Occupational health professionals face the challenge of change as the economy slowly recovers.

"The industry is moving to more on-site care. Nurse practitioners and on-site clinics are increasing," says Margie Weiss, PhD, CEO and community health advocate at the Weiss Health Group, a Neenah, WI-based consulting company that works with companies and communities on health and wellness.

"Occupational health and safety providers are also being integrated into sustainability initiatives," she adds.

Jim Lobel, CEO of InterGold LLC, a Florida-based provider of healthcare services to the public and employers, sees a trend of employers implementing long-term safety programs as a means of reducing costs due to injuries.

"Although these programs generally don't show dramatic results for a year or two, once they do, the decrease in new injuries is significant," says Lobel. "Some employers are seeing 50% reductions."

From an employer's point of view, Lobel says that this is "absolutely good news. From a provider's point of view, it's a mixed blessing since we see fewer patients."

Many urgent care clinics have entered the occupational health market.

"Even companies like Walgreens are beginning to deliver some services a-la-carte in the occupational medicine area," says Lobel. "When combined with wellness programs and in-house clinics, the effect on traditional occupational medicine providers is evident."

Lobel says that stand-alone occupational medicine providers are seeing a drop in revenues. At the same time, they are required to provide higher and higher levels of customer service and patient care.

"That said, as with all businesses, reinvention is a way of life," he says. "The lines are being blurred between workplace medicine and general medicine, even though the expertise necessary to practice workplace medicine successfully is not normally present in the broader health care community."

Lobel says that it is becoming rare to find a physician that is board-certified in occupational medicine, and it is becoming more necessary to train providers in the field.

"I believe that what the future holds is a trend toward combination providers — urgent care and occ med," he says. "The investment in a new center of either type can exceed a million dollars. Deep-pocket investors, hospitals and others are seeing the opportunity and taking the plunge."

Compensation and job factors

And what about the bottom line in terms of compensation? According to the 2010 Occupational Health Management Salary Survey, almost half (45%) of respondents fell into the $70,000 to $89,999 range, with the same percentage earning less than $70,000. Another 9% earn over $90,000. Notably, over half of respondents (55%) reported no change in salary in the past year, while 18% received a 1-3% or a 4-6% increase.

The survey, which was administered in August and tallied, analyzed, and reported by AHC Media, publisher of Occupational Health Management, identifies some of the factors impacting salaries and benefits in occupational health. Other key findings of the survey:

• Only 9% of respondents work less than 40 hours a week, 45% work between 41 and 45 hours, 36% work between 46 and 50 hours, and 9% put in over 50 hours.

• Thirty-six percent of respondents have worked in occupational health for only one to three years, with another 27% in the field for between ten and twelve years.

• Over half of respondents (60%) supervise a small staff of between one and three employees.

• Over three-quarters (82%) of respondents said they had no changes in the size of their staff in the past year, while 18% lost positions.

Weiss sees these new roles as some of the possibilities for occupational health in 2011 and beyond:

• Researcher/population health expert.

"Community-based programming will be driven by robust, regional community assessments," predicts Weiss.

• Traveling consultant.

"The movement of health care out of traditional health care settings and into community and work settings will continue," says Weiss.

• Counselor.

Wellness programs through Employee Assistance Programs (EAP) are prevalent. On-site programs may cover stress-prevention strategies, mental health, self-esteem enhancement, money management and relationship management. "An increased focus on preventive mental health and spiritual wellness is evident," she says.

• Educator/trainer.

"The focus on self-efficacy and collective efficacy strategies will continue," says Weiss. "The availability of self-care resources will become a facility planning issue." Online health promotion resources, such as print, video, blogs, and chat rooms, and the ability to use technology efficiently will become important drivers for space planning, she adds.

• Health care financial advisor.

"Employers will continue to shift health care costs and accountability to employees," says Weiss. You may be the one they turn to for answers and guidance.

• Business consultant.

"The emphasis on the link between corporate and community health will become more prominent," she says.

• Strategy expert.

An increased emphasis on developing and maintaining healthy worksites and workers will continue. "Corporations understand the interplay between healthy environments, healthy workers and healthy bottom lines," says Weiss.

• Integrative health providers.

The integration of complementary/alternative medicine into health promotion and medical care will escalate. "Worksite stretching exercises, relaxation therapy, meditation rooms, and the use of aromatherapy are a few examples of alternative medicine approaches presently being used in worksites," she says.

• Marketing expert.

"Varied marketing approaches for mass and cluster risk management are required to effectively deliver the appropriate health care," says Weiss.

A diverse work force requires equally diverse educational and marketing messages. "Office and field workers respond to different health promotion activities and educational efforts," she says.

Previously, worksite wellness was the responsibility of the company's occupational health nurse. This person's main focus was on getting injured workers back to work quickly and safely.

"Now, workers are asked to become partners in health promotion by joining worksite wellness teams," says Weiss. "Instant access to educational messages requires a variety of approaches."

• Evaluation experts.

Accountability for resource utilization with health promotion and prevention efforts will continue to be a major factor in determining worksite wellness programs. "Outcomes metrics will be tied to reimbursement," she says. "Key health indicators will be monitored on a routine basis to measure program effectiveness."

Despite these expanded roles and responsibilities for occupational health, there have been minimal salary increases due to budget constraints. "The 'new' economy is still unstable," explains Weiss. "Companies are still unsure as to the direction the government will be taking with regard to both the tax structure and health care reform."

Your best bet, says Weiss, is to stay flexible and focus on the big picture. "Healthy people, healthy worksites and health-promoting 'green' processes all intersect at the bottom line," she notes.