Need & Impact

The need for more occupational medicine specialists has been clearly documented and nowhere is the need greater than in the rural areas of Kentucky and Appalachia. However, through the years, university and state funding dollars slowly evaporated and the program was forced to accept fewer residents. This loss of potential practitioners is especially regrettable given that the area served by the University of Kentucky includes Appalachia, a region notorious for difficulties with access to healthcare as well as the over-representation of some of the most dangerous occupations, i.e., forestry, farming, and mining.

Being able to increase the number of OM residents in UK’s program, at least in part by establishing a reliable funding stream, will afford more opportunities for their involvement in outreach, service, research, teaching, and projects in the Appalachia area.

Through a variety of initiatives, access to adequate healthcare in the Appalachia region has improved over the past several decades. Despite this trend, the situation is still far from optimal in many parts and for many people of Appalachia. By example, two-thirds of Kentucky’s counties – 81 out of 120 and nearly all of them rural – are officially designated “Health Professional Shortage Areas” for primary care (Casey et al, 2005). Of these counties, many, if not all, of the counties in the Appalachia region are included in the count.

Concomitant with the scarcity of primary care in the region is the under-representation of medical specialties. In the case of occupational and environmental medicine, the situation is sobering. West Virginia has only 24 board-certified occupational medicine physicians and Tennessee has a total of 68 (ABMS, 2016). In Kentucky, there are currently 33 board-certified occupational medicine physicians (ABMS, 2016). It is worth noting that as recently as 2011, > 90% of the occupational medicine physicians in Kentucky were located in or around (<25 miles away) the metropolitan centers of Lexington, Louisville, and Cincinnati with occupational medicine doctors in Paducah (far west) and Ashland as the only “outliers” (ABPM, 2011).

The situation is even more incongruous when one considers that the working populations of central Appalachia are largely employed in occupations with some of the highest rates of work-related injuries and deaths, i.e., farming, truck driving, logging, and mining (BLS). Therefore, an area with a historical concentration of high risk jobs has the least access to board-certified occupational medicine physicians in the state.

The opportunity to increase the OMR will allow for expansion of resident experiences, research, and the provision of services in the central Appalachia region. It is a unique and exciting proposition to be on the leading edge of introducing and/or expanding occupational and environmental medicine into areas traditionally with the greatest needs and the most underserved citizens and workers. This includes:

• Championing occupational safety and health in a region where 50 to 75% of all fatal occupational injuries are associated with transportation/trucking; production agriculture, forestry, fishing and hunting; and mining.

• Cooperating with management, labor representatives, employees, and other agents of change to bring united forces to bear against the challenges of: antiquated communications and technology; outdated and, in many places, non-existent sewage, waste water, and drinking water treatment systems (ARDI, 2010); persistent high rates of tobacco use; prescription drug abuse and other high risk behaviors (Griffith et al., 2011); and excessive incidence of obesity, diabetes, cardiovascular disease, and cancer (Danai et al., 2010).