Occupational Medicine for Providers

In the Acute Care Environment

Occupational Medicine for Urgent Care

Practical, no-where-else-available Occupational Medicine training for urgent care practice.

Get up to speed immediately in occmed exams and work comp care, and a great review for seasoned occmed docs.

You constantly face these issues with occmed exams:

  • You have a lack of information you can trust at your fingertips

  • Other training from ACOEM or AAFP is not relevant to your acute care setting

  • It's impossible to keep up with OSHA and other employment exam related regulations

  • OSHA, NIOSH, ADA, EEOC, etc - how do you sort it all out?

  • The staff is confused about testing protocols

  • Which tests to perform on which types of employment physicals?

  • When are tests "invalid" and need to be repeated or confirmed?

  • You can't get new clients for specialized exams

  • You're not sure of the expertise and equipment needed to perform more complex exams like hazmat/hazwoper, police and fire, heavy metal and pesticide exposures, etc.

Worker's Compensation care is frustrating because...

  • Your clients complain about workers being off duty

  • You're not sure which cases can be treated as "first aid" (unless you've completed the lesson on "OSHA Recordables!")

  • Injured workers don't want to go back to work

  • You don't know the "magic phrases" that will motivate workers to stay on the job

  • You're not sure when it's safe to return to "light duty"

  • You lack a system to prescribe light or modified duty consistent with a worker's injury that they can safely perform

  • Clients complain they don't know what's going on with their injured employees

  • You need reporting forms and templates for better communication with your clients, and guidance on which situations it's better to call them

As a Medical Director

You don't have time to teach and re-teach these topics to your provider staff

  • Clinic Managers:  Shudder when a new provider starts, because you'll get the phone calls from unhappy corporate clients

  • Ambulatory/Occmed C-Suite Execs:  Wondering why employer clients are leaving? Concerned about OSHA, employment law compliance?

Do You Identify with

Any of the Issues Above?

_____________

 


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Get the Occmed Course Now!

NAOHP members 10% discount, use your passcode as the coupon

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What's included?

10 Videos
9 Quizzes
23 Texts
9 Downloads
5.0 hrs


Who is this Program For?

  • Front line providers in urgent care and occmed clinics

  • MDs, DOs, NPs, PAs and DCs caring for injured workers and performing occupational medicine exams

  • New providers

  • Perfect for onboarding new providers into your existing practice

  • "Old-Timers" . Even seasoned occmed docs rave about stuff they've forgotten or confirmed existing practices

Medical Directors

  • Guide your staff and delight your clients

  • Not Yet Providing Occmed Services

  • Training specific to starting occmed services in your center

Who is this Program Not For?

  • Anyone who thinks you can easily pull in new employer clients without "doing it right"

    • This is practical training for providers to learn the mindset, regulatory and compliance issues, and patient management techniques for successful occmed practice

  • Academics who want a lot of biostatistics & epidemiology - Get that in a university MPH type course

Now Let's Discuss What's So Unique About

Occupational Medicine for Urgent Care

___________

So far, since you've made it this far, we know you are "qualified" to learn more...

How can this program help you?

If you had to go out and find all the information presented in these lessons, it would take months, and then you'd have to sort through to get just what is relevant to front line urgent care and occmed practice.  

I know because medical directors of large programs have told me they've already spent months tracking down some of this stuff only to find it so well presented in a half hour lesson!

Most of the research you'd have to do would be full of too much information.  I've already cut through all that and succinctly present everything you need to know for all your occmed exams and worker's compensation injury care.

 

Why is this course so effective?

These are not just learning lessons, but also full of practical resources you use every day for your occmed programs.

Each of these has all the forms, sample clearance letters, guidelines, and even posters for staff reference to assure you are conducting these exams properly.

I've had to train my providers and staff and have used these forms and materials in my own centers and for consulting clients.  It's all been perfected and updated over many years, and used for hundreds and hundreds of happy employer clients.

How Do You Know For Sure

This is Truly the Best Occmed Course For You to Enroll In?

You'll be in good company.  I've taught similar material (although it has improved and evolved over the years) for providers in organizations like:

 


It doesn't matter what your background - MD, DO, PA, NP and even DC.  

Or specialty - FPs, IMs, Med-Peds, Urgent Care, Occupational Medicine and ER trained providers have all benefited from these lessons.

Here's the Kind of Feedback We Get

  • Walter Vieweg, DO, Director of Occupational Health, Lake Health System
    I did have a chance to see your respiratory, first report and spirometry programs and they were excellent! Serves as a great intro lecture and very good review for those already active in occ med. I like your "to the point" succinct approach. Your programs are logically structured and informative. I think this practical approach will be of great help. The presentation on BBP exposure was excellent. I am responsible for employee health at my hospital and deal with BBP exposures on a daily basis. I believe it took me months to understand all of the information you presented so well in a half hour lecture. This was a great review for me and reassured me that I was doing things correctly. I honestly have to say how lucky I have been to find you and your vast knowledge of occupational medicine. As you know, regulatory medicine can sometimes be boring and unclear. You have the unique ability to make these topics understandable and relevant. As always, I am very grateful I found your site and look forward to more of your excellent presentations.
    Walter Vieweg, DO, Director of Occupational Health, Lake Health System
  • I recently purchased your course Occupational Medicine for Urgent Care and I am very pleased with it. I have completed the first two modules and the course is greatly exceeding my expectations. The content is well organized and very pertinent to my practice. The presentations are easy to follow. The quality of the video is excellent. It is obvious that a lot of work has gone into creating this course. Each session has links to pertinent information and downloadable forms and templates that are very useful. I had previously created a blood borne pathogen worksheet for use in my office, but yours is much better. I will begin using it immediately. I'm looking forward to completing the rest of the modules in this course, and then checking out the courses relating to commercial drivers. Please let me know when additional occupational medicine or urgent care courses become available.
    John Jurica, MD, PromptMed Urgent Care, Waukegan, Il


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powered by:

YES This Course is Fully Accredited!

Sorry about the boring required language that follows!  But you can claim credit for each lesson as you progress through the course.

Physician Continuing Medical Education

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Postgraduate Institute for Medicine and Urgentcarementor, LLC. The Postgraduate Institute for Medicine is accredited by the ACCME to provide continuing medical education for physicians.

The Postgraduate Institute for Medicine designates this enduring material for a maximum of 5.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Lawrence Earl, MD
Lawrence Earl, MD
Urgent Care & Occupational Medicine Consultant

About the instructor

Lawrence Earl, MD is a seasoned physician executive consultant with Ryan Associates with over 30 years of experience owning and operating Urgent Care and Occupational Medicine centers.  Currently full time consulting for clients ranging from independent urgent care practices to billion dollar healthcare organizations on all aspects of urgent care and occupational medicine from strategy and design, marketing and implementation and operational optimization.

Previously he served as COO and CMO of ASAP Urgent Care, a startup urgent care organization with 4 centers in the New Haven, CT area, which were sold to hospitals and physician groups. Before ASAP he owned and operated IMCC, Immediate Medical Care Centers, for 16 years, providing urgent care, occupational medicine, corporate clinics, DOT clinics and other employer based services in northern NJ.  This group was sold to Concentra in 2010, with Dr. Earl consulting for Concentra in areas of provider training and clinical operations.  In addition to community based urgent care, corporate health programs at Concentra and IMCC included care of worker's compensation patients, DOT, respirator, hazmat and executive physicals and drug screens, as well as wellness services, health fairs, disease screenings, executive travel consultations and many other services provided at company locations.

Prior to acquiring IMCC, Dr. Earl was Corporate Medical Director for HealthNet, of Oakland NJ, responsible for medical operations of 14 urgent care centers in NJ, NY and CT, and as part of the senior management team, helped to prepare that company for sale to Coastal Healthcare group in 1994.

Dr. Earl is also medical director for NADME.org, the National Academy of DOT Medical Examiners, an online training organization to prepare medical examiners for the NRCME, National Registry of Certified Medical Examiners exam.  This organization has successfully trained 10,000 medical examiner candidates nationwide.

He has given presentations on NRCME, Urgent care and Occupational Medicine related topics at UCAOA, NAOHP,  Strategic Solutions Urgent Care Building & Branding and other conferences and has written and collaborated on articles in the Journal of Urgent Care Medicine (JUCM) and the Ambulatory Care Advisor.

learl@naohp.com

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Here Are The

 

Course Objectives for each Lesson

Work Related Examinations Module

PrePlacement & Fitness For Duty Exams

In the occupational medicine setting a physical examination is a completely different animal than in the family medicine or internal medicine setting.

You'll learn to conduct preplacement and fitness for duty exams in accordance with the Americans with Disabilities Act (ADA), HIPAA and other applicable employment legislation, and provide the client employer with a medical opinion on the ability to perform the essential functions of the job, with or without accommodation.

  • Describe the difference between occmed exams and wellness physicals
  • Perform examinations in accordance with the Americans w/ Disabilities Act - ADA
  • Describe Employer responsibilities under current employment law
  • Describe Occupational medicine provider obligations
  • Determine if employee has a disability as defined by ADA
  • Determine essential elements of the job
  • Recommend additional testing in appropriate individuals
  • Determine worker ability to perform essential elements
  • Recommend reasonable accommodations to the employer
  • Recognize other federal laws’ impact on employment determinations
  • Describe which types of testing can be performed before a job offer
  • Provide a Fitness for Duty report to the employer

bonus material:  MS_word_DOC_icon.svg Physical Examination Summary Report sample

TB Testing and Management

In the urgent care and occupational medicine environment, we are mostly concerned with TB testing for our clients, and most of those are in the healthcare setting.  Among those are hospitals, outpatient centers, dental offices, long term care facilities, home care agencies and municipal workers such as police, fire and social services.

Our discussion here focuses on performing TB testing and management in this context.

You'll learn to properly conduct TB testing, interpretation of testing, management of positive tests and appropriate referral, follow up and reporting to occupational medicine clients.

  • Describe what causes TB - Tuberculosis
  • Explain how TB is spread
  • Explain the difference between Latent TB and Active TB disease
  • Identify those at high risk of infection and progression of disease
  • Identify target groups for testing in the occupational medicine setting
  • Discuss different testing methods available, and when to appropriately use each
  • Perform a complete medical evaluation for the presence of TB
  • Explain why latent TB is treated
  • Describe treatment regimens for latent TB
  • Determine when to refer for treatment for TB disease
  • Recommend follow up exams and testing as appropriate

bonus material:  MS_word_DOC_icon.svg Clinic TB Protocol   MS_word_DOC_icon.svg Record of Skin Test Results form   MS_word_DOC_icon.svg Record of IGRA Test Results form   MS_word_DOC_icon.svg Record of TB Treatment Form

Respiratory Fitness (Clearance) Exam

5 million workers in the United States are covered by the OSHA Respiratory Protection Standard under 29CFR1910.134.  Respirators protect workers from a wide variety of inhaled agents, including chemical, biological, and radioactive.

In most cases, if the worker is healthy enough to do the job, they are healthy enough to use a respirator for that job.

You'll recognize OSHA’s Respiratory Protection standard and the required elements of the evaluation of workers for the ability to use a respirator.

  • Describe employer responsibilities under part 1910 of the Code of Federal Regulations (29 CFR 1910)
  • Perform Initial and Periodic Respiratory Protection evaluations in accordance with OSHA standards
  • Recommend appropriate physical examination based on responses to the OSHA Respirator questionnaire
  • Recommend additional testing such as spirometry, chest xray, ECG and exercise stress testing in appropriate individuals
  • Provide a Physicians’ Written Opinion to the employer
  • Recommend follow up evaluation

bonus material:  2000px-US-OSHA-Logo.svg Respirator Questionnaire  MS_word_DOC_icon.svg Physician's Written Opinion

"Normal" Spirometry

The reason I have “Normal” in quotation marks is because what I see all too often on occupational medicine and OSHA regulated exams is a spirometry test that has a result labeled “normal spirometry” when the test is in fact, invalid.

The Test is invalid when it does not meet certain quality criteria due to any combination of these factors we’re going to cover in this lesson.

You'll become aware of the factors leading to a valid spirometry test result and determine usefulness of the test within the context of occupational pulmonary fitness evaluation.

  • Recognize that the spirometer used in occupational spirometry testing meets or exceeds ATS/ERS and ISO standards.
  • Determine whether spirometry equipment has been calibrated and/or validated all days tests are conducted and is functioning properly
  • Recognize errors in testing not detected by the equipment
  • Compile essential elements of the Spirometry Procedure Manual
  • Assure technician staff are properly trained
  • Determine whether spirometry tests are technically valid
  • Maintain a quality assurance program
  • Ensure spirometry reports are complete and contain recommended documentation

bonus material:  list icon NIOSH approved spirometry technician training schedule  2000px-US-OSHA-Logo.svg Spirometry Best Practices  chart poster icon  Valid Spirometry Poster for Technicians  Pdf_by_mimooh.svg Common Errors & Fixes

Asbestos Exams

Exposure to Asbestos carries significant health risks.  Pulmonary fibrosis, lung cancer, mesothelioma and other cancers can result.

Workers exposed to Asbestos are covered under the OSHA standard 29CFR1926.1011.

Employers are required to provide a medical surveillance program under the direction of a qualified licensed healthcare professional.

You'll recognize OSHA’s Asbestos standard and the required elements of the medical surveillance program.

  • Describe employer responsibilities under part 1904 of the Code of Federal Regulations (29 CFR 1904) and the Occupational Health & Safety Act of 1970
  • Perform Initial, Periodic and Exit Asbestos examinations in accordance with OSHA standards
  • Recommend appropriate Chest Xray intervals
  • Describe the B Reader Chest Xray requirements
  • Provide a Physicians’ Written Opinion to the employer

bonus material:  Pdf_by_mimooh.svg Multiple resources from CDC, NIOSH, ILO on CXR classification and B-readers  2000px-US-OSHA-Logo.svg Asbestos questionnaires  Pdf_by_mimooh.svg Asbestos Clinical Guide  MS_word_DOC_icon.svg Asbestos Physicians' Written Opinion

Hazmat-Hazwoper Exams

18 million tons of hazardous substances were disposed of or released into the environment from 1998 through 2004.

Because of the seriousness of the safety and health hazards related to hazardous waste operations and emergency response, the Occupational Safety and Health Administration (OSHA) issued its Hazardous Waste Operations and Emergency Response (HAZWOPER) standard, Title 29 Code of Federal Regulations (CFR) Parts 1910.120.

We'll review the components of the OSHA Hazwoper standard 29CFR 1910.120 and conduct medical surveillance programs for employees subject to the standard.

  • Describe employer responsibilities under part 1910.120 of the Code of Federal Regulations (29 CFR 1910.120)
  • Identify the 3 general categories of work operations subject to the standard
  • Recognize employers must institute engineering controls and work practices to reduce worker exposures to hazardous substances, and when not feasible, provide supplemental PPE (personal protective equipment)
  • Conduct medical surveillance exams in accordance with a site's HASP (health and safety plan)
  • Recognize additional substance specific OSHA standards may also apply to certain employee examinations
  • Provide a Physicians’ Written Opinion to the employer
  • Recommend follow up evaluation

bonus material:   Pdf_by_mimooh.svg PPE Protection Level Guide  MS_word_DOC_icon.svg Hazmat/Hazwoper Physicians' Written Opinion

Workers Compensation Injury Care Module

Workers Compensation Return to Work Strategies

There is plenty of research that teaches us that after an injury, returning to normal activities as quickly as possible, including work, is essential for recovery and well being.

Prolonged time loss not only costs money, but it is never truly recovered by most injured workers.  Longer term unintended consequences like deconditioning and loss of career opportunities may result as well.

As medical providers, we partner with our employer clients to return injured workers to productive activity as soon as possible.  We do this by:

  • setting expectations from day one with the worker that returning to activities, including work, is vital to recovery
  • communicating and coordinating all aspects of care with the employer client and/or case manager and claims adjuster
  • clearly documenting progression of the case
  • timely follow ups to avoid unnecessary modified or off duty
  • identifying and communicating specific physical abilities for transitional work/modified duty after each visit
  • assessing any impediments to return to work and aggressively evaluate as indicated with outside diagnostics or specialty consults
  • aggressive physical therapy for time loss cases

Learn how to embrace early return to work strategies during the evaluation and management of work related injuries and conditions that result in successful recovery of the patient while minimizing the impact of prolonged disability.

  • Distinguish best practices in worker's compensation cases vs. general health visits
  • Determine work relatedness and causality of a worker’s injury or condition
  • Communicate effectively with the employer to minimize time loss and disability
  • Set Goals and expectations of clinical outcome and return to work functions
  • Prescribe specific, function based modified or restricted duty job tasks when return to full duty is not appropriate
  • Schedule follow up visits in a timely manner
  • Identify impediments to return to work
  • Seek specialty consultations and vocational assessments appropriately

bonus material:  list icon Treatment Guidelines  list icon Condition Treatment Index  list icon Activities Prescription Form sample

OSHA Recordable Injuries

What makes an injury OSHA recordable?

What are employers required to do to track work related injuries and illnesses?

How can medical providers can help their occmed clients reduce OSHA recordable injuries?

OSHA recordable injuries are only those that meet certain criteria, including cases that are considered beyond “first aid”

Limiting care to first aid for minor cases and avoiding unnecessary time loss can reduce the number of OSHA recordable injuries for your employer clients

In this lesson you'll recognize OSHA’s general recording criteria during the evaluation and management of work related injuries and conditions and while first providing necessary medical attention to the worker, will assist the employer (client) in keeping “OSHA Recordable injuries” to a minimum.

  • Describe employer responsibilities under part 1904 of the Code of Federal Regulations (29 CFR 1904) and the Occupational Health & Safety Act of 1970
  • Determine work relatedness and causality of a worker’s injury or condition
  • Describe the seven general recording criteria of an OSHA recordable injury or condition
  • Avoid prescribing inappropriate off duty or modified duty restrictions
  • In appropriate cases, limit treatment to “first aid” according to OSHA, rendering the case non-recordable
  • Recognize which conditions remain “recordable” even when treatment is limited to first aid
  • Avoid unnecessary time loss for these minor cases
  • Reduce OSHA Recordable injuries for your employer clients
  • Become an invaluable resource to your employer clients

bonus material:  list icon OSHA First Aid List  chart poster icon First Aid Poster

Management of Blood Borne Pathogen Exposure & Needlestick Injuries

In this discussion we’re mostly concerned about bodily fluid exposure in health care personnel and the risk of contracting Hep B, Hep C and HIV infection.

This session does not replace OSHA required training of HCP under the blood borne pathogens standard, rather here we’ll review current recommendations for post exposure prophylaxis and management.

So once you have your own employees or an occupational medicine client presenting with an exposure, we’ll walk through the procedures you need to take to properly determine whether an exposure has occurred, evaluate the patient and source individuals for presence of infection or immunity from HepB, HepC and HIV, recommend post exposure prophylaxis and follow up procedures.

We include resources for the PEP hotline and forms and worksheets you can use in your practice.

You'll clinically manage exposures to blood borne pathogens according to US Public Health Service recommendations, provide post exposure prophylaxis and immunizations as indicated and provide documentation and reporting consistent with OSHA's Blood Borne Pathogen standard 1910.1030. 

  • Define a blood borne pathogen exposure and determine necessary elements of an incident required to be considered an exposure
  • Evaluate an exposure for the potential to transmit Hepatitis B (HBV), Hepatitis C (HCV) and Human Immunodeficiency virus (HIV)
  • Determine the risk of contracting HBV, HCV, and HIV from an exposure.
  • Identify conditions indicating a higher degree of risk of infection.
  • Treat the exposure site
  • Correctly report and document the incident
  • Evaluate the Source Person (SP) or receive documentation about the SP from other sources
  • Evaluate the Exposed Person (EP) and determine susceptibility and  immunity to HBV
  • Assess the likelihood of transmission of HBV, HCV or HIV when the SP is unknown or cannot be tested
  • Administer post exposure prophylaxis (PEP) when indicated for HBV and HIV
  • Refer the EP for early treatment of HCV when indicated
  • Counsel the EP on risk of transmission, PEP, side effects, follow up testing, precautions to prevent secondary transmission and allowable activities post exposure
  • Perform follow up for testing according to type of exposure and PEP and for needed immunizations
  • Provide a "Physician's Written Opinion" to the employer for work related exposures

bonus material:  chart poster icon Post Exposure PEP chart Pdf_by_mimooh.svg PEP Quick Guide  Pdf_by_mimooh.svg Update Public Health Service Guidelines  Pdf_by_mimooh.svg  CDC + Other Federal Guides  list icon BBP Exposure management worksheet MS_word_DOC_icon.svg Hep B Postexposure Immunization Record  MS_word_DOC_icon.svg  BBP Physician's Written Opinion

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NAOHP members 10% discount, use your passcode as the coupon

Sign up now!

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