ter 2, which indicate that occupational medicine physicians are increasingly employed by clinics and less often by industry. The Association of American Medical Schools has frequently expressed the view that this increased emphasis on seeing patients is interfering with the conduct of the research and education missions at academic health centers. It may compete with the preventive aspects of occupational health as well.

Third, emphasis on primary care physicians, nurse practitioners, physician’s assistants, and other health care professionals instead of specialist physicians may undermine attempts to increase the small numbers of board-certified occupational medicine specialists. As an earlier Institute of Medicine report (Institute of Medicine, 1988) pointed out, increasing the ability of primary care physicians in occupational medicine is vital for the health and safety of workers, but that task is itself dependent on a larger supply of occupational medicine specialists. A similar argument applies to the undeniable need for more coverage of occupational safety and health in physician’s assistant and nurse practitioner training.

Fourth, the use of teams to deliver health care means that occupational safety and health training programs should expose students to the delivery of health care by teams.

Fifth, the growth of managed care means that more occupational safety and health services (including those paid for by workers’ compensation) will be delivered in a managed care setting, so occupational safety and health students should be exposed to managed care during their training programs. Rivo et al. (1995) and Meyer et al. (1997) propose new curricula that can be used to better prepare physicians for practice in the managed care setting.

Sixth, occupational safety and health students should understand health care financing and the pressure to reduce health care costs and the likely impact of these on the quality of occupational health services.

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