get it out there, we did not go into differences between training programs. This isn't a Peter versus Paul kind of thing, one training style or structure versus another. This is OEM as a whole, and so please keep that lens through our presentation. So the specific research questions we developed, how do prospective applicants get exposed to OEM? What do they know about OEM? How do they select their specialty, generally? Especially if it's OEM versus another field, which it usually is. What values and perspectives influence that decision? Things about their personality or history, for example. And we want to know this, because then we can select, modify, and target these folks. What do they perceive as the positive and negative aspects of OEM? And I'll tell you, they're quite different than I think you are in my beliefs. What would they suggest to increase the attractiveness of OEM? This is market research, guys, come on. But it hasn't ever been done before. So we're happy to share those results with you today. Here's the design. We designed, set up, to be able to capture this requisite information to solve the existential threat to our specialty, extinction. So the phenomenon of interest was undescribed. Nobody really could develop a survey or target the people in a traditional quantitative approach. So we decided to use interviews. Qualitative design. It was a semi-structured, private, anonymous interviews with prospective applicants. We'll talk about the exact target population in a minute. We had both inductive and deductive dimension. And you study design folks, I would love to go much more in depth, but most folks probably don't care about the nitty-gritty of the qualitative design here. Needless to say that we followed the standard, you know, grant and IRB and structure. But if you're not super experienced, I'll keep it very brief for you in terms of the flow of how you develop this. The interview guide is a document that you prepare, like many of these others, that helps you essentially add structure and validity to the final findings. The interview guide, specifically the asterisk there, is because several parts of this we added redundancy with outside partners, professional research and analytics firms, to make sure that the quality of our data was valid. There's no question that what we have found is valid. And we can go through the quality assessment and everything there, but it's through redundancy and multiple qualitative approaches. Recruit people, interview them, develop the codebook, that is to say those major kind of words or concepts that we've found between the interviews and throughout interviews, transcribe everything, code the actual interviews, and then do some analysis and drive some conclusions. And those naturally lead to the policy implementations we'll talk about at the end. Dr. Rivette, unable to be with us here today, led the analytics team. Recruitment. Inclusion criteria is pretty broad. You didn't even have to be an adult or speak English or be in America, you know, like any of these other studies. We didn't have any of those restrictions. We were able to take anybody, not even doctors, right? Being a physician is not a requirement to be in our study. We were asking folks, anybody who aspired to train in medicine at any point or fashion, that had at least heard something about OEM. This is broad. Needless to say, most of our respondents were, as you'd expect, a little bit more established on that path. Our only exclusion criteria has nothing to do with who they were or what they thought. It was that they were already matched or trained in OCMED because that changes a person's perspective and they aren't the customer at this point. I am aiming for who they were two years ago, five years ago. It's one of the big fallacies of all the prior studies to this question and the full field of OEM training in general. So how do you do this? Our methods were pretty straightforward. We emailed a lot of different avenues to try to get at different populations, different parts of the country, different parts of training, different values, priorities, and different systems. Here's a list here. AOHC Residency Fair had a sign-up. Use the internet list for this college. We had an OEM Joint Pipeline Task Force with dozens of representatives in all types of organizations across all the states. Use all of them and all of their networks. Med school advisors. And then we used a snowball method. If you're not familiar with snowball sampling for recruitment, typically you just would ask your really high-value, really informative research participants, do you know anybody that would have something to add to this conversation? Two of our respondents, not a lot, were recruited via that method, very highly relevant. We selected everyone to be interviewed, and everybody actually was interviewed and included. There was no attrition from this study, no source of bias. Sampling continued in terms of our N. We continued sampling until we found meaning saturation. That is to say, you're not discovering any new themes or content, you know, participant after participant. And we really didn't know what that number would be until we finished the study. Fortunately, we didn't run out of money for anybody who's run a study before. We had 21 study participants. Very diverse, but interestingly, pretty consistent in their answers. We conducted interviews just this past November and December via Zoom. We had 17 hours of responses, so the average person would speak for 49 minutes. In their words, all the nitty-gritty, what they think about our field, how they're going to get in, good and the bad, and a lot of conflicted stuff. We're going to paint the picture of exactly what that looks like in their words in the next slide. Lots of pages of this stuff, and honestly, their voices echo in my mind every day. By the way, if you care about, like, doing something about this, we need your help. Every way to implement this, especially if you're involved in a training program in any fashion currently or would like to be, and you want to get these answers into the real world through your local implementation, please let me know. It's a huge data set, and it's already filtered and coded. I can give you exactly whatever product report you want to drive whatever type of decision you need to make at the local level for any group. Average age was 32, not so surprising, but look at the range, 23 to 51. We captured a lot of folks. Different folks, it's good, but they shared the same stories. Even the guys that began medical school 0.4 years ago, that is, like, right in the beginning of their first year, had remarkably similar stories to guys that started medical school 15 years ago. It's interesting. Every year of training was represented through, you know, the first year of medical school, you know, 2, 3, 4, PDY1, PDY2, 3, 4, all the way through board-certified independent practice, a huge range represented. The gender, race, and military status, which are kind of the core traditional demographics in prior OEM studies, for us, even given the low end, were surprisingly proportional to both general ACOM membership, attendance, as well as prior studies into the pipeline. There's three overarching themes, and we're going to spend the rest of our time today just talking about this. First, the various unknowns of OEM are barriers. People don't train in OEM, and subsequently practice in OEM, for pretty consistent reasons. There's a lot of unknowns, though, very specifically, and we can go through those in subsequent slides, exactly what they are. Here's an example. I'm not going to read it to you. Here's some very broad categories, and there's a lot more detail for anyone who's interested. The second fundamental idea is that there's misalignment between when a person is aware of and interested in OEM, and when they're available to train. Would you take a $60,000 salary right now to go back and do something that you loved? No. Would you? Okay. John, raise his hand. Thank you, John. Okay. Yes. And he did. Is that realistic to ask for most folks? And many other barriers that really just kind of are an unfortunate conflict between who we kind of are, what place we play in society as OCDocs, and an appreciation of that maturity and breadth doesn't come automatically to 23-year-olds. It comes with time, but unfortunately, with time, we lose the opportunity to go back into a training status for a variety of reasons. So there's this mismatch, misalignment, unfortunately, a critical driver of the low numbers of applicants. The third completely separate theme that we found was that even people who want to train, and this is a huge assumption. Okay. So they found out about it. They liked it. They pursued it. They learned some about it. Okay. And those are all huge steps. But even once we get there, somehow, miraculously, you have a magic wand, and everybody is aware of OEM, and we have all the money, and all these other things. There's still a problem, and it really kind of only affects our specialty, regrettably, more so than anybody else, and that is the procedural burdens to enter training. And maybe you didn't experience that, but these people did. And more importantly, it wasn't just a struggle that they went through. It caused them to turn ship and go to family med or something else. That's a lost opportunity. The field generally aligns with participant values. We're going to hear specifically what those are, but the overall theme here, number three, is the field of OEM is inherently attractive. We know that. We know all our friends in general surgery who wish they could bounce over into our field, and they don't. They couldn't then either, and we're going to paint the picture of why and how we can change that, what we have done to change that, and what the future looks like. Theme one, Sherlock Holmes. Exposure is pretty minimal, if any. Oh, okay, we knew that. OCMED is not part of the curriculum in any school. According to most of our participants, they said this, zero exposure through the formal channels. There are some exceptions. This is the vast majority. I think we had a half hour lecture that was canceled. I laugh when I do these interviews. I think there are two places that have medical student classes. Mary Ann Florent has built one into the University of Maryland, and UC Irvine has built one into the University of Maryland, and UC Irvine has built one into the University of Maryland, and UC Irvine has built one into the University of Maryland, and UC Irvine has built one into the University of Maryland, and UC Irvine has built one into the University of Maryland, and UC Irvine has built one into the University of Maryland, and UC Irvine has built one into the University of Maryland, and UC Irvine has built one into the University of Maryland, and UC Irvine has built one into the University of Maryland, and UC Irvine has built one into the University of Maryland, and UC Irvine has built one into the University of Maryland, and UC Irvine has built one into the University of Maryland, and UC Irvine I just got one approved in the last nine months. So this is a new thing with Alliant. Thank you. Hard work. You know, Tyler's working on one, too. There's some exciting fronts on this. Thank you. I hadn't heard about Irvine. We need to grow it, but this isn't the only step we need to battle it. Our field, there are like five distinct phases that applicants are turning away that they shouldn't be. And what can we do to change that? Thank you for your input. Thank you for your comment. And then, you know, the military thing. Why did I mention military earlier? Whether you have experience in it or not, the military is just a huge demand and supply of OCMED training and practice. And a lot of folks, especially through like the GMO, flight surgeon type pathways, a lot of folks get their exposures to and fall in love with OEM through the military. So we'll talk about that military theme throughout. It's a high fraction of our field, and current trainees, and prospective trainees. Continuing theme one, these unknowns of OEM. I always thought it was a fellowship. This person and many go on to say, it's a fellowship, so I can't apply. I'm only a PGY-2, or whatever. They immediately wrote it off. Why did they not know we were a residency? Oh, it's because they're dumb, or they didn't look it up. Or maybe is it because that information actually isn't out there? Or it's out there and it's conflicting. These are a lot of things we've got to address. I don't know anyone in OEM, so I had to rely on these very dubious sources. I don't want to list them here, but they did. Some internet forums and other things. Is this where we want people learning about our field? I don't think I'll be able to solve the uncertainty question. This is a person at the crux of OEM and another field. Ambitious, very competitive person. Are they going to go into ophthalmology or something at the time? Or OCMED? How many residents is OEM stealing from ophthalmology? None? OK, one. Thank you. Thank you. Dr. Levine, one. No, not me. No. Dr. Saito. Oh, Dr. Saito. I should have recalled that about his story. So there's one. There's a lot more that it should be stealing from ophthalmology and every other field. A person just says, I don't qualify for this. They just move along. Many people who had exposure and interest, shockingly, did not come to OEM because, in their own words, they could not find answers to these basic questions. Sad, right? Theme two. You recall that this is the one where people's interest in coming into and their awareness of OEM and their desire to train and practice in the field is mismatched with their opportunity to train. I'm too old. I can't move my kids. I make too much money now. I don't want to go be a trainee socially anymore. Various things. I really love this first quote. OEM is something I enjoy, being a flight surgeon. I would enjoy this career long term. I would be able to facilitate my family goals, non-medicine career goals, while having a very fulfilling medical specialty. I would see as having a lifetime, infinite number of challenges that would be stimulating and rewarding. There's so much in there. And we've got hundreds of pages of this stuff. The number one word in this category as we're going through the structure of the interviews is wow. Aside from like the and and and some articles, it's the word wow. Come on, this is an asset, guys. Why isn't it working? We are attractive. Why isn't it happening? Well, we figured that out. And we're going to be continuing to present that, this presentation. And by the way, this presentation only covers three themes. I mean, we've got dozens more. And 100 sub-themes between all of these as well for anybody who's interested. But I just want to present the most salient ones that are broadly applicable to you. Results theme two. OK, so there's this shift. You have like the standard doctor, right? OK, I want to see patients. I want to help people. Think back to medical school interviews. There's kind of a mold, right? Like if you're a pre-med, it's really competitive. You want to get into med school. And then somewhere along the way, people shift in their perspective. Think back to like the third year of medical school. Think back to some of your friends or your own experience. And there's like, hey, I discovered a field. I really like this one. Or maybe I don't like this other field. What's oc-med? I don't know. I haven't heard anything about it. But then later on, you hear something about it. And more importantly, who you are changes your perspective on life or work or whatever it is changes. You've got a bunch of kids now. Or you're frustrated with the inability to prevent conditions. Or you want to work on a population level because the one-on-one stuff isn't satisfying you or whatever it is. Something shifts in your perspective. I don't want to just be a monkey in the system. Like, go see a patient. Go see a patient. And it's a little humorous. But we've all been there, at least at one phase. The pandemic made me think about what's more important in life. Stability has an appeal now versus in my younger years. Meeting my family at night at the dinner table, that's what's important to me now, since my son was born. You hear the same theme, that shift in perspective, that makes two things happen. The drive up towards wanting to go into OEM. But these same pressures oftentimes were what decreased their ability to go back into training of any kind. It was a mismatch. They want to turn around their Gen Surge career, their family med career, whatever it is, general prev med. Many folks want to turn around any given field, probably from OEM too. But they can't. Why not? My limited window of opportunity to complete residency with my kids' ages, supporting my non-career family goals. It's hard to go back to school after being paid significantly higher. Average salary is about $60,000 right now, often without $60,000 a year, often without benefits for your family. Could you do that? Hard sell. Hard sell for a lot of this conference, who's family med trained or otherwise phenomenal leaders, clinicians. Can't go back to training. But could you if we structured it a little bit differently? These are the chats that we're having. OK. Lots of folks want to change their specialty. And then there's this during and after the military thing, which is really kind of a unique time. We had a lot of participants say the same story with regards to this kind of last idea after getting out of the military. So you're talking about somebody who's 30, 35, 40, somewhere in that range. They're getting out of the military after however many number of years. And their one year of training, because the military does this as a large part of the DoD model. One year of PGY training with the ACGME, they're eligible for our training programs. They've been practicing OcMed. They like it in almost all cases. And they want to come back and train. Many of them do. But how many non-military 35-year-olds are we capturing? Not many. So military separation seems to be one of those big life events that changes people's ability and desire to go back to training. And at least I can say through all my military years, it's not that much of a decrease to go down to 60 a year, starting from the military, because you're only making about double that in the beginning, especially if you have other revenue sources. OK, theme two is we're talking about these people that as they've developed the desire to go back into OcMed, they don't quite have all of the ability sometimes. But there's different paths to get there as well. I think about it every day. This is a beginning of the second year family medicine resident, I think, who says, I think about it every day. Complete the full family medicine residency. And I'll say that she wasn't very happy thinking about 21 more months in this, and get boarded, versus transitioning into OcMed, essentially that cycle. This is, as you saw, it's about a third of our total applicants. This is a huge way that we get people into OcMed. But how do they think about it when they're actually making the decision? How can we help them make the best decision? And maybe that isn't always going to OcMed. Maybe they go into complete family and then practice, or do both trainings, or other things. I'm not saying one way or the other. It's not a position. But they are struggling, so many of them. Even if it's just 5% of family med, internal med, general surgery, whoever at residence, even 5% of them are more than our entire field at any given time. So there's this huge potential to reach these customers and bring them in to our brand. I've had three extra years, GMO military years, to reflect on which specialty. This is that maturation process. How do I like to work? How do I like to make a difference? And what's working out there for me? Military experience seems to be like a single biggest alignment that we've seen. You can train in internal medicine and practice occupational medicine. That's many of us here today at the conference and in the field. Gosh, there's a huge job demand. We need everybody. But would it be a little bit better if we could provide that opportunity to the people who wanted it, to train in OcMed? I can always pursue it in the future. Usually doesn't happen. The third theme that we found, first, I want to talk about what their values are. This is kind of a precondition, is that who they are and what they want and what they think OcMed is, whether it's accurate or not, they actually align. This is the kind of stuff money cannot buy. We already have it, in fact. So their values, for example, they say, oh, I want to work beyond medicine. I want life beyond work. I want variety, options, a flexible career, happiness, marriage, and children. Hear this from everybody. Prevention, I want autonomy over my schedule. I want time with my patients. I have a very specific geographic limitation, usually due to dependent family members. I want a non-traditional career, these quirky personality types. That's many of us, me included. I want to do something in administration. Training needs to be manageable. I want to do something like I did when I was a flight surgeon. I want good job opportunities, best satisfaction of any medical specialty, lowest burnout of any medical specialty. That's what they want. You guys already know what the answer to these questions is, right? In terms of alignment, we could go on and on. They want to be board certified through ABMS. They want to repeat internship, be clinically competent. When you ask them to describe OEM, interestingly, I was floored when they said, the most common word by far. What do you think OEM is? I remember they haven't practiced it, most of them, or learned much about it. They say, holistic. It's not just the DOs. Holistic. They use that word specifically and describe it in much more detail. That is to say, it's this whole concept of, it's not just your knee. It's your knee in the context of doing your job, or I would dare say, the context of lifting your kid at home, climbing the stairs with your groceries. So there's this functional whole person, all time, all functions, that we as a field are considering. At least they think so, and they're very attracted to it. Friendly conference, as we've experienced here today. Diverse ways of working, and projects to solve for a different number of clients in a different number of settings. We could go on and on. You know what OEM is about. These align. This is a critical assumption, and it's an invaluable asset. Oh, and clinical care. I was on some of the quotes. But the vast majority of people want to maintain throughout their career, they say, some level of clinical care. Wow, this is actually a field. So what are some of the good things about OEM? And of course, we had to ask the different question on the next slide. The lifestyle is good. This is pretty much what I do as a GMO flight surgeon, and there's a lot of demand for jobs. This sounds awesome. That quote, you look at the factors. We found it in well over half of the people in a similar situation. There's three or four things. Satisfaction or burnout, jobs, availability, or pay. Lifestyle stuff, which typically comes down to the hours, when you really ask them, what do you mean by lifestyle? They're talking about total hours, distribution of hours, unpredictability of hours, control over hours, and similarity to military practice. Now, the interesting thing here is that there's actually some differences and we're going to talk about this kind of throughout the rest of the presentation. There's some differences in terms of the style of responses. There's almost two cohorts that we found. Didn't anticipate this at all. You've got your medical school and PGY1 folks. Think about that style of training. It's didactic, classrooms, like very basic level. Like, surgerize these conditions, don't surgerize these conditions, right? So it's pretty basic. And that's the mindset by which most of these early, I will call them, or junior respondents in med school, PGY1, had and is a stark shift. The time of this shift seems to be PGY1, PGY2 transition because universally, when you get to the PGY2 and onward, decades onward in some cases, that's different. The way they make their decisions is different. What they value, who they are, and what they want in a job and how they view OEM is actually slightly different. But there's still alignment between these two cohorts. But there are implications for marketing strategies. More junior participants typically said, I want a mix of, you know, clinical and population health type things or prevention, diversity in practice settings. Senior participants were a little more practical and less idealistic. I don't know if that's a good or a bad thing that happens in life, right? Senior participants said, not surprisingly, they want opportunities to influence policymaking. They want opportunities to influence policymaking, whether that's privately, through healthcare, through the employers, or through the government. Okay, all right. The differences between these two groups are also present in what they did not like about OEM. As you read this list, you have to notice that these are not big problems. Oh, they don't know very much. No, they can't describe the field. They don't know what the income potential is. Now, typically, you know, as medical students do, they compare it to like, oh, you make less than cardiothoracic surgery. Of course you do. Everyone does, you know. But they're not considering cardiothoracic surgery. Typically, they're almost universally considering either family or internal medicine. We have the data on that. It's over 80% or just those two specialties that they're considering. And compared to those specialties, how do we fare? Do they know? How did that influence them? Income potential, lack of public appreciation. It's interesting. The younger folks really want to be known as within that community. Like, oh, I am a well-respected member of the community who's making a difference to the general population. The real doctor question. And many of them use these words. A real doctor. What does that mean to them? In their words, it was the same answer every time. It's the lower acuity. You know, you're not doing trauma surgery, right? So, it's lower acuity, typically, and a lower volume, in many cases, patients per week. So, that's how they define real doctor, and they see that as a potential negative, especially as perceived by their peers, and perhaps as well themselves, but they didn't say that, the peers. Fewer procedures. Okay, and they don't know how competitive it is, how competitive they are. What's the average board score, by the way? We don't know. And we haven't had a capacity to even gather that information. How many people can consider us, as junior applicants, if they don't even know what our average board score is, as a field? I see all these military folks. I see all these board-certified folks going into the field. This is inaccessible for me. But it's not. Huge amount of our trainees come straight through the pipeline. You know, PGY1 directly in. Senior folks, though, had different negative opinions of some things about OEM. They said that the clinical case type can be frustrating. Think about those chronic, low-back pain patients. And it's not just primary care follow-up in six months. Like, it's a worker's comp. You gotta see them more often. You're intimately responsible for coordinating this stuff. It's just frustrating for people. Same with the disability system. There aren't as many job postings for non-clinical jobs, and this lends to the perception that their jobs aren't out there. Whether that's real or not, that's what they think, and that's what's driving their decisions to even enter the field. They're a little worried that you can practice OCMAD without training in OCMAD. And that non-physicians can practice OCMAD. And generally about the future of our specialty. Those are topics that have come up for years, and really are gonna be debated at this conference on Wednesday. Also that they really, really liked one-year training options, especially for folks that have been practicing in OCMAD. You know, some of them are fellowship trained in like an internal medicine specialty. You know, they're already doing coal miner pneumoconiosis every single day. They want to train in OCMAD for a one year, but they will not do two. There are one-year pathways. They know about them, they want to do them, and they can't. This turns people off to pursuing it. Again, we can make serious progress on all this. The other thing I want to say, and the last point there is, what is a pro is a con. One of our biggest pros is also one of our biggest cons, to different people. And that is the mix of non-clinical patients. So you've got clinical and non-clinical, that defines our field, more so than any other field, GPM or anybody. That says, wow, I really like that mix, but my friend thinks that's not a legitimate way for me to spend my medical career. And that shift evolves a little over time, as we know, to kind of favor OCMAD as time goes on, but it's interesting that a pro is a con in this case. Other studies on this have confirmed the same phenomenon. PGY-1 is also a continuation of Theme 3, that the process overall of getting into training is a barrier in itself. It's not that people don't want to, and even if they discovered it and had all the money in the world to fund all the training positions, the way we go about doing it is clunky. There's a few steps of this. Okay, PGY-1, you have to find it separately. You want to train in my OCMAD program? You can't. Go find a PGY-1, talk to me next year. How many of them come back a year later? Like, almost none of them. Loma Linda has PGY-1. Thank you for mentioning Loma Linda, Akbar. Thank you for being here. And we're gonna hear a lot more about his brief and his model in the subsequent presentation. Go pee, get some coffee, come on back. Yes, that one's not part of the scope of this NIOSH-funded project, but yes, thank you for bringing that up. And that's a model we should continue. It's worked, and it will work, according to them. We've already asked, and it's a universal answer. There were no nay votes on that one. 100% congruence with this answer. On the application system, this was a surprise to me. Many people, it caused them, in their own words, to stop considering OEM. Why? Just apply through ERIS, like every other specialty. Oh, really, it's that simple? Well, they don't think it is, because when they look, it looks more complicated, because not all of them do use ERIS. There are actually three systems. In their words, it's not streamlined, but think about it, they have to apply to the MPH like separately from the, and then that's not really a big deal for those of us that have been through the process, but they don't know that, and they think it's a barrier, and they stop applying. What can we do to change this? This is easy stuff, guys, really easy. And specifically on SOFAS, lots of data, specifically people say, I will not apply to programs that require SOFAS. Right now, there's two in America that do that, and they have their reasons, and we've talked a lot about that. But the perspectives of applicants is, I won't consider you. Interesting. There's some pros and cons there, but it's interesting from their words. The interview is interesting perspective, a little beyond this study. Nobody said it was a deal breaker, that they were all, pretty much all remote interviews, but it was interesting to find that everybody agreed on the same idea. There are, everyone loves remote interviews, and everyone loves in-person interviews. But there's a conflict here, because there's two different values within everybody. It was consistent. One is convenient, but then one gives you crucial intelligence, or intel on the ground, boots on the ground observations, to make the decision of, where am I gonna fit in and be happy for the next couple years? So this is just an inherent conflict. There's really no way to resolve it within the interviewee, or the perspective interviewee. The match, this was interesting. Lots and lots of different negative words about it. Confusion was by far the first number. If anyone doesn't remember the match, essentially it's like a job offer. You just get a phone call. Hey, Johnny, you wanna come over here? Kanisha, we'd love to have you. Thanks for coming. Actually, no, I'm waiting on UCSF to call. Sorry. That happens. It's a manual kind of system, and it's a little bit of a game, and it's, people have different opinions after they've gone through it. But that wasn't our question. What do they think as they're considering applying to Achmed? They say, how do I match into your field? They look on NRMP. We're not even on NRMP. How do I get in? Oh, we'll just call you. Oh, that sounds cool. Well, two people said that sounds cool. But everyone else said, oh my gosh, actually the way that you match is a deterrent from me even applying. And if I don't want to match, and I don't want to apply, then I'm not even gonna do a elective rotation in your field. I'm not even gonna ask my friends about you guys, and they just walk away. And then when their friend says, hey buddy, what medical specialty could I do? OEM doesn't even come to mind. We are not even at the table in the general medical discussion, partially for a lot of these factors. It's risky, second most common word that came up. Illegitimate came up a lot, like that exact word. This is not a real specialty. It's like, oh, this is a non-AVMS approved training program. No, no, it actually is an AVMS approved training program. It just doesn't look like it. And the perception of the process directly influences whether or not they come into it and reinforces that stereotype. And we've been there for generations. So here's some fun quotes about risk. Won't go through them all, but you can take a look at what they're saying, and we've got hundreds more. Risk causes interested applicants, qualified prospective applicants that are in many cases the most competitive academically to never consider us because what they've learned says, I can't trust this. This doesn't look safe for my career. And they walk away. And then they don't send their friends to us either. You're making people drive away off the bat. Okay, so the match quotes. I say a little bit less relevant now because two days ago, in case you guys haven't heard, hot off the press, maybe this is the time to spread the word, for good or bad, after robust debate, decades of debate actually, the question of the match has changed. ACHMED, the last surviving specialty of the 1950s system of manual matching. That was before the NRMP. In 1952, they started the systematic rank base, and it was on paper, but then they had computers take over, and then there was an automated computer thing to take over. And there's different companies besides NRMP that do this, UCSF, Urology. But we still had a manual process. We were the last specialty, decades after every other specialty, even General Preventive Medicine has a computer that runs this. We switched as a field, for good or worse, and there's lots of implications and lots of discussion about this, two days ago. But you're here in this session because you want to hear, not what do the program directors think about it, what do your buddies think about it? That's important. What do they think about it? Well, unless you know 21 of these folks, let me tell you what they think about it. They love it. They now can consider us and learn about us because NRMP creates data on all of the ACGME websites and all these other secondary, Doximity, all the other feeder systems, through AAMC and AMA and everybody. So we will be transitioning this cycle to NRMP as a field. It's a huge shift, right? Hotly debated, huge shift. Yeah. I don't take a position on that once or another. I just collect the voices and share the data. Why not apply to this field if you like it so much? People won't train in a specialty that's unknown to them or others. This is that theme one, remember? Unknowns are a barrier, but this is an overcomable barrier. Stick around for the next presentation if you want to hear how we've already delivered that and how we'll continue to change this so that the next generation of our replacements will be more robust, more informed, more passionate, and more willing to be informed, more passionate, maybe get a couple points higher on their board scores for whatever that's worth. But this will redefine our replacements, the next generation of OCDocs. I can't go back to training now. Remember theme two? People who are aware of and want to go into OCMED can't because not just the process is a barrier, that's theme three. It's because the timing and the values in their life revolving generally just being in a training status is incompatible, theme two. And on theme three, to get very specific, there's no path, I can't match out of medical school. I want to tell you a story about a lady who did public health as undergrad. She got a master's degree too in public health. She actually worked for NIOSH, moving around the country for all these years. I mean, this is like a doctor who did a very illustrious OEM career by any of our standards. Can you train, you want to go back to train in OCMED? I don't think I'm competitive. There's no path for me to do that. This is someone who's, I mean, they've been doing it, right? Something about this needs to change. And you hear this story over and over, same themes. So with the exception of Loma Linda, we'll hear more about that model in our next presentation. And please, Dr. Akbar Sharif is here. Do we understand you for a minute? If anybody has a question, Akbar Sharif is over here. The president of, the director of Loma Linda created out of necessity, entirely different model than every other training program in a lot of ways that we have in America. And it's thriving in every way. Parts of this will be the model going forward, need to be, or our specialty won't survive the next generation. The twice application is really risky. This is a theme. So you take a fourth year medical student, you know, pick of the litter, and let's say they really want to go into OCMED. They've got to go through the application system twice because unlike other specialties, you know, ENT for example, they won't advanced match you. No program does. You know, you're going to some independent PGY1. And then after you've completed that, we would love to have you on board. Right now they're saying, don't call. Don't even call until you're qualified. Get through that cycle, pass your steps, get your other match, complete that, and then come talk to us. But they don't. They go to ENT or whoever else next. Risky, we talked a lot about that. The last thing there is just those two cohorts, right? So this is med student, PGY1 cohort, and the way that they value life and approach their career and non-career interests, and what they think about OEM and why they think it's a good match is equally as positive, but just different factors than what I'm calling the more senior applicants. So successful information campaigns and recruitment should study and reach these potential customers. We're the first, there need to be a lot more of this. Or just look at the data set we've created. This is an easy study, guys. We already got the funding, we already put everything together. Just read it and draw your conclusions or publications or whatever you need. Please, share with anybody. It looks like I got an extra comma there on the second bullet, sorry about that. The non-clinical mix is unique and attractive to some, but it's negative to others. But remember, like a million sperms swimming towards the egg, you don't have to get every one. You don't have to catch every fish in the pond. You just need a few ones. Find the alignment and capture them. The last bullet on this slide is the application and match systems and the requirement for an independent and earlier PGY1 application and match. Structural procedural things, they discourage applicants. And I think with the NRMP, actually, because you can simultaneously match in advance and to both programs, guaranteed to the other program, both increases significantly their qualification to both the PGY1 program and the OEM program. There's synergy here. We skipped a decade in development when we adopted the NRMP a couple days ago. Okay, so policy. We need to increase awareness, generally, unless you have a lot of free time, you're not gonna be able to knock doors. We need to use the internet, but then also have people available to answer these follow-up questions, many of which are us in the room. We volunteer. We talk to everybody that's interested about OEM, but that's not gonna be sufficient. We also need the internet part. Our recruitment materials should understand the value of these junior and senior applicants. There's a shift there, remember? Targeting high-yield applicants, this is efficiency out of necessity. Specifically, there are three groups of people that we found to be overwhelmingly more receptive to this mismatch of timing. People who want to but can't go back to training has three exceptions. We talked about DOD, military separation. Also, upon completion of IM and FM residencies, or sometimes even in the middle of IM and FM residencies, and others, but typically these two, the third category, although smaller, has a very high rate, virtually 100% by the time we've included them, in saying that they want to train in OEM. How are we targeting the people with like MPAs and MPHs, law degrees? We're not. Could we be? Would that help our field? It's very high-efficient, to say the least. These next two, I put a couple checkboxes just recently because of that NRMP match. We've already reduced the risk of at least the match system. There still are some questions with the other pieces, but that was the big one that would deter applicants. And that also eliminates the need virtually, depending on the details of the NRMP, which are still in discussion. It could potentially eliminate the need to even find a BGY1 program. Send us your fourth-year medical students. We also need more seasoned people in OEM, but also send us the fourth-year medical students that have, before this cycle, never had a path to our specialty. And then one-year options for training. I understand those are logistically difficult. There's some headway we can make, and we'll talk more about that in the next discussion. Future research, because this is a research presentation. Yes, there are some more directions. If you have some interest in this, or a resident that wants to do it, or just out of curiosity, let me know. There's pretty much an unlimited source of data in this that we need to mine and get published out there if you want to participate or make your own study. Ultimately, because we didn't want to do like a cross-sectional survey on this, there's some limitations. You can't transfer these results to everybody, but that wasn't the purpose of our study. But it is an inherent limitation with any qualitative work. It's cross-sectional. We didn't track people over time to guarantee that they applied to OCMED, but again, that wasn't our goal either. But it is one limitation, as you're trying to say, well, in this study, can it solve all of OCMED's problems? No, it can't. That's not what we designed it for. But future steps could. This was also conducted by an OEM training program, so there's always a possibility that there's an overstatement of, oh, I love you guys, of course. I mean, we didn't provide the money or anything like that, but there's always a possibility of bias. Special thanks to a lot of our partners in development and execution for this. World-class partners. Thank you to all of them. Director Dr. Kales, the Dean of Farber Cancer Center Survey Qualitative Methods Corp, led in this project by Dr. Rivett, Pipeline Joint Task Force, the ERCs through NIOSH, the independent group for the Center for Work Health and Well-Being. Regrettably, we're pretty slow on time, so I would love to take your guys' questions. What questions do you have about this, and what the next step will be for this movement? John? We have a mic on the floor here, feel free to pass it around or just come up, and I'll stick around to... Just to comment about the power of having a PGY-1, great that Loma Linda has that, that's great, but I used to be their Residency Director at the University of Minnesota in Health Partners Program, and we had a unfilled funded position that I worked with, and got a funded PGY-1 in a flexible program there, and got a dynamic young physician in, and we became Chief Resident in that program, but it paid off for four or five years down the road, we had, because people in that program found out about OCMED, in the next four years we had two from anesthesia drop out and do it, one from family practice, finished family practice, one finished five years of surgery, and then applied, and the other was an infectious disease. Yeah. So by the fact that we had one person there, and the second year, we didn't need to fund a PGY-1, because we had so many applicants, they were unfilled, and the program was continued on, but the power of having a PGY-1 means you can then recruit dynamic young med students and physicians, and it worked great for this program, just to comment. Connecticut's doing the same thing, and there's these wonderful stories across the country, but there are too few. We're hoping that these structural changes will inspire, or give the ability to the local programs to do this much, much more. So to update your numbers on how many OEM people are taking the boards, I'm on ABPM, and so in 2023, only 65 people took the boards. 65, and only 56 of those are residency trained. 2022, it was 84, and before that, it hung around 100, so it's gotten to the point where at our January meeting, what the hell is going on with OEM was a major discussion, what the heck is going on, why are the numbers dropping? It looks like applicants are up a little this year, but I think you have potentially ABPM's attention. The other question we keep asking, people ask is why can't we reopen the practice pathway, and it was asked at one point to ABMS, and absolutely not, they're not letting established agencies, or established board certifications like OEM open up a practice pathway, and typically when a new specialty opens, like addiction medicine, clinical informatics, they only get a practice pathway for a set period of time, so both of those expire in 2025, but ABPM's looking at the data, and why are we going down, and as you said, there's multiple reasons for it, but thank you for your study. But it's not doom and gloom, Beth, because the future with some of these initiatives, you'll hear dozens more in the next presentation. That's good. If you stick around, get some coffee, go to the bathroom, if you like, about ways that we've already implemented solutions. I think the future is very bright, actually, because of what we've discovered here and in many other initiatives. So good morning. Thanks for a great presentation. First, a reflection, and then a quick question. Number one, I'm told I'm one of a dying breed of sorts, so as a third-year medical student some 35-plus years ago, I actually chose OCMED after having an opportunity to work with OCDoc. I was a confused third-year medical student, didn't know what I wanted to do, and after I worked with him, I fell in love with his specialty. Looked at all four of the, at the time, combined internal medicine and OCMED programs, and chose the Columbia Morristown program, trained, got dual board certified in internal medicine and occupational and environmental medicine, and have been practicing in the field for 35 years ever since. So my question is, what happened to the combined program options? As a third-year student, it was very attractive to me to have the opportunity to both train in population health and occupational and environmental medicine, to come out with two board certifications, and to be able to chart a career in government, academia, or corporate medicine, which is where I've spent my entire career. And I've had a very good career, a very, you know, both academically stimulating as well as I've done pretty well, financially as well. So I think that that piece also for students is a thing. So I'd like to see us not only look at all the alternate pathways, which I know we need, because we do need more people in the specialty period. But I also think there's an opportunity we have to attract students who were, like me, confused and not knowing what to do. I think there are a lot of students who reached that PGY3 year and like everything a little bit, but nothing kind of tickles their fancy. And I think we should be trying to capture those students. So I wanted to just add that. Thank you for sharing that. This is the topic of combined training, and it was much more prevalent, I'll say, at the least, in the 90s, as were a few other things about OCMED. Actually, in case anybody doesn't know, this experiment was retried even after they all closed. One opened back up, Harvard, big marketing, lots of interest, lots of attraction, zero people. You'd think, I would have thought, that it's aligned. When it was recently tried, though, there was no demand. But maybe things have changed. Maybe we should periodically investigate this dual training, but at least recently. It's not like it was at the time, for some reason. Yeah. Oh, thank you. Good morning. Excellent thematic analysis. I'm glad you've used your MPH 102 class to some good extent. Thanks, Sam. I apologize for my voice. Dr. Kales apparently throws a pretty good party. This is very interesting. Many of the phrases start off very similar to what you hear during motivational interviewing. I can't. I didn't know we could. What if this, but there's some pros, some cons for tobacco cessation, which I'm sure you've done many times. How might you use what you've learned here to engage those conversations yourself? You're right, Sam. Personally, I think that there's a ton of opportunities for mentors, people with access to these potential applicants, to use motivational interviewing or even any other kind of just logical argument style. They seem to all be working very well, from what I can gather. Let's put that MPH hat back on. I'll tell you that there needs to, I think, be also a different approach to changing the structure, policy, and framework of this. As we all know, from a population level, very hard to get tobacco cessation changed with motivation interviewing alone for the population. You're also going to need to raise the age. Massachusetts just raised the age of smoking. This is happening. Policy levels, whether you agree with it or not, are going to be more pervasive and effective. Delivering consistent, sustained change than one-on-one approaches ever could. I think we need to, as we said on one of these other slides, I think we need to have systematic change, broad, automated, internet-based, whatever, implementation, but also, like you said, motivational interviewing. We need us here, mentors, passionate ambassadors, to help out however you can. That's a part of it, but it's not the complete solution. I hope you publish this data. Yes. Have you considered a comparison, perhaps, with recent grads? What are their thoughts, immediately, compared to these words? That would be a different study, but those studies have been done. Different structure, different questions, and actually, there's one currently pending publication from Dr. Blumberg out of UCSF that asks those questions, but it's not a direct head-to-head. We'll let the readers do that, but both will be published this year. Final thought. I'm sure there's a line. The military experience is an aligning factor. It is. The military aligns. What if you rephrased it as exposure in place or almost even training in place, alternate pathways aside, but what other sources could you tap that might be a goldmine as much as the military has been for us? Well, we discovered through this study, and I have some other ideas, but I want to leave it limited to what our research has identified, the two other groups. Same slide, third bullet. People that are in or nearing completion of, but don't really want to become a hospitalist or primary care, right? These traditional big family and internal medicine programs, and we have data from like the other match and a bunch of other groups showing that it's essentially, people mentioned emergency in some other fields, but it's psychiatry. It's overwhelmingly internal and family medicine that we're competing for and against to both get them at the MS level, at the PGY-1 level, and also the PGY-3 level, and then the other group would be those diverse masters folks, essentially entrepreneurs, anybody who has already proven that they're outside the mold of traditional one patient at a time in a hospital. Yeah. There's also a lot of people working in occupational medicine clinics that are way past that, but are doing the work and have that exposure, like military. Correct. You think of the average person, you know, you've been at Concentra for five or 10 years, you've had a ton of on-the-job training in whatever company it is, you're practicing full-breadth, OCMED, not just clinical, but beyond. How can we get them back into training? I'll tell you, those discussions, at least five different avenues, have already been happening in the past year. I'm hopeful that the parties that are not currently in agreement on some things can find a resolution, because that is a huge untapped source of potential for our field. It's through the complementary pathway, if you're interested. We'll talk. Thank you, Sam. Excellent. Mark Greer, I'm the Executive Medical Director at The Ohio State University, so I oversee all the internal and external facing occupational medicine services across the state of Ohio and wherever. So, last, a little bit of background information. About three weeks ago, I get a call from our ambulatory clinic services saying, hey, we need a week-long rotation for our MS-3 students. So I'm like, absolutely, sure. Especially MS-4s, and then being able to potentially push down MS-1s and 2s. Is there any information out there that I can go from zero to 60 and operationalize this where I can say, this is the fun stuff, this is the data, you're saying this is how we compare it with family medicine, internal medicine, et cetera. What can I do other than just winging it? So what's out there for me? And so, not only for you, so definitely, I'd like to collaborate, but anybody that's in this room or that's listening to this, please reach out to me. I'm happy to talk. So again, last name's Greer, G-R-E-E-R. Go ahead. There are a few examples that are wildly successful across the country. Maryland is one. Case Western is one. And we've today learned that Irvine, UC Irvine, as well as UT in Texas, Tyler, are also in development for this upcoming academic year, mandatory for all medical students. And optional for many more at many more institutions. Great presentation. There were a couple of slides there showing some of the statements that reflected my experience. So I found out about OCMED, med school, and people thought I was crazy for just applying to prelim years during fourth year of med school and reapplying again, you know, separately. They're like, what are you doing? Like, well, this is like, you know, the path right now for this specialty that is like a normal job. You know, multiple offers. You get to choose where you want. Work-life balance. This makes sense. But, you know, a lot of med students are not, or a lot of med students are risk-averse. Yes. So that's one comment. My question is, have you all thought about using social media as a way to kind of elevate, you know, the specialty by medfluencers, which is now an emerging way to promote, you know, not just interest in the medical field, but specialties. And I imagine with this new group of budding med students and physicians, seeing the day in the life of an OEM resident would, you know, really skyrocket popularity of our field. So we all heard it here. Dr. Pascal volunteered to be the first social media influencer for OCMED. Thank you. And I should have seen that coming. And second question is, do you see this specialty following the trajectory of PMNR, which, by the way, when I was applying to med school in 2018, no one knew about it. Cut to now, 700, upwards of 700 applicants this cycle, 200 matched. It's competitive. Yeah. Yes. Yes. We hope to have all 700 and funding for them, King. And the funding, beyond the scope of this study, we will touch on in the following presentation. Please, if you guys need to go pee or something else, we're over our time. I'll stick around indefinitely all week. But another question here. Great work. Great presentation. A data point for your third bullet. Back before occupational medicine for me, when I was a family medicine faculty at UC Davis, acting associate resident director, we always did five-year follow-up surveys of the graduated residents in family medicine to find out what they found least well-trained for in their practice. The number one area, year after year of doing the survey, which was published in the academic family medicine journals back then, it may still be going on, was occupational medicine. We found that 8, 10, 25, even 40% of the practice was occupational medicine as they got into smaller communities and worked near farms and factories and things. They found themselves in that field that they were unprepared for. So a strong plug for tapping into that group of docs. We're presenting at the conference, past and future. And interestingly, we just had this chat with AFP because they said, hey, can you develop a curriculum for us to get exposure? This just happened. So that the family med trainees can get exposure in training and beyond, perhaps, to OCMED. And I think the response was, we don't need to create a new curriculum. We have a huge curriculum. Please use it. Yes, yes. But can we get it more baked into their standard processes? That agreement needs to be improved. Thank you. But it's just budding at this point. Thank you. This weekend, my name is Mike Levine. I'm an ACON board member. And first, as a board member, I'd just like to thank you for this incredibly important work. And on a personal level, I'd just like to say that you are a remarkably fine presenter. So thank you. This weekend, my wife, Liz Allison, has retired as department chair of biology at College of William and Mary. She handed out 210 diplomas to biology majors. She probably got most of the names right. She probably gave 70 of those to people with pre-medical aspirations. In the last couple of years, a program called the MEET course was developed, which some of our ACON members have participated in, which created opportunities for a class of undergraduates to hear from different types of medical professionals, to talk about their paths, to talk about how their lives are, to talk about what kind of training is needed, et cetera. And I will tell you, Achmed has been heavily represented. Good. Thank you. One of the challenges for me, though, is a question. What outreach are we making to pre-medical advisors at major universities where our people ultimately generally pass through in their journey? Because we have to get the idea of occupational medicine into people's heads earlier than we do. Early. We're not even doing a job reaching career advisors at established medical schools. Many of them in other surveys and things have said that they are unaware of Achmed and that they could not support their own students going into it. Talk about barriers, right? But this is a general awareness. I'll tell you, the prior initiatives, most established through AOEC's OHIP program, hundreds of people coming through this pipeline. Guess how many went into Achmed? None. And that's an Achmed program. Zero in history. But at the same time, many people that we chatted with who never heard about it in med school actually did get it in undergrad, Dr. Levine. So I think any systemic approach, which surprised me, should include earlier, prior to med school, as well as also, obviously, in med school. Thank you. Ladies and gentlemen, we've been here for a long time. I'm going to take a small break. I will see you back here at 11. Dr. Molenax and I will be presenting. If you want the practical implementation, like nitty gritty, it's happened stuff, not just the science research quotes and stuff, we will be here, and we'd love to spend another hour with you.

Occupational and Environmental Medicine

OEM field pipeline

attracting trainees

retaining trainees

barriers in OEM field

values alignment in OEM

holistic approach in OEM

job availability in OEM

policy-making in OEM

marketing strategies in OEM

career decisions in OEM