Good afternoon. Welcome everyone to this public policy panel discussion. I'll be your moderator. I'm Warner Hudson. Y'all can crowd down here if you get lonely out there in the big spaces. I think first I want to thank Pam Heimel, my other half, for letting me come here while she's recuperating from a bad injury and her sister is looking after her for a few days. It's been a rough slog for her, for sure, but she's doing much better. I also want to thank the Council on Government Affairs team. It's been a great tiger team the last two years I've had the privilege of chairing. Rosie Sokas has been our co-chair the last two years and Rosie is not able to travel due to some personal situations so she's not here today. Bob Bourgeois stepped up to become the incoming chair so as of this meeting we'll become the new chair of COGA. Dane Farrell has been our advocacy policy liaison with the government, replaced Pat O'Connor who had been with AECOM for gosh 25 or 30 years, as long as I can remember. Dane's done a fabulous job. We would have been lost without his help and leadership. He's a workhorse who responds to everything super quickly. Aaron Ransford has done a wonderful job as our AECOM staff support person and honestly the whole COGA team have done a wonderful job of steadfastly contributing to the mission and doing a lot of work, a lot of which is between the calls. It was kind of an email of the day that needs reading and responding to so my thanks to all of the COGA team for everything they've done over the last year and two years. The hardest part of our job I think is to stay focused. There's an endless spray of legislative things to respond to and things to deal with on the regulatory side and we want to be in a position to lead not just to respond and react. We want to initiate things that are favorable to our members, our specialty and to what we do for our patients, workers, employers and the like and so one of the mantras that I have is up here, the main thing is to keep the main things and don't get distracted by all the stuff that you can't be effective with. We've tried to stay focused on what we are experts in that's in our wheelhouse and that we can make a difference with and if we diddle with every little thing that pops up, we'll never get anything done. We'll just be bouncing from one ping pong thing to respond to to the next so that's kind of what we're challenged with. Some of our priorities have been pipeline development and funding. I hope all of you made the two wonderful sessions this morning that were given which were very illuminating. A lot of work to be done, a lot of good research, some of which will be published soon. We of course want to improve worker health, workplace health and safety for those who are our patients and be good stewards of the environment in things that affect our workers. So we have a really great panel team today. Dane is going to introduce each one of these panel members individually but it's myself, the outgoing chair, Bob Bourgeois, the incoming chair, Bob McClellan, Brett Perkison, Michael Cosnett and Dane Farrell and I assume Michael Cosnett is somewhere going to show up shortly. Oh, we see him in the back. These lights are blinding. I need sunglasses up here. What we're going to cover today for those of you that are just coming in, we're going to look at federal funding to train future generations of OEM physicians and as we heard this morning, improving the pipeline is not just about funding, it's about having plenty of people applying for the spots and before that it's about getting in front of medical students to know about the field, to get interested and to make the structure friendly for them to be able to apply and for those of you that haven't heard, you'll hear later, we are moving to the national NRMP match system for the next cycle so that's a big deal and a huge piece of news that's two days old. Bob's going to talk to us about, Bob McClellan, I can't say Bob up here because we've got a lot of Bobs, about data privacy related policies and implications on health data, electronic health records and the practice of OEM. Michael, excuse me, we're going to talk about heat exposure and workplace lead exposure, Cosnett will talk about that and all the people that were keyed up to talk about silicosis who were involved in moving that forward as a regulatory effort have conflicts with other meetings and other sessions so Dane has agreed to pick up the ball and talk us through that so with that, I'm going to go backwards and Dane is going to introduce each of the panel members for you. Thank you, Dr. Hudson. So we'll start it off, I'll introduce myself, I'm Dane Farrell, I work at Cascade Associates, we're a Washington D.C. based government affairs firm, long way of saying, I'm ACOM's lobbyist in D.C. My friend, Dr. Bob Bourgeois over here graduated from Louisiana State University of Medicine in 1983. Prior to his return to Morgan City in 1993, he served as the medical director for Martin Marietta, which is now Lockheed Martin in Orlando, Florida. He was also the consultant to Sea World of Florida and Walt Disney World. He is a past president of ACOM and was a three-term president of the Mid-South Occupational and Environmental Medicine Association. Dr. Brett Perkison is an assistant professor at the University of Texas School of Public Health and the Division of Occupational Environmental Sciences and director of the school's Occupational Medicine Residency Program. Before joining the faculty at the School of Public Health, Dr. Perkison worked in both family medicine and occupational medicine clinic settings and served three years in the Navy as a general medical officer. He was also part of the designated task force that co-authored a summary document which was accepted by ACOM as their official guidance document on the health effects related to climate change. Dr. Robert McClellan is a professor active emeritus at the community of family medicine at the Dartmouth Institute of Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth. Dr. McClellan has extensive experience as an occupational medicine medical consultant in a wide range of other economic sectors and maintained a clinical practice in occupational environmental medicine for close to 40 years. He is a past president of ACOM as well as the New England College of Occupational Environmental Medicine. He's deeply engaged in incorporating occupational health data as required fields in the general electronic medical record for over a decade with success. Dr. McClellan helped author an article published in JOEM entitled Electronic Health Records, EHRs, and Occupational Data, a call for promoting interoperability in addition to an upcoming article on recommendations for improving the specialized OEH electronic health record. He is also working on a forthcoming article on digital privacy. Dr. Michael Kosnett is an associate clinical professor in the division of clinical pharmacology and toxicology at the University of Colorado School of Medicine, an associate adjunct professor in the Department of Environmental and Occupational Health at the Colorado School of Public Health, and an attending physician at the Rocky Mountain Poison and Drug Center. He's board certified in internal medicine, occupational medicine, and medical toxicology. Dr. Kosnett has held numerous leadership positions and national appointments as a medical toxicologist, including service as the president of the American College of Medical Toxicology, member of the Committee on Toxicology of the National Academy of Sciences, and consultant for the US EPA, the Department of Defense, CDC, FDA, the Agency for Toxic Substances and Disease Registry, and the World Health Organization. So that's the short list of our panelists here today. Jumping in a little bit, what has happened in the past year on ACOM's Council on Government Affairs? It's a long list. It's probably not too readable here. Understandably, it's small font. We're happy to follow up. If anyone's interested in actually reading through this list, we'll send it along. But it's been a busy year. OSHA has been pushing out several new regulatory initiatives. We've had a lot of back and forth with Congress, trying to work the issue of, you know, what's the value of OEM? Why should we be funding OEM residency programs? What's the right avenue for that funding? And then also working a lot on getting folks from ACOM appointed to pivotal advisory committees within the federal government. A lot of agencies have committees that oversee occupational-related policies within the agencies. So we want to make sure that we have the right people in the right places. So that's a snapshot. Happy to follow up with details of folks. My email's at the end of that presentation as well. So we did want to kick it off talking a little bit about a case study and how advocacy works and really a success story that has come out of California. Folks are probably aware the growing number of reported cases of advanced silicosis among workers exposed to respirable crystalline silica who work in engineered stone fabrication shops. This issue is really identified in California and in other communities across the country. A lot of disadvantaged, at-risk migrant communities who are working in this construction field. As folks are aware, silicosis is preventable but an incurable progressive disease that causes serious fatal health effects and can be caused by breathing in RCS particles. This has definitely been of notice for a lot of mining communities in the past. So I think OSHA and other and MSHA are looking at how to translate some of that science that they've learned from those fields to this new emerging epidemic. As awareness started to grow around this, it was largely fueled by data from the California Department of Public Health. They had identified 95 cases of workers who had developed silicosis since 2019, 10 of them who had died from the disease. And the alarming portion of that is the young age of a lot of these workers wanting to make sure that they're able to intervene in an early stage to be able to catch this. At the vanguard of responding to this identified crisis really was physicians in California, OEM docs, pulmonologists who are seeing these cases firsthand and they saw the call to act and they heeded that call. In early 2023 in February, WOMA, the Western Occupational Environmental Medicine Association, petitioned the Cal OSHA Standards Board to adopt an emergency temporary standard to control the hazards of airborne silica dust in shops that fabricate engineered stone. They were concerned that the general industry standard just wasn't taking care of folks appropriately. So that ETS petition included several provisions advocating for stronger respiratory protection requirements, prohibition on dry cutting, requiring employers to have written plans to protect their employees, strengthening penalties for violations and requiring the reportability of these cases. It did take some time to work through the process in California and ETS can be brought by anyone. The federal OSHA also has this process. Folks might be aware of the COVID-19 health care ETS that came out. So similar. It's been used probably to some more success in California and getting some of these workplace provisions in place. So the California process had several opportunities for witness testimony, engagement with all the stakeholders, folks who are manufacturing these products, folks who are working with these products, the patients. And WOMA did a really outstanding job of looping in all the right folks at the right time. They engaged with ACOM leadership. They engaged with COGA. They got folks participating in these hearings. They had the patients come in, their families come in to tell their stories. So it was really a grassroots effort that was able to generate a lot of attention both from the regulators in California to federal OSHA to the local and national media. And that was really I think what helped at the end of the day turn this into a success story where in December the Cal OSHA Standards Board voted to approve the ETS. So now they're in the process of also working on a final standard. And we're happy to see that there's that WOMA didn't just stop there at that win. They went further. They self-generated a provider database tool to make sure employers were able to actually respond and have access to the right folks who might be able to provide medical surveillance to comply with the standard now. So and that actually even gave an idea to OSHA. How can we respond to this at the federal level? And they've since tried to have more collaborative conversations with ACOM on how we can look bigger to make sure that we're taking care of not just the folks in California but around the country. And we did also see OSHA took notice of what was happening in California last year. And in September they issued a new enhanced inspection initiative building off their previous national emphasis program on silica. And that enhanced inspection initiative was really targeting those specific industries that are working with engineered stone. So we just think this is a really powerful example of how a component can really start at the local level. You build grassroots support and you know make a big impact that then can go on to the national level. So another thanks to the group at WOMA, their legislative and regulatory affairs committee, folks like Dr. Bob Blank, Dr. Paul Papanek, Dr. Bob Harrison, Dr. Raj Dash and their lobbyists out in California, Don Shinsky. So with that I'll turn it over to my friend Dr. Bob Bourgeois to talk a little bit about OEM funding. Thank you, Dane. So actually, you know, like Dane's saying, we've been really busy. I can tell you back about five years ago, when we started talking about going to Congress to try and get some federal funding, we said, you know, in 20 years, nobody talks to us, they won't call us back or anything. This year, we've made contact with about 20 senators already and talked their offices and we actually have been using, you know, folks in the local area, folks that have some stroke in that in that community or the constituency. And so we've made a bunch of impact there. And a lot of folks didn't know who we were, what we were, what we did. You know, we all do hand therapy, right? So so now a lot more of them know about AECOM, they know about occupational medicine. And they also know that, you know, we kept the country running during COVID when everybody else was kind of buttoned up. And we made sure people could work safely and healthy. And that was good. So besides that, that gives us a little bit more visibility. So the Senate Help Committee, Health, Education, Labor and Pensions has come to us to ask for help on a few things. And so now we're starting to become, you know, back like we used to be recognized experts. So some of the things we're going to do for COGA this year, like Dr. Hudson was saying, is looking at things that are occupational environmental medicine, things that we would be the recognized experts on. So folks would say, hey, what do they think? Because we want them to ask us and and things that we're going to make an impact on. If it's something that, you know, we can bang our heads against the wall for five more years, we may look at lower hanging fruit till we have more time, more staffing. But that's where we're looking. The residency funding, you know, we went after some funding with Senator Cassidy from Louisiana. He got that through appropriations. We asked for four million. We got three. It went to HRSA. But they put some things in the the grants that made it not practical for occupational medicine programs. So we talked to him about making sure that that doesn't happen next time. So we're going to work on doing that. The other thing is like Dr. McKinney had a bill in Minnesota. So a state bill that's going to provide some funding for residencies in state. So we're going to try and look at helping with other issues like that if we can get some of those going. Dr. Perkinson's got some insurance funding from the work comp providers that are paying for some residency slots. So right now, the biggest thing that's holding up the pipeline is not finding residents. It's funding residents. So our main impetus this year, the biggest thing we're gonna do is try to get more funding. And so we're gonna have a few different committees probably working on that from from different areas. And and if you will listen to the pipeline talk a few minutes ago, I mean, that's exactly what they're finding, too, is that we need to get the funding and get that cranked up and going. So we're gonna do everything we can to do that. So anyway, that's that's where we are. We're we're looking at dedicated funding, maybe even trying to get line item funding like Pete's and whether that's Sue Hursa or going back to C. M. S. And saying we don't really take patients in from Medicare in the hospital as patients. But we provide you with healthier patients by keeping the workforce healthier. So maybe we're we're actually a good ally. So we're looking at a whole bunch of different avenues. And if any of you can think of really good avenues to look for funding to besides powerball and lotto, because I tried it. That didn't work. But anything you could do, just send us a note here and there. We'll try and see where we are. Thank you. Big. The big green button. Uh, yeah. Okay, great. Um, so it's pretty clear that the American public in general, um, has become concerned about digital privacy. Um, and, uh, the Congress has begin to pay attention to this. Um, but we have a special, um, special need within the practice of medicine to think about the data that we collect and who has access to that. And as we know, in O. E. M. There's a particular concern because sometimes the data that we collect is on behalf of agencies or on behalf of employers. So we want to be sure to get this right. So, first of all, just the history of a comms involvement in the issue of occupational health and health data. So back in 2000 and 11 in response to an a comm letter that I think I wrote, but you signed Warner. We expressed the concern and wanting some guidance from the E. O. C. About the electronic medical record that was now being used to collect both employee health data as well as, um, general health data. And they wrote back to us saying, Hey, you know what? Beware. This is a problem needs to be addressed. Then, in just a couple of days after that letter was sent, the Institute of what was called the Institute of Medicine back then held a workshop that we participated in on the ethical issues of including occupational health data in E. M. R. S. Might it not go the way that a person who actually provided that data wanted with that? Could that data be used in ways that would be adverse to them? Then just a year after that, we we published a position paper on the Web, um, reflecting some of what we had to say at that I. O. M. Workshop around general health, electronic health records and the occupational health elements of that, and how to be sure that it would be used correctly. And one of the things that we called for was the firewalls so that people who were using this integrated EMR, including both AHK health data as well as general health data would have access to the different types of data based on their privileges to see that data. Then in 2023, Dane mentioned we published an article in JOEM on electronic health records and occupational data, and actually calling for promoting interoperability in ways that would make sense. Then in 2023, the Senate HELP Committee actually provided us for an opportunity for ACOM's input around digital privacy and health records. That has prompted now a digital privacy article that we're working on that will provide guidance to all of us that we hope to be published in JOEM in the next year or so. So let me just talk for a little bit about why there's all this concern about digital health privacy. Well, certainly we all understand that there's a sensitive nature of health data, and that unauthorized disclosure can do harm, including discrimination and stigma. It's also fundamental to our patients' trust in healthcare. Without this trust, patients are going to be unwilling to provide the data that we need to actually care for them well. There are also significant economic implications for the institutions whose data is breached that can result in substantial financial penalties as well as loss of trust in that healthcare organization and its reputation. And this has happened in the past several years. So there are a lot of challenges to digital health privacy. We constantly, I'm sure that every single person in this room has been notified by some organization or another that their data has been breached. This has happened, of course, with healthcare institutions, health insurers, et cetera. And then it turns out that a lot of the third-party apps and the wearables that we're using in OEM for wellness programs, et cetera, are not subject to the same regulations as traditional healthcare providers. They're not covered under HIPAA currently. And then when we introduce the interoperability in a general health record between the occupational health information and the general health information, it obviously brings up a number of potential vulnerabilities. And it turns out that our patients aren't really necessarily aware of all of these issues. I remember in an ethics talk many years ago now, a lawyer standing up, and we should have two doors as you enter the occupational health clinic, that made it clear when you were entering the clinic on behalf of yourself and being cared for as an individual patient with all of the protections, and when you were entering that clinic on behalf of an agency or an employer. Because patients oftentimes just don't understand this. So what are some of the strategies for enhancing digital health privacy? Well, certainly robust security protocols. There's a lot of work going on to try to, in the arms race, if you will, around cybersecurity, regular audits of systems to be sure to identify and address vulnerabilities, education of both patients and staff on an ongoing basis about the rights and the measures taken to protect their data, and then transparent data use policies so that patients understand how their data is used, stored, and shared. And particularly on these wearables that so many of us are using right now in wellness programs, they have no idea about how this data is now being stored and used and sold by those companies that produce the wearables and the software. Also, and this has been a longtime recommendation, data minimization, that is, don't collect and store any data unless it's for a specific, for the specific given purpose for that encounter. And then there's the need for legislation and compliance, and we're way behind on that for sure. HIPAA currently doesn't really cover all of the issues that are necessary to cover. There is, and Dane may be able to talk a little bit more about it in the Q&A, there has been a bipartisan draft on privacy around this type of data. It does not deal specifically with OEM issues at this point, but I hope in the bill as it actually gets brought forward does include that based on our advocacy. And then the Cures Act, as you may know, has empowered patients to allow access to their data so that they can correct inaccuracies and say, have a say in how their information is used. So some of these unique aspects of digital privacy and OEM practice are going to be covered as well as this kind of background information about digital privacy and guidance that is coming in this paper that I've just talked about. And that will include an overview of some of the issues of digital privacy and employee health, discussion of the unique legal and regulatory framework that addresses these issues, talk about how we can better use digital health tools in the workplace and maintain privacy, talk about cybersecurity, and then some of the risks that are opened up to digital privacy when some of these safety measures are not taken. And so with that, I think we're ready to go on to the next. Thank you. Well, as you all know, heat stress is a hot topic right now. 2023 was set world records for heat temperatures. And so it is uppermost in many of our employers' mind. And so it's a nice opportunity. I'm glad to have the opportunity to summarize some of the work that's being done right now in the U.S. to meet these demands. So we'll start basically with two different aspects of this, the regulatory standpoint and the legislative standpoint regarding heat stress. OSHA, since at least 2021, has been trying to put together a federal heat stress standard. And I'm glad Dr. Hodgson's here today from OSHA to maybe answer some of the questions as well. But this year, this really moving forward over the last past year on really coming forward with heat stress legislation from OSHA, regulations from OSHA that will be released this August. And we don't have the details of that regulation yet. But you can, the Small Business Advocacy Review is a process that OSHA puts through that went through last August. And that information is publicly available where they put the OSHA regulation regarding heat stress for small businesses to review and offer their input. And so going through that information, one thing that everyone agrees on is that there's a need for more training, training programs for workers to be aware of heat stress and the importance of it. There's a lot of different feedback regarding a lot of different other areas. One is sizability and scalability. As always with all occupational issues, the smaller businesses are concerned is how can we implement a large heat stress program on a small scale. The other aspect is indoor heat. One of the kind of predecessors for a federal heat stress standard is the Cal-OSHA heat stress standard that came out a few years ago. And it was really in regards for agricultural workers. So as you can expect, it's mostly addressed as outdoor temperatures. But from indications thus far, the federal heat stress standards are going to address indoor temperatures as well. And so you can imagine all the different scenarios as how long does one have to be indoors before you're part of the heat stress prevention program. How much ventilation? How should you even measure the temperatures using the wet bulb, globe temperature or standard air temperatures? There's a lot of different issues that have come up. But they are tackling that because indoor heat is quite a bit of a problem as well. You think about large warehouses where there's an outside ambient temperature. And then that inside environment becomes just as hot. So we're excited about this coming in. Other processes is that it has been reviewed by the National Advisory Committee on Occupational Safety and Health. And they've offered their input. And as I mentioned, in August, there'll be a 60-day period for general input. So you all be on the lookout for that. And I really think that from our standpoint as occupational medicine physicians, we can offer really pragmatic ideas about what can work and what can't work. Because there is a high chance that this won't go through. There's a lot of pushback. There's a lot of issues about work productivity. How much time should somebody rest? How is it going to affect productivity? And I think we really have the answers to make kind of common sense regulations work that can really save a lot of worker lives for the future. Just briefly, there is some federal legislation that's been out there for a number of years in both the U.S. Congress and the U.S. Senate. The Asuncion Valdivia Heat Illness and Fatality Prevention Act. That incorporates a lot of the Cal OSHA standards. And it's, again, it's just issues of like how close should you have a water station to the workers? Should you have a, where should a shaded area be? How much of a rest break? Can you start earlier hours or later hours? Really geared kind of to the outdoor worker. But so far that hasn't moved out of committee. And then the same really for the Senate bill. So there's movement. There's a lot of legislators who are working on it. But so far the legislation really hasn't been able to move forward. The OSHA regulations seem to be, at least initially, our best bet for having some heat stress standards. And then finally, just the issues of state versus legislation really, I think, illustrates the need for a federal standard. Is in my own home state of Texas, in Houston, the city municipality had some heat stress standards for their workers. And it was actually overridden by a Senate bill. The Texas Regulatory Consistency Act. And that consistency part is that the argument is that if you have local municipalities having heat stress standards, you'll have a patchwork of different regulations that makes it difficult for employers to keep up with the regulations among each different individual city. So, and I think, and you see that same argument in other states across the country. So again, suggesting the need for a federal approach to this. And then finally, there are other organizations that have come out with different initiatives. The Safety Professional Institute have come up with a number of excellent heat stress recommendations that are available kind of from the safety standpoint. They also implement the importance of training. And as well, the other issue is medical surveillance, which so far was not in those early OSHA proceedings. Is the issue of recognizing people who are more at risk for heat stress and having a medical surveillance program. And I worked with Dr. Rhonda McCarthy, who's not here. We published in JOAM this spring on the, she did a municipal heat stress program and showed how a medical surveillance program really brought down heat stress injuries and illnesses over a period of time. So, with more data, that will become a stronger argument. And finally, Cal-OSHA is also having their own initiative on indoor temperature as well. So again, we have something to follow on. So, thanks and more to come. I spoke earlier today at 8 o'clock on the efforts to have revisions to OSHA's lead standards, both on the federal level and in California. And I've been really pleased that ACOM and the component, particularly WOMA, has been very active in this area. You know, the occupational lead standard was adopted 45 years ago. And at the time, it was advanced in many ways. But it hasn't been changed. And there's a real need for it to be updated, not the least of which is because lead exposure that's permissible under the current standard has been associated with a considerable increased risk of dying from cardiovascular disease. So, it was interesting to see that two years ago, do I advance? Okay. Two years ago, OSHA announced an advance notice of proposed rulemaking to look into the possibility of how and when, well, not when, but how they should update the OSHA lead standards. And it was really fascinating and valuable to see how ACOM could play a role in this. Now, one of the things I thought was interesting is, you know, we put out position statements periodically as ACOM. It was great to see in the OSHA preamble or call for information that they quoted in the Federal Register, ACOM's position statement from 2016. It really gave, it made us feel, I think, really good that one of our position statements was getting the notice of OSHA. So, what we did is we responded, we put together a task force and we put together a series of comments about why the OSHA standard indeed needed to be updated. And we published this as well after we submitted it to the formal docket in the form of a position statement which was published in JOEM in March of 2023. And we had a great contribution from a number of people here. And it's a good resource to get that information out there. And then another thing that I think was really very gratifying for me is we went to Washington. Dane Farrell is a fantastic individual and a tremendous asset to our organization. I mean, it's one of the, to me, one of the most exciting things about working as a, you know, volunteer member of ACOM is that they have a full-time professional like him who has access and knowledge of what goes on in Washington and who are the people. He set up five meetings for us with congressional, both the house representatives and senatorial offices and also committees to get the feedback and to talk to them about this. And it went really smoothly and it was just a great experience, Dane. And then we did something similar in California. California had finally issued a notice of proposed rulemaking in last year of doing its own standard, not waiting for FEDOSHA. And ACOM got together and we put together a letter for the docket in California to CalOSHA. And then we actually testified, many of us, at the meeting of the CalOSHA Standards Board on February 15th of this year. And it's one of the most gratifying things in my career was that it got passed and now California has the strongest occupational-led standards with respect to protecting workers. And I think that the voice of occupational medicine really, both on the component level in WOMA and on the national level is taking, is getting noticed. And I think this, what happened in California, is going to pave the way, hopefully, for this to be done on the federal level with the federal OSHA standards. Great. All right, thank you, panelists. We now have a little time for questions from the audience to the panelists. And so I would urge any of you that have questions to step up to the microphone and have at it. As people are sort of, you know, thinking about what they want to ask, we have a few canned questions I'm going to aim at the panelists. So the first one I'll ask to Dr. Perkison. So this two-part challenge of funding and getting medical students interested in the specialty, what changes need to be made to raise the visibility of the specialty and to improve the process by which they get into residency? And maybe touch on the recent vote to move residency application process to the NRMP match, which is a very big deal that's been debated for a long time and finally agreed to a couple days ago. Well, I think it's, like so many things, it's multifactorial. And I think the first thing of getting on the NRMP matching was a good first step. Not only will that allow medical students to see that on their match, but it also gives us as program directors the ability to do, to match medical students to an intern year, transitional intern year with them also matching to their PGY2 year. So that's a great first step. The real crux of the matter also is also the funding. And so I think that really will take place with, will be solved by all members here among ACON because we represent different groups. I think corporate funding sources, I think union funding sources, workers' comp insurance sources. I think if you think about it for the last 40 years, we've been providing trained specialists, occupational medicine specialists to all of these organizations, helping them run smoother, helping employers stay safe. And we haven't asked a lot in return. We were created from NIOSH as education resource centers and we haven't asked a lot. But I think it's time to start asking. I think it's time to not be shy, to put our development caps and really what I, in my own opinion, I think a national, a national foundation, a national fund where all these organizations could contribute to the continued education of residents could go and then that could then be distributed nationally to the 20 existing programs that we've got. And I also think, I also think continued great lobbying efforts on the part like Dr. Bourgeois and Dane to really fund it, kind of the right way, if you will, through increased NIOSH funding. I think that that is super important. It's just that I think it may take time. Maybe it'll happen next year, but it may take 10 years from now. I don't think we have that much time. I prefer to hedge my bets and approach it in different areas. Do any of the other panelists have any comments on this? Dr. McClellan? Yeah, well, recognizing everything that you said as being of most importance. It's also exposure, of course, of our medical students and perhaps even younger to the field. And I will say that for the first time in my 40-year career in occupational and environmental medicine, I was contacted by four Dartmouth medical students before they arrived at medical school to say, hey, I heard you knew something about environmental medicine. And indeed, there is a very active group nationally. I think they're called Medical Students for Planetary Health or something like that. And they're doing a scorecard of every medical school that looks at how much of their curriculum exposes them to planetary health and climate change, et cetera. And this has been an opportunity, again, for the first time in my life, both in their same interest at the undergraduate level. 40% of the admissions essays at Dartmouth College had to do with climate change. And so I would say that, yes, we need to get occupational medicine into the curriculum. We've been saying that for a long time. But where the interest is right now is in planetary health, environmental health, and we need to be there and forward. And a shameless plug for my session next Tuesday, tomorrow, Tuesday afternoon, is about teaching students at all levels, including our level and undergraduate level, about climate change. Great, thanks, Dr. McClellan. If no other comments from the panelists, I see we do have someone from the audience at one of the microphones, go ahead. Hi, Sasha Gutierrez. I'm working for the FDA. I live in Greer, South Carolina. Since I moved there, I have not been able to find any occ health clinics. And I don't even know where all the companies are getting their occupational medicine done at. I suspect it's a hospital system. But my question is, how do we use the funding to bring OCMED to these rural areas that have these huge companies because they're rural areas? How do we get the OCMED docs there, the trainees there? What can I do? You know, it's a great question. And I think one of the stumbling blocks with the funding that Dr. Bourgeois referred to is that it requires some involvement of community health clinics, which are, I think, federally designated clinics for underserved areas. And we don't typically have that as part of our repertoire. But what you bring up is that we probably should have some presence in the federal regulatory and legislative viewfinder that encourages our folks to go into these underserved areas. Many of the largest factories, plants, employment centers, warehouse distribution centers are in rural areas that are medically underserved and that aren't typically the most ideal place for a young physician to pick up and move to. And so it's a good question, but I'll turn to the panelists and see if they have other comments on that. Dr. McClellan. So while ideally, of course, it would be possible to place an occupational health physician everywhere that it's needed, we know that's not likely to happen in the near term. And so I think there are a number of things that are, first of all, happening right now that allows the projection of occupational health expertise into the hinterlands. There's a program called Project ECHO, which started in Arizona, it was Arizona, maybe it was New Mexico, that is a large state, as you know, a rural state, and that the need for specialty expertise was almost impossible to expertise, to access for people at distance from the cities. And so this happened to start with a liver specialist interested in hepatitis C. He started a program which he marketed to primary care providers across the state that involved a essentially an hour long over the lunch program of a 20 minute didactic content provided by the specialist, but then a case history presented by someone from the primary care community, and then a teach all learn all experience where there was interaction, live interaction to solve whatever the primary care problem was in dealing with this. Since its initiation, this has now been expanded greatly and internationally. It's been highly successful in a number of specialties, including in occupational health. So during COVID, well, right before COVID, we did one on substance use for employers. So we're doing these for employers now, recovery friendly workplace. During COVID, we had three project echoes to help employers deal with COVID related issues. And now we have one on mental health. So this is a means of projecting our expertise into remote areas. Thanks. Thanks, Bob McClellan. You know, it also reminds me of my days back as a family medicine faculty, well, resident fellow and faculty at UC Davis Medical Center and before that at UNC Chapel Hill as a medical student. Family medicine has these things called AHECs, area health education centers, which spread family medicine primary care through the rural underserved areas throughout the country. And it's worked really well. It's grown the residencies to where they have satellite programs and family medicine. I know in North Carolina and California has the same thing with added funding from Song Brown funds. And I just wonder if there's a way that occupational medicine can look at the history of the AHECs in family medicine and either piggyback on that or create some kind of process to emulate what has been done with funding to draw our members into areas that are not as well served as they might be. I remember the day when Montana had one occupational medicine physician. I doubt it's in double digits today. Any other thoughts from the panelists on this? Great question. Okay, great. We have another person at the mic. Sorry, it's very hard to see up here without sunglasses and blinders. That's okay. I'm very short, so it's easy to miss. Thank you very much for this wonderful panel. My name is Chang, and I'm an immediate past chair of the Walmart Legislative Committee, so thank you very much for the shout out. I see so many of my heroes up there, Dr. Bourgeois, Dr. Hudson. Thank you so much for being mentors to many of us over the years. My question is about how to get more physicians in our field engaged and also very passionate about maybe getting involved, running for office, or at least knowing about other people in our field that are running for office. So I'll share my story. I'm from a more rural area in California, and just from my local county medical association, I got involved at the state level and then with the AMA, and so I see how some of the other specialties, they really get people excited, especially younger physicians, and they would have younger physicians that would support them with mentorship and maybe even programs. To get them to run for Congress or local school board, and for example, one of my close friends from my county is a primary care physician, and she ran for the state legislature, and it's just been one of the big popular things for younger physicians now to go to the primary care meetings, get to talk to her, interact with her. I wasn't even aware that we actually have an OEM physician from Johns Hopkins running for Congress, Dr. Clarence Lamb. I did not learn that from our medical association. I learned from the API caucus where I have friends. So how can we get more of that information out there? We are doing good things, and we need to get more people involved, I think. Thank you. Great question and great comments and great subject. I'm going to actually turn to Dr. Bourgeois, who probably has a lot of fresh experience in getting people involved in advocacy locally in Louisiana. So advocacy in Louisiana is actually driven by the orthopedic folks. So when we combine forces with them, we can actually get some things done. So I think for the components, especially the larger ones, when you have multiple states, you almost have to know what works in which state because you can't do this one thing for everybody, and that helps. As far as getting more physicians involved in that sort of thing, we talked to some of the folks today from the Navy about going back to the general medical officers in the Navy when they come to Pensacola, the flight surgeons, and offering to do more with them in OCMED. And a lot of them are doing a lot of it already and probably like it. So we can pick up some folks there. We're making some inroads through the ambassador program in the med schools because now we're starting to do some talks in the med schools early. Mary Ann Cloran's done a great job with a bunch of that. You know, we gave some money to LSU a handful of years back, and now we've had another med student who's here at the meeting this year who just graduated, so now he's going to start a residency. And so we have two now that flipped from PM&R to OCMED, taking advantage of the money to go do a rotation. So a lot of those kind of things are starting to work in different areas, and I think the more we get out to the med schools and the more we make the med students aware of what we are, and certainly because now we're a specialty. You know, we had that ACGME announcement two years ago. Now we're going to be in the regular match, so all of a sudden we are doctors, you know? So I think a lot of that's going to make a big difference with visibility. This year was one of the best years for candidates for the match for OCMED, you know, in a while. So we have way more applicants than we have funded spots, and if we have, I think it was what, 45% of the spots are unfunded but approved, so we can do that. Maybe some of the smaller programs that are struggling can combine with a bigger one. You know, there's got to be some scale that makes it, you know, easier to do, and maybe we can get bigger and bigger programs. But, you know, I mean, right now, I mean, I think the pipeline, you know, as far as work on the pipeline, this is the most encouraged I've been in 35 years. Yeah, thanks, Dr. Bourgeois. You know, it does make me think that I wonder if CODA or some other group within ACOM can put together a tip sheet that can go out to all the members that just in a few bullet points summarizes how you can get involved in advocacy, what the process is, what the opportunities are, what the needs are, and how to move forward. Because right now, it's kind of ad hoc and ad lib, and so people that are high energy and are gonna go run, run, run, do it will find their way in. But other people who might be really great contributors who are a little less assertive may wander and sort of not feel welcome. And so I think some kind of a tip sheet is probably a simple thing that we could do at COGA or one of the other councils or committees. I do think back to how on earth did I get involved in this whole area. And back when I was more active with WOMA than today, the first committee I was involved in was legislative, and somehow I got involved in the California Medical Association Committee on Scientific Affairs, and I ultimately wound up on the Executive Committee for that at CMA. And through it, learned a lot about the process, how long it takes, how dedicated you have to be, how much reading and patience you have to have. I watched some of the semi-retired neurosurgeons and radiologists always win the day at the big meetings because they asked the questions at the last minute and could change the resolutions in their favor. And so I think people have to have a long view of how to make inroads on this. I didn't see the primary care people in PEDS, medicine, family medicine, much less OCMED, have nearly the success of the procedure-oriented folks who had the money and the willpower to stick with it for a long time. Those folks had more success than the primary care folks and certainly than OCMED. But that's sort of how I got involved, and I think everybody's story is gonna be a little bit different. But we can kind of incorporate some of those, where to start locally with your component and then migrate to ACOM comments into a tip sheet. But it's a great question. Thanks, Chang, appreciate it very much. Dane is gonna offer up some and then we'll come to the folks at the microphone. Yeah, just briefly on that point as well. I mean, my contact info will be on the last slide here. But for folks who are interested, if you're in DC, happy to set up meetings. If you wanna get involved, we're always looking for folks in the states to carry the message because it comes a lot better to the members of Congress when it's someone actually from their state, not me necessarily. So we do virtual meetings too. So if folks are interested, drop me a line. I'm happy to get you involved in ACOM's advocacy efforts. Thanks, Dane. And I see a question or a reply from Dr. Perkinson. And I was just gonna add, you know, I, before getting on the Council of Government Affairs, I was on the Council of Scientific Affairs and policy is something I was always interested in in learning more about it. And really the way, you know, that I decided to learn it was just get on the council and I have learned a lot. I hope in the session today, maybe we maybe have illustrated some examples of how medical knowledge can translate into policy. And as I see it, maybe we need to continue to do sessions like this. And for individuals that are thinking about running for Congress one day, you can see how your knowledge, your experience can really turn into really good legislation. You know, I remember when Richard Pan in California, who was a Peds resident when I was a resident of Family Medicine at UC Davis Med Center in Sacramento, decided that he wasn't gonna make a good enough difference with things like vaccines unless he dog on it, ran for the state legislature, which he did, successfully did. And has been an outstanding member of the California legislature for a couple decades, at least now. So a lot of people have done this and kudos to him. Also, I'll just mention Bob Blink from WOMA has done some talks on how he got involved in policy and legislative actions. And I know it was already mentioned by Dane that he, Bob Harrison, and Paul Papanek did a wonderful job getting in front of the Cal OSHA Standards Board to get the emergency standard in place on the silica issue of manufactured stone. But his saga on how he got involved is a really good one and we might, you know, ping him to get help with the tip sheet for our members because they did a great job. They structured a meeting with the Cal OSHA Standards Board so that there were science experts like Bob Harrison. They had a patient on oxygen who was, I think, queued up for a lung transplant speak. And in the end, it was a unanimous decision to go with the emergency standard, which they had initially, you know, it was like a four to three vote, so it was very close initially. But in the end, it swung the day. So his is a good story on how to go about it and hopefully we can get his input on the tip sheet. And we do have a question from the floor. Sorry. Hi, this is such a great panel. I have about 100 questions, but I just want to express one concern, which is too much confidence about our pipeline. I don't think we have a strong pipeline. I've been in this field also for many decades and we do get a lot of applicants. We don't get a lot of great applicants. We get a lot of people applying to programs where this is an afterthought or they didn't get into something else. The programs, many programs have shut down and there's a huge competition across programs for the best applicants. So I think that a very targeted task force that is really focused on recruitment to our specialty would be a good thing and not a patchy, you know, the patchy ones here and there are wonderful, but they aren't going to bring in 200 new applicants. I think we need a more concerted and centralized effort. So I just want to put that out there. Yeah, great, great comments. I think that probably you went to the two pipeline sessions earlier today. They were really, really well done and they went through all the data, the different groups that are working on it, the need for this long view effort that you've talked about and what can be done. I think that one of the things I learned at those sessions today was that although funding is a huge obstacle that we need to solve and exposure in front of medical students to our specialty is another big challenge on the visibility front, a third one is the structural issues which create trepidation, fear, uncertainty and people don't go down the OEM route and that is hopefully going to be addressed in a very large way with the NRMP match that was just cited on a couple days ago because as people think about applying to a residency slot, not in PG-1 but in PG-2, having to sort of qualify to get an MPH and then look at a PG-3 or et cetera, there's too much uncertainty. So many people avoid going down the route that they really would like to go down because of these structural problems and I think maybe I'll get Dr. Perkinson to talk about the impact of this NRMP match decision by the residency directors in addition to the funding and the visibility issues that you've highlighted. Brett. Yeah, I know there's a lot of ups and downs with applicants and I really think that yes, there's a concerted effort in a way that I haven't seen before in just these last couple of years. We've got great people working on medical school curriculums for occupational environmental medicine topics. We've got an improvement in how the match is working. We have outreach to different residency programs and collaborations with it. So I think we're getting there but we certainly, we still have a long ways to go. So thanks for the feedback and the perceptions. So I hope in a couple of years that you can be able to come back and say, boy, it's gotten a lot better. Dr. Bourgeois has one comment and I think we'll have to make that the last one because I see on the clock we're out of time but go ahead, Bob. And the other thing too with the match, if you think about it, you know, when we matched in the fourth year of med school, you know, I listed my five top surgery programs and I got my first choice. Now, you know, because the resident, because the med students aren't, they would be matching but until now there was so much uncertainty and concern. What if I don't get in? What if I do this? I gotta move twice. I got all this other stuff. So I really do think, you know, being in the match is gonna make a huge difference in getting better and, you know, the better and brighter students that we, you know, we wanted to get that were maybe scared. And I think if we can fund the first year where the residencies can have a first year fund to do a tailored adult med transition year, whatever they wanted to call it, you know, where you don't have to move again, I think that'll make a big difference too. So we're working on both of those things. Which Loma Linda, I will add, has done and they've drawn some very, very high quality applicants. So thank you for your great questions, your attention and thanks to the panel and y'all have a great rest of conference. Thank you.

panel discussion

occupational and environmental medicine

funding for training

worker health and safety

digital health privacy concerns

heat stress challenges

NRMP match system

residency programs

advocacy and policy-making

recruitment and visibility