All righty, good morning everyone. It's still morning, right? How is everybody doing? We're going to try to get started. We have plenty of good material to project today, so we want to make sure that everybody has a chance to have good conversation and dialogue. For those of you who don't know me, I'm Kenji, I'm the president of AECOM for another few days. I'm hoping that everybody came here for a good discussion and a lively discussion on the importance of our future pipeline. So this presidential task force sort of came about for years now, starting from past presidents until today, and this was a bit different in that we kind of wanted to make something more actionable, and I had to pick the right people to do that, so luckily I have a dream team on stage with me today that really put this task force ideation to practice. And as you'll see today, some good results came out of this, and we have a couple of articles coming out, and I think it's going to give us more of a quantitative way to look at something that's more qualitative than the past. So it's a really good opportunity for us to share some of the findings, but also the ideas of what do we want to do to motivate our future profession, especially in a day and age where, right now, there are some concerns about what our organization is going to look like in the future, and please come to the town hall tonight and on Wednesday to discuss that a little further with the membership. But this is about the future of our profession. The future trainees is going to be practicing the occupational and environmental medicine of the future. So, without further ado, I want to give thanks, first of all, not only to the task force, my co-chairs, Ross and Matt, who did a great job pulling together a great team. And I want to emphasize team here. There was 24 people who actually made this happen, and you'll see two of them on stage with us. One couldn't make it. But I think it's going to be really important for us to really focus on thank you, and to all the 24 individuals listed here, for the time and commitment they've made to making this process more practical, taking theories that we've had in the past couple of years, almost a decade, and actually putting it into actionable plans. So, you'll be seeing some of that results this morning, but I want to make sure we get thanks to each of those individuals and give a round of applause to them as well. Thank you. So, I'm going to go ahead and hand this over to Matt to get things started. I'll be around for the rest of the conference as well. Unfortunately, I've got to hop out real quick for another meeting. But feel free to stop me if you have any conversation points or anything else you want to discuss with me further. But I'm going to hand over to you with good hands to be able to have this discussion go on without me. Thank you. Matt, over to you. Thanks. Kenji, thank you for your support and your kind words. And this isn't just a summary. It's not just entertainment. Right? This wasn't the first chapter of the story, and it's certainly not the last. And we'll talk about what the whole story looks like with a highlight on this past year in the next hour. Okay. There we go. Today, we're going to talk about the background of the issue. If you were here for the last hour's presentation, there's some overlap in terms of background. But the strategy, the topics, the implementation, and the future are entirely different. There's a lot of synergy, obviously, and we rely on essentially the same group of 50 or so people to be moving this forward. If you'd like to join that group, we need your help at every level, in every organization. We're going to talk about what we discovered as a task force and what the task force was, why we're doing it, what we discovered, what we delivered, and what we will deliver. Overall, the problem is that we don't have a lot of board certifications in AHMED. Why is that a problem? We provide a service that's requisite for the economy, for society. It's sometimes hard to quantify. Sometimes goes unappreciated, but nevertheless, we've seen what happens when it's not there. And at least we don't accept a future that doesn't have our contributions to society, the workforce. The problem is there are so many different issues going on here, funding and recruitment, like we talked about in the last hour. Many other processes that are interrelated, but they're also really tough to define both the nature of the problem as well as what the solution is, and that's what I'm very happy to today report to you. We've been able to bring some clarity to what the problems are, how they got there, how they relate to the other problems, and then what we're going to do about them. And it's not just theory. We've done it. We've put it into place, and we're already seeing results. And that's just this chapter, and there's so much more. It's already in the works, and will be bearing fruit for a generation to come. Oh, yeah. We need your buy-in and coordination. I'll say that in order to even get as far as we have, you know, these past few months, years, other projects as well, we need folks to contribute, not just with ideas or solutions, but policy. Change things that's happened, and it will continue happening at a bigger and bigger scope until we've achieved our goals. I'm very hopeful for this. We have a great team and great process. There's a couple of slides from the — that many of you may have seen in, like, the Future of OEM article, which came out a couple years ago from a previous initiative within ACON and beyond. That's why these dates are a little bit old here, but I'm going to share some more recent numbers with you. Thank you, Beth, for updating those, and we got them straight out of the annual report recently. So, this looks bad, right? Do you think it got better in the last four years? Actually, it's gotten markedly worse. Unfortunately, there were only 58 people last year to go through the residency pathway to board certification. Fifty-eight. We aren't going to keep our thousands of people conference with 58 new ones a year. Half of them don't even come here. They're not involved in that at this level. So, this is kind of an existential thing. The number of — and it's been declining every single year. You see 94, 83, 72, 58. I mean, you just go down the numbers. It all tells the exact same story. And let's not look at it from board certifications. Let's say, well, how many people could be trained? How many are we training? Is this a reason why? Are they just not training? Well, they're not filling. Forty-five percent of the — and this is, again, from the Futures article. Thank you to the prior folks working on this. About 45 percent overall of our positions that are ACGME approved, and that's not even meeting the job demand, which is many times higher than that, are not being funded. By whom? We'll talk about that. Why? We'll talk about that. What's the next step? But that is to say, the structure is here to train more people. People want to train in this. People certainly want to practice in this. Why aren't they? How can we get them to do it? These solutions we'll overview over the next hour. Typically, when you see the word unfilled, with almost no exceptions, when we're talking about unfilled residency spots, it's for one reason — funding. Unfilled is unfunding at this level. Yes, there are other issues, but it is the biggest and most immediate cause, also the hardest. Applicants per year just got the IRS stats for 2024. Hey, it's better than last year. But there still aren't even 100 people that are even curious. These aren't residents. They don't go into the residency. These are just people who ever thought about it enough to click a button. They don't even have to pay to click that button in many cases. So these are pretty low numbers from IRS, hot off the press. We did a second way of approaching this number through an RDA survey. You get essentially the same numbers. Two methods, same answer. So what are we going to do about this? Because we still want to have this conference. Great food, friendships, healthy work environment, help our communities, make an impact in the world. But the pipeline is drying up. The new wells are going to be tricky. So we were sitting around at the last conference, scratching our heads, you know? Hey, what are the big problems that keep you awake at night? And everyone's got their several, but this is one that's consistently kept a lot of us awake for years, generations, actually. You can read about it in the 1950s. It's so fun. There's a couple articles in the 70s and lots in the 90s that talked about the same issue. Guess what? They sound similar to 2022. 2023 didn't look a lot different. 2024 already looks different. Well, not the IRS numbers. That's a downstream thing, but look at the upstream ones. It's already different. And all the other preconditions are there. We're going to talk about the success, right? But it's going to take a ton of work. We need your help, your minds to come up with and implement solutions. We were, as a task force, endorsed by, but not run by anybody. Endorsed by everyone. Across the field of OEM. I'm not talking about ACOM. It's everybody else, right? We'll show some pictures in a minute. It's every group that's involved in this. Anyone who touches the field of OEM in America had their voice heard. We needed them, and we sure as heck benefited from them. Three big ones, of course, from the very onset. They were very strong in terms of support, endorsement. Throughout the project this past year, ACOM, of course, the American Occupational and Environmental Clinics Association, and the OCMED Residency Directors Association. Our goal overall, if you had to put it into one metric, is to increase the applicant pipeline to U.S. residencies, meet the occupational health needs of the workforce. We're talking about number of trained, board-eligible OCMED physicians. We had a huge number of assets, as you can get passion, expertise, trust in each other, and the systems, and the field. The shared vision amongst ourselves, and what we even wanted, and why we were doing this. Sponsorship. Our incentives, I think, no formal incentives. We're all aligned. We all wanted to get the same job done. But there were some important limitations, as any initiative has. Budget, we didn't have any. So, this is all like local, and personally, otherwise funded, which is tough. But we made it happen. Time, of course, was limited. But that also was one of our assets. We'll talk about that. And we lacked the authority. Obviously, who are these guys? We lacked the authority to do some of the implementation that required local, or a higher level of authority. But we can still influence them. And we have. There are three phases. I call them trimesters, because they're about three months each. And it was growing in intensity and impact, as it went on. Anyway, pregnancy analogy. We've got four kids. First, we explored. Very important step. No assumptions on this. What are the obstacles and root causes of this? Why aren't we getting, why is the pipeline drying up? Develop some creative solutions. And lastly, to implement those. Overall, we had a few principles. You know, as we were chatting with Kenji and many others, Ross and I were sitting around a year ago saying, like, how are we going to solve this? You want to do a survey? You want to just get a bunch of beers and sit down for an afternoon? Like, how are we going to do this? There's no rule book. We said, well, we're going to need to create an environment that doesn't have any boundaries in terms of topics that we are willing to undertake. No one we're afraid to ask. No topic, no question we won't ask. Also, we can't have our agenda, if we truly want to be broad and have a big impact, to get to the heart of the matter that has evaded our field for two generations. We can't be run by any established momentum. So we weren't. In fact, today, here, it's the first time that anybody, even the board, anybody else has full access to what we're presenting. No budget, also, unfortunately. Ross and I knew that just individually and the way we structured things and interacted with everybody, we had to maintain this curious mindset that's very agile in terms of individuals as well as our group. As the topics evolved over time, and they certainly did, from our first session to the last, you wouldn't recognize it, many iterations, we were able to do some incredible problem solving from kind of that necessity business aspect that really you don't get in traditional medical approaches. We were time limited in one year. That was our promise to everybody. I said, Dr. Kroll, we will not be bugging you after AOHC 2024, and I am good for that promise, but if anybody else wants to take up the next year's initiatives, we need you. Thank you to the few who have already volunteered, but we need more. Ross and I, anybody, did not come up with the content of what we would be talking about, only the way that we would approach it, and that was critical. There's no agenda. You'll see some other initiatives going on. We didn't have an agenda other than to just deliver that outcome. More OCDocs to help America. We needed diverse perspectives and experiences, and we needed to be really quick to adapt as things evolved throughout our course. When we recruited people, we had a very specific thing in mind. There's no elections. Nobody jockeyed for this. No one's getting rewarded, but we knew many of you, what you were curious about, what you had expertise in, and your personalities. How can we get the right mix of people so that the end result was a good solution, and that includes people that oppose each other generally or on specific issues to reach the best solution. We didn't need an echo chamber of do more of what we've been doing for 55 years, because there's a lot of publications on that, and it's not working, but we moved the needle. So excited to tell you today about it. We have live chats. They don't care how we did it. Anyway, we had lots of groups and different ways of communicating. Here's some of the groups that kind of added their expertise and support to this discussion. This is OEM, right, in America, and that was intentional from the very beginning, before recruitment even. This was our step. So we had a chance of success, and I have to say, the way that we approached this was phenomenally fun and successful. We approached 28 people. A huge fraction of them were immediately in love with this and were available, made time for this, because they realized how important it was, and were with us from day one until today, and perhaps beyond, even though they don't have to pay them, and our task force members were critical. Most were Octocs, as you can imagine, but we did have others. Many people had experience with training programs. Naturally, this is a pipeline to training into the field, but not all. We had huge representation in terms of the way people had, where they worked, how they worked, the age range, right, 27 through 85. I mean, this was everybody, and this was very intentional. Here's our members. Thank you to many of you who are here today, and for all that many more have done in collaboration with our core members over the past year. Here's a little Zoom chat, you know, just one of the many ways we get together and say hi every few weeks across the country. We had independence from all other organizations, which also means you're independent from their budget, but it also means you're independent from their agendas or momentum. That was critical. We had two coordinators, Ross and I, who had the pleasure of doing lots of typing and putting ideas together, and we really relied upon the front-line members to come up with the observations and the solutions and the implementation, and then to actually carry that out and measure the results and all of that you'll be hearing about today. Lots of chats. Here's an example in case anybody hasn't done, like, something like this collaboratively, remotely. This is Zoom, but you could do it in many ways. In other words, like, if you had an idea, regardless of who it was, time of day, you stick it on here, we talk about it, everyone gives you feedback. We're organizing and exploring, you know, all sorts of topics constantly, and this was just one way that we captured it. Again, there's much more that we did, but it was just really rejuvenating to have a great group of people, a great way of working together, and it really paid off. What we discovered, and I'm going to hand this off to Ross, is it's not just visibility and funding. Those are two really big categories. They're very well described in literature for generations. Not too many folks know about OCMED. Not just applicants, right? I mean, like, other doctors, the general community, even the AMA and ACGME are confused about us sometimes, AMC, unfortunately. And it's not just funding. Oh, give us more money and this problem will go away. That's huge, but there's a third category that we, for the first time I can tell, have uncovered that's really unique to OEM, and it's not a good thing. That is, there's these structural pieces, these processes through the training, getting into the training specifically, not the training process itself, which people are well-documented to be happy and well-prepared for the training. We're talking about getting into the training. How does the person get from curiosity to a match? And the rest is history. It's all very positive, but that piece is very messy. It's risky. We hear that word so much. People say they're unfamiliar, inaccessible. We hear this a lot, too. These were ideas that we've been hearing, and you ask everybody, and the story is similar when you ask people in that perspective. And we had people in here who were, like, you know, pre-meds and pre-trainings and med students and everything. We hear their perspectives. So, we formed three teams around these three core groups, visibility funding and these structural pieces, led by Dr. Kral here on our visibility piece. Dr. Ribeiro, who couldn't be with us today, on the funding piece, and Dr. Perkston on the structural piece. Our teams were autonomous. We did not set the agendas or the way that they would work or their membership. And you'll get a chance to hear from them and ask them your questions later on this morning. Ross, you want to talk about some of the themes, things that we found and what we did about it? All right. Thanks, Matt, and thanks, all, for coming to hear this talk this morning. It's a pretty important topic. I'm going to first hit on just kind of the themes that each team uncovered and discussed, and then we'll talk about the things that we delivered on. First and foremost, and many of these, I think, will be familiar to you, is the number of board-certified OEM positions dwindles. The demand for our services is not dwindling, so that gap is being filled increasingly by others. And there's a risk there, right, that as our numbers get smaller and the non-board-certified group gets larger, that we may have some difficulty defending our turf, that we may – it may kind of be a threat to our ability to control our destiny as a specialty, right? So it's a concern. There's no clear path to growth. There's no easy button there. It's sometimes difficult to describe what we do to others because of the broad diversity of what we do. And I think in particular, we've struggled as a specialty over the years to communicate our value to our stakeholders, and that's – you know, that continues, I think, to be an issue. You know, we discussed, you know, who's in charge of this, right? Whose job is it to fix this problem? Who has the ability and the authority and the capacity to fix the pipeline? What entity, what organization? And I think the answer, unfortunately, is there is no entity that's in charge of that, right? There are no single group. And so it's – you know, that's part of the reason for this task force and our initiatives. On the bright side, I do think that we clearly are attracting folks, you know, to our specialty when we are able to get the word out and, I think, get information about Achmed in front of them. And, you know, it's just getting the word out. Also, we think that there's some untapped potential in the environmental side of what we do, which I don't think has fully been fleshed out in our practices. So to dive into the individual teams a little bit for funding, you know, we're the only specialty to our knowledge that is largely unfunded, right, compared to what we're supposed to have, right? So most specialties are funded by CMS. We are not. There are other specialties, however, that are not funded by CMS that have been able to largely, if not entirely, bridge that gap, mostly through HRSA funding. You know, our funding is instead more scattershot, more piecemeal, inconsistent year-over-year, and highly variable between programs. You know, ostensibly NIOSH should be funding us, however, Congress does not give them the money to do that, so, you know, they're in a bit of a bind. NIOSH is not just responsible for funding OCMED programs specifically, but also some of our other stakeholders in occupational safety and health, like industrial hygiene, you know, for example. There's been some robust debate over how our programs should look. You know, we have a number of small programs that are spread out that's perhaps maybe not the most financially efficient way to do it. Would it be helpful to consolidate? You know, well, then that limits geographic diversity, and that's, you know, for many applicants, you know, having something close to home or close to family is important, and we don't want to limit that. You know, it's not a one-to-one ratio. It's not necessarily linear in terms of, you know, doubling funding. It doesn't necessarily double output, and then I think this is a really important bullet point on the last line here is, in order to make a compelling case for funding, and we have people that are absolutely trying to do that, you know, it's going to be a lot easier if we have a lot of applicants. If we're barely filling our funded slots, you know, it's a hard sell to say we need a lot more money for more spots, you know, so the more applicants we can attract, the stronger our argument will be. For visibility, you know, we've all been there in medical school. It's, you know, every specialty is trying to attract people to their side. OEM is small. It has very little exposure in medical school. There's very few champions at the medical school level, you know, most medical schools to push OEM, so there's a, you know, little initial exposure. For those that do get some word about OEM, there's, they often find that there is, it's hard to get further information. They don't know how to track down an Ocmed docs. It's hard to even find good information on the internet. You kind of have to piece it together, and that's, that's a deterrent. You know, local marketing campaigns can be effective. The AECOM ambassadors have had some efforts along these lines, you know, but it's just, it's hard to do with the number of medical schools we have out there, and it's difficult to scale. You know, many applicants do discover OEM later in their careers, and that is something that we can try to leverage and exploit to our advantage. You know, it's kind of both good and bad. We can try to exploit the good side of that. You know, we did, I mean, just looking across some major medical databases at the beginning of this task force, there were huge gaps. Oftentimes OEM wasn't listed under a list of specialties, you know, or OEM was listed, and then when you click on the page, it was like totally blank, nothing at all. It's kind of embarrassing. It makes us look, you know, like we're not like a legitimate specialty, right? Once exposed, we do think people get interested. You know, how do we, how do we expose them? And then the structural themes, you know, to add on to what Matt said earlier, there's multiple aspects of OEM training that are off-putting to applicants, and a major deterrent to people even putting in an application. You know, there's, it's confusing, right? There's multiple pathways to training, multiple pathways to board certification. It's viewed as inaccessible, right? You can't apply as a medical student. You got to apply, you know, for your internship, and then you got to apply separately for your PGY-2 year, and then you got to apply separately for your MPH program, right? That's a lot of ways things can go wrong compared to a program where you're applying one time, one time only, right? And it's a lot of extra work for that matter, right? And that runs, that runs us into the kind of unfamiliar category, right? Some of these OCMED programs are not on ERAS. OCMED is not using the NRMP, which is what most programs used for their match or a similar system. OCMED's match system is really an island to itself, and it's a lot of extra work, right? If you're applying to three specialties and you wanted to add another one on the NRMP, it's, it's almost like just checking an extra box. If you wanted to add OCMED, it's a whole different process, all different documentation. It's a lot of extra work, and that, that difference leads to this perception that OCMED is weird or sketchy or illegitimate, you know, or it just, it makes people uncomfortable, I think. And if you heard the prior talk, you understand that's a major, that's a major and significant barrier to people even putting in an application in the first place. And then there's, you know, there's other things about our specialty that are somewhat difficult to understand. The complementary pathway, the training place, you know, it can get complicated. All right, 18 things we ended up looking at and 12 things that we looked at implementing, and we do have a JOM submission forthcoming. But this is, I think, really the meat of the presentation is what do we deliver on, at least this year, from our funding team? And I'll say that I think the funding team has a tough job. It's probably the toughest nut to crack, some very complex and long-standing problems. But they, they did, they did do the following. They tried to empower training programs at a local level by authoring two things. One is a talking points document to concisely describe the value of OEM to help as a fundraising aid, right, at the local level, and also developed a survey for programs to calculate and communicate their funding needs. And it hasn't been fully worked out, but the idea is that an organization such as ACOM's COGA, right, the Council on Government Affairs, that really leads the push at the federal level, could use this to help leverage our funding requests. And having that debt, that additional data and granularity would be very useful. And then, you know, I want to recognize, you know, Dane Farrell and Dr. Bourgeois in the audience, you know, it's been an integral part of this effort and part of this team, and we do have folks like you that are meeting with high-level public officials that are advocating on behalf of our specialty and pushing, pushing for that gold ticket of more federal funding. Visibility team, I think there were some more, I'll say, low-hanging fruit, and we try to take advantage of that. One thing that we were successful in is creating a website, a new website specifically designed for people that are interested in OEM. And the whole purpose of this site is to answer all the questions that they have all in one place. It gives you all the information that you need. You don't have to piece it together, a bunch of different websites. You don't have to rely on shady posts on Reddit, right, or student doctor forums. Here it is all in one place. Here's where you go for additional information. That site is up and running. Thank you to Dr. Fagan, Dr. Gittleman, and others for the partnership with AOEC to host that site under their auspices. That site is live as of about a week ago. We did, we did seize the opportunity to put some products out, be some media products. I think most notably about two, three weeks ago we got an article published on Kevin MD, which is a pretty big name, well-known medical resource for a wide variety of providers. The author is a convert to OEM after 10 years of family medicine practice and then did OEM residency. I think it's a good article and there's a forthcoming podcast on the same topic. We also got a podcast episode on the Short Coat podcast, which is more medical student oriented, you know, podcast. We did successfully update the big name medical training bases, training databases, such as the AAMC CIM site, AMA Frida, Doximity, and others. There is, I think, more to come on beefing those up. As we partner with ambassadors, and thanks to Dr. Kroll, who's not only led the visibility team, but is the head of the ACOM ambassadors, we're looking to run some ads and banners on, you know, Student Doctor Network and some other forums where people tend to go to ask questions about specialties like OEM, and we'll link it back to the to the new website. We're trying to provide ways for people to connect with rotations. You know, the ambassadors just came out with a new single email point of contact for folks that need, you know, that want to reach out to someone and ask questions like that, like, hey, I don't know anyone in OCMED here. How do I, how do I set up a rotation in OCMED? Who can help me with that? We did identify that there's a CDC rotation available nationally, very not well publicized or marketed, but through through NIOSH that are available, available to folks. They're partnering with organizations like ACPM to continue to beef up sites like the CIM site. And then, last but not least, our structural team. So they put out an ACOM webinar helping to clarify the complementary pathway and how folks can take advantage of that. You know, that's sometimes a source of confusion. We did, there was, we did have much discussion, and thanks to Dr. Sharip on this, about the Loma Linda PGY-1 model, right? They have that, so Loma Linda is unique in occupational medicine programs in that they have an integrated PGY-1 year. So they have one slot where a medical student can match directly into OEM at the PGY-1 level. So they have a partnership with their transitional year at their institution. They've reserved a slot for OEM residency, and they track directly through from PGY-1 straight into the two and three year at Loma Linda. The feedback has been that they've gotten very high quality applicants, very highly motivated applicants for that slot. And also, because it's within their institution, they have some ability to kind of tweak the content of that PGY-1 year to suit their purposes. So it's been very, been very good for Loma Linda, and we definitely are trying to push that to other programs. They did create a graphical depiction of the different pathways, the board sort of certification to try to help visually help people to understand this, and that is on the website. And then, you know, what I really think Dr. Perkinson has, I think, been spearheading this effort on the NRMP, but as as Matt Ham mentioned last hour, you know, OEM has not been on the NRMP before. That's, I think, a big deterrent. And as of Saturday, that has changed. So the program directors voted overwhelmingly for Achmed to join the NRMP as a specialty. So starting in this upcoming cycle, we will be on the NRMP, and residents will be able to select Achmed just like they can all the other specialties that are on there. I think that's a huge boost for the process and a big win for Achmed. So nicely done. In addition to just making it easier, I think, for candidates to apply, that will also help us collect some really robust data. NRMP collects the data on all their applicants. It makes it easier for us to compare the data on our applicants to other specialties, and it makes it easier for us to trend our data year-over-year. And that's, we have not had that capability previously. All right. And then the last thing I'll talk about is just, I'll kind of run through these briefly, but the projects that we explored and discussed, but we just didn't really have the money or the authority or the bandwidth to implement and dig into. We do have two research studies coming out of this task force. Dr. Ham's study, she's talked about, and then Dr. Blumberg also. For funding, you know, there's a lot of potential places you can go, right? Private funding, like a scholarship fund. You can look at maybe unions, insurers, local OEM employers. There's also other avenues federally that can be explored in addition to the traditional ones. There's other grant types that are out there. Some of these are just major efforts that take a lot of bandwidth, and some of these things are more program-specific to what they have available locally. There has been an interesting discussion about maybe pushing to create a regulatory requirement that drives board certification in OEM. So there are other countries that have done this recently, and it has been very successful for them. It has really driven up the demand for board certification in OEM. You know, that obviously would be a big project, but it's probably worth future discussion. There was discussion about trying to reallocate the pie that NIOSH has for, you know, and fence off more of it for OEM. The feedback has been universally negative on that, I think from NIOSH in particular, because it would harm their other stakeholders and probably create a lot of problems. So the focus, we remain focused on trying to grow the whole pie for everyone. State grants are always an option. I think this is being pursued actually in Minnesota currently. And then, let's see, for the visibility side that we've talked about creating like a shareable kind of off-the-shelf curriculum that can be used in undergraduate medical education or even in graduate medical education for other specialties. I know Dr. Cloran in particular has been very interested in this, building on her work at the University of Maryland. You know, and we, many schools don't have an OCMET interest group or even a PREVMET interest group, right, so we could form, at the national level, right, a way to fill that void and potentially even have speakers and do grand rounds and that sort of thing. That's a worthy discussion that's going to take more time to flesh out. We did talk about monitoring your social media and being more active on that. That is a bit labor-intensive and we do have a small volunteer pool, but that's a possibility for the future. We also talked about focused targeting on the highest propensity applicants for OEM, you know, the military GMOs, your people that already have MPHs and perhaps your dual, you know, MD-MBAs or MD-JDs, the people that tend to seem to gravitate to OEM and higher numbers. You know, while we had the discussion, of course, you know, it's going to take some time to spread that the Loma Linda model elsewhere. We certainly, I think everyone agrees on the task force, that it's really imperative that we make it easier for people to match into OCMED. That's clearly a deterrent and whether it's an integrated PGY-1 or whether it's just a simultaneous match, right, with the PGY-1 and 2, but reducing that barrier is going to be key. It's imperative that as a specialty we move in that direction. There was discussion about maybe pooling some NIOSH funds centrally to advertise on behalf of the specialty, you know, that's really way above our level, and then also streamlining the MPH process. Although we know that it's not a barrier, it is perceived by applicants sometimes as a barrier and a concern that they might not get accepted for that, and then what do I do? That is something I think that we can easily address at our level, although it's probably going to be more of the program by program fix. And then we're not planning to walk away cold turkey after today. We are trying to kind of warmly hand off some of these projects to continue them into the future with some of our partners listed here, and with that I'll turn it back over to Matt to close us out. Thanks, Ross. You might be thinking, oh, that sounds nice. I wonder what that entails. Tons of work and tons of details. I mean, if someone has many products, I mean, we can only really scrape the surface of, like, do you notice how, like, one bullet point was a website? I mean, just to say that there are a ton of not just development, but real-world impact that's happening immediately and long-term targeted and strategically from so many of these things, and I think that we are sitting at a juncture now where we have enough momentum, passion, and support externally to really change the whole way that our field has been recruiting, and that will change the next generation. We need a marketing campaign. Who's gonna do it? Who would benefit from that? Ooh, AECOM would get more members. Ooh, residencies would get more applications. Oh, the workforce would have more OCDocs that were trained. Okay, well, lots of people benefit from it. Who pays for it? Congress said NIOSH will, but then they don't give them the money. Good luck. Been trying that for decades. Who's responsible? This is at the heart of the problem. We'll be making a lot of progress on this in the upcoming year. Marketing as well, you know, in terms of visibility as well as funding. We need to study, I think, a great opportunity. There are annual program surveys that, to date, have not been systematically studied, and no publications coming from this. If you wonder about the state of the training programs themselves, not just the beginning, like the whole process and the outcomes and everything, this has been presented narrowly in pretty raw format to a couple dozen people. Could we take all of the data forever, analyze it, push it out to everybody so that we all can learn those lessons, and then locally, within our sphere of influence, input the change? Yeah. That's low-hanging fruit, but we ran out of time to do that, but this is easily within the next cycle. We need to get data. Show me the research. Go make a study. Prove the value of OEM. That's going to be key to community support, funding, taxpayers, Congress, and beyond within the medical community. We were talking about something at AMA. Hey, what's ACMET? This is the AMA. You're an administrator for the AMA. You don't know who ACMET is? Same thing happened at ACGME. It's not just the taxpayers that we need to get on board in Congress. This is medicine. This is the rest of health and safety. This is the rest of the employer network. We need to really demonstrate our value to all of them in different ways and to deliberately design the way that we'll convince them based on their values. That's a tricky prospect, and if any of you would like to help devise how to do that or to actually undo it, as we have for many of these other initiatives, that will be a critical next step. Taking a step back at who we are at OEM, we don't have a single identity, and the elevator pitch is really tough, even to each other. Hey, what do you do for ACMET? How much time do you have? We need to get better at that as a field collectively. Until we get some, you know, big enduring funds federally, there needs to be local creativity for funding, but the real bottom line question is, and then we're done. You don't have to listen to me anymore. Congress wants to know, because we're there, we're asking the senators, how, what's the mechanism, will giving you money deliver for my constituency, my taxpayers, the people that re-elect me, you know, the senators? We need to prove that the return on investment for Americans, having better lives, economic productivity, the quality of life, any argument you want me to take, we need to make that argument this year to them, or I'm not quite sure that the future as we know it, given the decline, is going to be sustainable. That's all the content we have for today, and then Ross and I get to be quiet. We have Dr. Perkinson here and Dr. Kral from two of our team leaders, and we can take any questions as well as on the funding campaign from many of the audience members as well. We have much to offer in terms of questions and answers. This is our time. We have some minutes together. Big thanks to a ton of groups, these most especially, for their enduring support. What questions do you have about our task force, or more importantly than the structure of what we did, congratulations, on where we're going and how we can get to that next step? Microphone's here on the floor. Yeah, please, Jose. So that everybody can hear you. We have a remote audience as well. Yeah, thanks for the talk. I'm curious. Can you talk a little bit more about the steps to having that combined match, so you have an advanced position at the same time as an intern position? It seems to me the benefit of the Loma Linda model is not so much that you have an integrated PG-1 one year, but you have an integrated decision. So if you know that you have a third of people coming in after the intern year, you potentially have between a third or maybe 50% of people that would do that, are there any thoughts of maybe requiring or recommending programs to have maybe save one spot for two years ahead of time, or something like that? So any steps towards that? Yeah, first of all, thank you all for coming today. I think this is definitely a topic we want to discuss on a national basis. So the NRMP, I think, that we just voted on yesterday, I think will be a way of doing that. It's definitely a way of simply specifying you can have a spot that's reserved, in effect. Somebody could go through a transitional year, a PG-1 one year, and then you can reserve that spot for them to start as a PG-2. So by us signing up for the match, you now have 20 programs that have the potential to do that. And so I don't think that'll take place overnight. It's going to take a little bit to kind of set it up, and ideally trying to work out transitional intern years with the medical schools. But now we have a lot more leverage and ability to do that easier. So it's a great idea. Thank you. Just a minor question on the NRMP match. Any decision? I just want to hear about the thought process joining the NRMP match versus joining the PrevMed match, because I know they have a similar type of match. How did you decide one versus the other? Because I know they have the advantage of the PrevMed match that they don't actually go through the entire rank list. It's just the first few matches, that's when they get paired up. Well, so we actually voted on the NRMP, but within the next two weeks, we're going to vote on a fellowship match. And I don't want to get too much in the weeds for the audience, but there's a fellowship match, which you think of like ophthalmology and urology, where they meet like in January, and then a general match that occurs on match day in mid-March. And so the program directors are going to decide on which one to do on that. If they go with the general match, then it'll simply be the same day as the general PrevMed match, and a person could, just like they were applying to different specialties, can do the same. They could apply to both general PrevMed medicine as well as occupational medicine. If we do the fellowship match, it will be different. There's pros and cons on that, but I think we're all leaning towards the general PrevMed match. I think the main hookup for that is the students will have to apply for their MPH in mid-March, and some of the programs are a little worried that that's cutting it a little bit too close for the application part for the MPH. Thank you. PrevMed is going to NRMP now, too, right? PrevMed also is going to the NRMP, I think, if that answers part of that. I just want to thank you for all your work on this very important topic and area. We on the JEDI committee have committed to presenting at the National Medical Student Association meeting in New York in August, so Dr. Defoe, Dr. Clark, and I will be there to share the knowledge of occupational medicine to the National Medical Student Association. So if we can partner better, please let me know how. We'd love to. Thanks. That's exciting. Yeah. We have a lot of resources. That's easy. We'll be in touch via email. Thank you. Mike Levine. Those who know me know that sometimes I can be enormously concrete. And I just want to talk about our metaphor, which is a pipeline. And a pipeline is a piece of durable infrastructure that is fundamentally inert. And what you're talking about is generating flow through the pipeline. We have one. It's not utilized fully. It needs to be expanded if we're to actually accomplish our goals as well. So we need to build more pipeline, but we also need a motive force, both a push in terms of the applicants and a pull from the people who benefit from qualified individuals being available to serve their workers. So I don't know how we do that. I don't know what other metaphor we might want. A concrete man lays it out. Thank you. Sorry. It may be more like vasculature and our atherosclerotic buildup over the past 75 years since we've been an organized specialty. I think we just stented it. Okay. So maybe that's a little better. Is that okay? I like that. I was actually going to make the same joke about stenting. Oh, good. Yeah. All right. There it is. It's official. We've stented the pipeline. Thank you, Dr. Levine. Thank you. down to positioning, it costs, in general, about $140,000 per year for a funded residency position. For this complimentary pathway, if you're not familiar with it, it's the person's actually a practicing occupational medicine doctor that wants to get board certified. So we're not paying their salary. And so we're actually at the University of Texas School of Public Health, we're doing one complimentary pathway for free every year. We're not charging them, they're not charging us. And I feel like we can do that without bogging our administrative group down. But there's a potential of doing that for $10,000 a year, something like that. We could expand the complimentary pathway dramatically. And so we can talk about kind of what's the best way to go about funding people fast. But I'll stop there. Thanks for all your hard work, this is wonderful. We may finally move the needle. I have one question. I've always wondered why we don't have an OCMED workforce study. Because a lot of other specialties have used them to prove that they need more docs. NIOSH did a OCHealth study, was it 2010? 2011. 2011. Great study. And they lowballed it. I mean, it was like 600 or 700. I haven't looked at it recently. But it didn't say we needed many OCMED docs. I tried to talk John Howard into redoing it in 2021, or 2022, but it was COVID. But what I would always hear is, well, Nyla Metlock says there's a lot of openings. Well, God bless her, she's dead. But I think there is a huge need out there. Nobody's documented it. The other question I heard from HRSA is when you go to the ACGME database, it looks like our residencies have a lot of unfilled spots. And the ACGME database doesn't show, I don't think, who's funded and who's not. So I think it would behoove the residency programs to make sure what they're putting into the ACGME database as number of spots is accurate. So I know in Minnesota, I think we list eight. We now have five, but we normally have four. And it got to eight because if someone got pregnant, we added a spot. And if someone got sick, we added a spot. But HRSA looked at that and said, why the, this is what I heard, why the heck would we give them more funding when more than half of their spots aren't filled? We know because it's sub-funding. That isn't on the database. So those are just two comments. Thank you, great point. Dr. Hamm, you mentioned in Next Steps this idea of a study to prove our worth and then return an investment for Congress. I've talked with Dr. Crowley for years about this. How do you measure prevention? And I don't know if this group has discussed this at all and what possibilities we might have for doing that. You know, I think that's a great point. So I guess, you know, it depends on who our audience is, I guess, and so one of the things, and I, for those of you that are in the audience, I really encourage you to come up and talk to us afterwards or reach out to us. But as I say it, we've got funding with NIOSH, we've got as a resource, maybe HRSA. But then as mentioned, there's also private sources. There's what you might think of as corporate resources. There's unions, and then there's also the workers' comp insurance companies. And at University of Texas Houston, we've been able to fund, and UT Tyler as well, we've been able, between us both, we've been able to fund six residents for the next five years from a generous endowment from Texas Mutual Insurance. And so to your point, I think for that audience, maybe an easy one, and the study has not been done yet, but are those cases that are being managed by board-certified occupational medicine physicians, do you have a faster return to work, lower disability rates, all those other things that they measure, that that's important. Texas Mutual Insurance believes that just because they work with us a lot, but not because of the concrete data. But I think in regards to that, every state in the country has got their own workers' comp insurance. And I think we need to start thinking in that direction for that particular audience. It's something I've been thinking about. Yeah, just starting with some simple measures, you know, that are duplicable and representative. Starts with data. Thank you. Hi there, this speaks to the marketing piece y'all were mentioning, Reddit, SDN, and kind of in a negative light. So I'm kind of a Redditor, and I love Reddit, and I happen to be on it, and I looked up occupational medicine, and there are the occasional question that comes up that does not get answered. And from my viewpoint, I actually think that's an area that we should be going after, because I think that the younger generation is really used to unfiltered opinions and access on salary, on day-to-day work, on, and if you go on anesthesia, if you go on Gen Surge, if you go, that information is there. People will write in what their job looks like, what their salary is, and it's anonymous, because your username is anonymous. And I believe that actually Reddit could be a strong tool to use, because I think in OCMET, a lot of people get in through word of mouth, and those are conversations. Some people who are in OCMET may not be wanting to put out there with their name on it, but in the Reddit space, and I get it, there's a lot of crap, I mean, I understand that, but, and there is, there is, and there's a lot of people who are like, really, I don't, this is probably not true, but there is the opportunity there for a lot of people who are in OCMET who are doing very well, and have amazing hours, and whatever, who may not want to broadcast it openly, but could put it on there, and people who are interested in looking, and there do seem to be some who are interested in OCMET and are going to Reddit to figure that out, and they want the unfiltered discussion, not. And I, yeah, thank you for that. I agree, I think in general, the sentiment of the visibility team was that that would be a great thing to do. I think it had more to do with just bandwidth and assigning people to do that. But you know, that's clearly something that we can try and get volunteers to get on there for exactly that reason. I just think the other specialties are doing it. Yeah, yeah. And the younger generation, they're just used to social media and getting a lot of unfiltered access. And we've got a bannering set up for Student Doctor Network that takes us back. So we already have spent some of the ambassador sponsorship money is coming, so that we will have that too, and kind of point to some of the other newer sources as well. So yeah, no, I didn't mean it to end up sounding like that was not what happened. You want to look legit, but. Yeah, yeah. Yeah, I think one of the goals of the website, right, is rather than, you know, responding just with a long free text, is we can pop the link in there, you know, and then people can look at it. And one of the pages actually on the site that's in development is we're creating a list of profiles of actual occupational medicine physicians that are willing to, you know, volunteer some information. We're not gonna ask for their salary and all that on there, but we, so that people that don't know a single Occ Med physician can go on the website and look through and say, hey, here's some actual Occ Med docs, and what do they do, where do they work, in addition to all the other content. I mean, I think that's how most people get into it. They meet somebody, they're like, oh, that's a cool gig, and yeah. Right, so we're trying to fill the gap. For people that don't know anyone in Occ Med, how do they learn this stuff anyway? And that is, we are seeking to fill that gap. The next step then is also real world experiences, right? Like how can you connect with somebody? So ambassadors, we're trying to kind of shift a little bit toward connect people with somebody who they can shadow with that's near where they're located. You know, kind of a matchmaking for at least a chance to meet people. And also to, you know, engage the students and residents more within ACOM to, you know, have maybe at least a virtual student interest group. There is no Occ Med student interest groups at any school in the country. There are Prev Med general student interest groups, but not Occ Med specifically. Hard to do it school by school, but a lot easier to try and at least do something central. That's where we're kind of landing on as a group. Thanks. Great, it's a great. So I'm one of the few graduating medical students going through the two-step preliminary year then applying again sort of process for the OEM residency. And I was lucky to have several great mentors and advisors, some of whom were on this task force to answer my questions and encourage me and provide reassurance to things that were unclear. And one of the major concerns I had at the time was like I noticed that many within the field of OEM were already board certified in other things. And I felt like going directly through an intern year directly to OEM, how would I be viewed in comparison to someone who already has like experience and board certification in other fields. But I was provided enough reassurance at the time that it wouldn't be a problem. And here I am today continuing on with it. But here at AOHC, I've gotten a couple of comments from a few people when I tell them about my path and what I'm doing right now. Like, oh, you're not gonna complete the full internal medicine residency? I mean, I don't know about that. And so here I am seeking a little more reassurance. And I am asking the sort of general question of what's your sense of how this sort of thing is viewed? And is there a sort of problem with the perception of this kind of thing? I guess, you know, so as certainly as a program director, we get people, applicants with all kinds of different backgrounds. You know, a lot of times in the military, somebody that's done an intern year, they've been out in the military for a number of years and then they come back, you know, as a PGY2. Myself, you know, I did family medicine. I finished that board certification, then did occupational medicine. And I've done both over the years. But I do say all that is that I support, I encourage you, you can do this without needing to do all that extra. That we can provide the clinical competencies in our residency programs to get you comfortable with seeing patients one-on-one. What we do in our program, and I think many others do, is that we would emphasize during your PGY2 year more clinical time as opposed to corporate time or other service things so that you, because that is a cornerstone. Patient care is a cornerstone of what we do. But I think that you will have a successful career and you don't need to worry about that. And I congratulate you for coming today. And if you want to hear more, I also was a residency program director for seven years. I would echo exactly what Dr. Perkinson said. So yeah, we just tailor the training to meet what your needs are, that's all. And we have had plenty of residents come straight through and not a problem. So the military has some ways to go straight through now too. So I left that out because we're kind of an outlier, but yeah. And honestly, I think as program directors, we probably need to emphasize that route more because we need to connect, make that connection between medical school. And so you're a forerunner. We need to do more of somebody with your background. Thank you. I'll add on to that real quick with a story from, one second, Dr. Korn. My first conference that I went to, which was the WOMA conference many years ago, I sat next to someone and struck up a conversation and he was dual boarded in family practice and OEM. And I asked him if he thought that that was beneficial to boarded in family practice first. And my assumption, of course, was that he would say, oh, absolutely, I learned a whole lot. He was like, absolutely not. I had to pretty much unlearn all the bad habits I learned in primary care during my occupation medicine residency. So there's a lot of different perspectives on there. And if you have good skills that you pick up in your training, there's nothing to be ashamed of to be only board certified in occupational medicine, nothing whatsoever. We're over time, so I'll keep it really short. This is actually in response to that. I'm Marianne Korn from the University of Maryland. I think that response about, you're not doing something else first, is really a reflection of the norm. But that's a default norm because so few people hear about OCMED in medical school stage. So just because so many of us were boarded in something else first doesn't mean that it's a requirement. It's just that people didn't make the discovery. And are you guys working on a secret handshake? Any other questions? Well, thank you, everybody, for coming here today. There's so much more work to do. We need your help. We just got our first Reddit ambassador back there. Thank you. And in whatever way you're comfortable. We need you. Thank you for helping.

Occupational and Environmental Medicine

OCMED

Task Force

Recruitment

Training

Pipeline of Professionals

Visibility Enhancement

Funding Mechanisms

Training Process

Residency Programs