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Doctors at Work Podcast.

Episode #73

What’s a career in occupational medicine like? With Sarwar Chowdhury

Mat Daniel


Sarwar tells me that occupational medicine is a very varied specialty, which draws on a range of skills particularly problem solving, negotiation, and report writing. Much practice occurs outside the NHS, and the routes into the specialty include both NHS and training outside the NHS. It’s one of the few areas of medicine where doctors get to spend 45 minutes or longer talking to a patient, and his career allows him to practice medicine whilst at the same time working with many different non-NHS contexts.

Sarwar Chowdhury has several years experience as an Occupational Health Physician (OHP) and is Medical Director for Medigold Health. He operates as a Senior Lead Occupational Health Physician for a Tertiary NHS trust as part of a wider MDT of Occupational clinicians. He has extensive experience with undertaking complex medical management referrals, pre-placement medicals, health surveillance, blood bourne virus (BBV) monitoring, treating clinician referrals, clinical governance and policy writing.

He has expertise in private Occupational Health for SME/businesses conducting high quality assessments including Management Case Conferences, Complex Management Referrals, Driver Medicals (Group 1 & 2 licences), Rail, Firefighter, Local Authorities, White Collar businesses, Biological Monitoring, Health Surveillance and Ill Health Retirement (range of industries including NHS). He acts as the Medical Review Officer (MRO) for verifying Drug and Alcohol Test and Screening results is involved with clinical governance and auditing of Rail Work as the Duty Rail Doctor covering a wide range of Train Operating companies and supervision/support of dozens of clinicians across the UK.

He practises as an AFOM – Associate of the Faculty of Occupational Medicine and is certified as an Office of Rail and Road Doctor (ORRDOC), FOM Tier 4 HAVS approved, HSE appointed in Asbestos & Ionising Radiation.

He is close to completing a prospective CESR route training (4th Year) for Accredited Specialist status in Occupational Medicine as a Consultant Occupational Health Physician. This involves also completing his MSc in Occupational Medicine at Manchester University and currently holds AdvDipOccMed status after 2 years of the course.

He co-founded and runs the Occupational Health Academy demonstrating entrepreneurship to create a brand and website, leadership in co-running the course, teaching skills with delivering courses in medical education in Occupational Medicine for the Diploma of Occupational Medicine (DOccMed) exam & MFOM Part 1.

Aside from his work, he volunteers as the CESR ‘training’ Representative for the Society of Occupational Medicine (SOM), guiding and liaising with Occupational Health Physicians seeking to gain MFOM (ad eundem) outside of the traditional CCT route.

You can connect with Sarwar on LinkedIn.

You can find out more about Occupational Medicine on the following resources.

You can also watch on
Production: Shot by Polachek

Podcast Transcript

Mat: [00:00:00] Welcome to Doctors at Work. My name is Mat Daniel, and this podcast is about doctors’ careers. It’s part of my mission to help others create successful and meaningful careers. Today, I’m having a discussion with Sarwar Chowdhury, and we’re talking about what a career in occupational medicine is like. He tells me it’s a very varied specialty, which draws on a range of skills, particularly problem solving, negotiation, and report writing.

Much practice occurs outside of the NHS, And the roots into the specialty include both NHS and training outside of the NHS. It’s 1 of the few areas of med Seen where doctors get to spend 45 minutes or longer talking to a patient. And his careers allows him to practice medicine whilst at the same time working with many different non NHS contexts, and thinking outside of the box.

Mat: Welcome, Sarwar. Tell me a little bit about yourself.

Hi. Um, so, uh, I, [00:01:00] um, My my native country is, um, Bangladesh, but I was born in England. I’ve been a doctor now for over 10 years Based in kind of London area, um, and, um, I’m an occupational health doctor and a medical director.

Mat: So today we’re talking about occupational health. What is occupational health?

Sarwar: So occupational health Is in simple terms, the relationship between health and work, um, health and safety at work. So it it combines what we call Occupational hygiene, which is kind of workplace hazards and how it affects the body, but also underlying health conditions that affect work. So health and work Work on health effects. Um, but also there’s a lot of ethics. There’s a lot of law and legislation.

So it’s quite a nice little blend of of those kind of 4 factors, occupational medicine, ethics, and more, um, and it’s its own specialty. And it it

Mat: sounds quite different to Most of the maybe sort of general practice or [00:02:00] hospital pathway because, you know, most of us spend all our time being doctors, but you you’ve outlined An awful lot of stuff that isn’t necessarily

Sarwar: mentioned. Yes. No. Absolutely.

And I I I think, um, you know, although, uh, you know, our Experience most, uh, you know, most of us with occupational health would be just to make sure that we’ve had our immunizations before we start a hospital rotation. But actually, it goes well beyond that, and some of you who are listening may have had some experience with occupational health where there’s been an issue with a health on work or work on health issue or There’s a requirement for advice with adjustments for working. Um, and, uh, you know, it’s it’s it’s a nontreating specialty. Um, but at the same time, you you still use in all the medical knowledge from day 1 medical school, all of your experience. Um, and, you know, we talked about GP just there, but there are other specialists like psychiatrists and stuff that do go into occupational often that you know, any Any health experience, any medical practice experience is very useful.[00:03:00]

Um, and, uh, you know, surgeons make excellent occupational physicians as well. Um, so, yeah, it’s it’s, um, slightly different, and you have to think kind of differently, and hopefully, we’ll go into some of that today. Um, but at the same time, the great thing about it is that you’re not Completely out of your comfort zone and not using your medical knowledge. You are still doing that in every day. Um, parts of my work, I am still doing history taking and, You know, doing doing what what what most of us would be doing anyway is just in a different manner and from a different angle.

Mat: Yeah. Let let’s start at the beginning then. So what attracted you to occupational

Sarwar: health? So, um, yeah. I mean, For for me, Matt, my my career, um, you know, started kind of, um, you know, part of went through medical school at Bartletta London in East London, Graduate 20 12, and I was kind of going through the motions that most of us do with f y 1, f y 2.

And then I suppose most of us at around f y 2 need to start thinking what we’re gonna do for the next 25, [00:04:00] 30, 40 years of our life, which is actually a really difficult thing to do. Um, so what I did is I started to locum a little bit and just wanted to feel kind of, let’s say, different specialties, a little bit psychiatry, a little bit of pediatric Surgery, a little bit of rehab medicine, you know, uh, and I did a a a variety of kind of rotations, let’s say, um, And did a bit of traveling and just wanted to get in that outside perspective because there’s more to life than work. Um, but also, I just didn’t know what I wanted to do. Um, I think some of us kind of default towards GEP, and maybe maybe I’m wrong. Maybe there are a lot of us that in that I really want to be a GP, but I feel that a lot of people I speak to, especially colleagues I have, um, do GP because it’s, let’s Say the easiest way to CCT in a few years, but also to try to get that work life balance.

And, actually, what I found is actually I didn’t really want To do that, and I felt that actually there’s other specialties that could lead me to [00:05:00] get that work life balance where I’m doing more 9 to 5. I’m earning a very decent salary, and I’m still using my knowledge. I’m still being consulted, so to speak. Um, And also, you know, just just get engaged. I still wanted that interaction with people and, you know, history taking, Um, and, uh, you know, to just kind of generally try to help people, although it may not be treating, you know, occupational medicine fit all of that, and it ticked all those boxes.

Um, and also career progression, its own specialty. I didn’t wanna just enter a job and stay at the same level for 25, 30 years. I wanted to See if there’s some sort of progression. And, yeah, you know, I I almost fell into it by accident. Um, and, uh, maybe if we do go through my career history, we can talk a bit more about But, um, yeah, it it it just ticks so many boxes.

Um, and I think the people I’ve never heard of an of anybody that goes into occupation medicine And then comes back out. It’s always the other way where they do occupational medicine, [00:06:00] and then they end up giving up or, like, letting go of some of their other portfolio Aspects and and going into it full or part time. So it it

Mat: sounds like there’s different ways in then because you said that, You know, maybe you could do your f 1, f 2, and then you can enter occupational medicine. But you’ve also said that sometimes people do variety of different things and then they enter, Or sometimes people already have a CCT in something and then they

Sarwar: enter. Yeah.

Absolutely. And that’s the great thing about occupational So instead, if whether you’re doing a portfolio career, so some of the GPs that I come across wanna do 1 or 2 days a week occupation medicine, Some hate their specialty and couldn’t think of anything worse than doing another day what they’ve been, you know, either training in or looking towards, or they’ve realized that the opportunities Actually aren’t that easy and actually would require them to relocate, for example. And unfortunately, you know, some of the pediatric surgeons that I worked with in my rotations Gens earlier on in my career, they were moving around like crazy because, obviously, there’s only a few areas that that actually [00:07:00] have pediatric surgery as a as As a specialty in a in a tertiary hospital, for example. Um, and, uh, you know, that that that kind of led, You know, me to kind of, um, look at all the other opportunities, and I’ve I’ve done other kind of conversations and talks. But, Yeah.

You can do the traditional f 1, f 2, um, medicine or GP, s t 1, s t 2, even surgery, s t 1, s t 2, or psychiatry, And then apply for a training number s s t 3 with a, you know, a registrar post, and a lot of people do that. They don’t really Come outside the NHS, they just go straight into, like, a net you know, the training programs, um, registrar, and then CCT at the end of it after SD 6. But others look at it different ways. Some people are later on in their career. They’ve had enough.

They just wanna do, um, you know, the basic qualification, occupation medicine, practice as an occupational physician, and see the rest of their working days out. Others, you know, they changed their mind, and I’ve heard of s t 6, uh, ENT [00:08:00] registrars. I’ve heard of consultant anesthetists come into occupational medicine. So, you know, it it really, really varies. And, uh, You know, um, that’s the great thing.

There’s so many entry points. It’s so flexible. So, um, you know, you really could do whatever you wanted with it. Um, and, uh, you know, it’s been very attractive for that reason, and it it does help that it pays well as well. So yeah.

What what what makes it an attractive career? So I think, yeah, we what what we just touched on there, which would be things like the flexibility of it, the fact that it’s It’s own specialty and niche, and I think some people really like to kind of own their specialty, and they don’t just want to be, let’s say, a generalist. They want to specialize and become a matter expert. But also, I think, for me, I you know, in speaking to other people, not only the work life balance, but the fact that actually It’s it’s all almost out of the box thinking. Traditionally, from day 1 medical school up until when we start practicing as doctors, we’re almost trained and [00:09:00] thought and made To think in a certain way and quite rightly so.

But I think sometimes, you know, when you start to take a step back and look outside the box and think about other factors And and how you can apply yourself and what you’re interested in. For example, law and legislation. I don’t think I did a lot of that at all Up until I entered the occupation medicine, there’s actually so much out there, and you you there’s so many subspecialties, rail, diving, aviation, Oil and gas. So, you know, it really is just whatever you want it to be. And I think that’s the the headline is that occupation medicine is occurring.

Whatever you want it Could be it can be what you want it to.

Mat: Yeah. So give give me an example of what do people do in their typical week

Sarwar: then. So, um, it’s it’s obviously not involving on calls and weekends and nights. So that’s the main kind of headline There as well.

But, um, you know, it’s a it can it’s a 9 to 5 or it’s a part time, whatever hours you feel, um, that you want to work. And I think most people, When I started 9 to 5, Monday to [00:10:00] Friday, um, you would get typically about 45 to 60 minutes Per person. So it’s not a rushed, um, kind of interaction with someone. You really do get to spend time with them and really find out what’s troubling them and really take a detailed history. Um, you can be remote.

You can be in clinics. Sometimes they visit on sites and up into construction sites, uh, depots where the the train sleep at night, Um, you know, um, a a massive kind of factory that deals with, uh, you know, making planes and stuff. So it really varies what you can actually get involved in. Um, and, um, you would spend that 45, 60 minutes, and you would look at, First of all, what, uh, the fact that managers refer themselves, obviously, a concern or a a need for advice. Take a detailed occupational history, A clinical history, uh, about their symptoms and how it’s affecting the treatment and things like that.

And then do something what we’re probably not used to, is more of a functional history. So [00:11:00] how’s it affecting their day to day, their activities of daily living, washing, dressing, cooking, house, what those kind of things, and try to Place that in context with their work. And then finally, kind of, you know, basic examinations happen as well. So, You know, if somebody’s got cognitive issues, I wouldn’t be on tour for me to do it like a mocker or, um, you know, an AMTS. Or, for example, you know, if someone’s got lower back issues, just kind of do a basic kind of touching toes kind of thing.

Um, and then, um, Beyond that, you you would talk about your fitness will work. So you would do that 45 to 60 minutes. Um, typically, you could have 6 to 8 cases a day. Um, the reports, right, uh, that you form at the end of it normally can be done within that time. But if not, or there’s something else going on or say, for example, you’re at home and you need to pick up your children, it can wait.

Um, you know, you can complete that report later on. Um, and, um, you know, Once most of the time when you’ve seen them and you’ve done the report, you may not see them again. It’s a 1 of advice. [00:12:00] But sometimes you may see them again. Um, and and that’s kind of what the typical week’s like, but it can vary.

It it depends what you do. If you are more management leadership, it might look slightly Different if you are more into kinda medicals and health surveillance, it may be slightly different. Or if you’re doing kind of more pension assessments, it may be that you don’t speak to anyone, you pop Your headphones on and you just work as as you wish to and and, you know, in silence and in peace. I’m

Mat: I’m wondering with that report writing, Is there potential for challenges there that, you know, because you you pretend you you will somebody’s career or somebody’s pay or can they work or can’t they work. So it sounds like it’s quite high stakes.

Sarwar: Um, I mean, it’s it’s It’s not like medical legal reports. So, you know and I wanna make that clear. So, you know, it’s not that, uh, you know, your report will be used to, let’s Say, you know, just determine whether some accident was caused by something or actually something or someone’s fault or, [00:13:00] you know, what the kind of Implications are in terms of any sort of, uh, you know, civil case or or settlement. But at the same time, the the reports So I’ve asked and and and the main reason is that health and safety law and equality act law, um, states that actually the employer has a Duty of health and safety, and that has a duty not to discriminate against somebody’s health. So even though you’re writing your report, actually, the onus is on The employer.

So, you know and, uh, ultimately, all you’re doing is giving your opinion. And it can happen that employees don’t consent for the report to be released because they disagree with you. Okay? Uh, and, actually, sometimes, and it happens quite often, the employer receives your lovely report that you’ve spent time doing. Look takes 1 look at it and Says no.

Actually, I disagree. Oh, I don’t wanna do that. Or it’s not feasible. I can’t I can’t implement it. So therefore, I can’t really do a lot of that.

Um, some of it Has implications on the employee’s employment. Okay? Um, but [00:14:00] more often than not, it’s more about Working with the balance of work and health and trying to get them to work and trying to get them to, you know, manage their symptoms, manage their functional restriction in terms of work, Alleviate some of the manager’s concerns, um, and, uh, you know, allow for things to progress you almost like, let’s Say a problem solver. You’re forming a solution to a problem that’s happened at work in somebody’s health and something that’s going on. Um, and and and that’s often what it is.

It’s a bit of negotiation, but it’s Also a bit of problem solving and and it helps. Um, I guess the only other thing about it is that, you know, if there was, say, a legal challenge and actually The employee felt that the employer was supposed to be doing something and wasn’t, and there’s a health and safety issue or a risk of discrimination against their health, for example. Ultimately, an employment tribunal would decide whether it was or not. And they do use occupational health physician Reports. But ultimately, uh, as I mentioned before, the their onus [00:15:00] remains on the employer.

So, you know, it’s it’s up to the employer to Defend themselves, and they can say that they use an occupational health report for that. But, you know, the challenges may come Around that, they may say, okay. Well, if you didn’t like this report, why didn’t you get another 1? And etcetera, etcetera. So there is some risk, But it’s lower risk.

It’s not that you’re gonna get sued because you gave the wrong advice. You’re only giving your opinion and you robustly justify based on Evidence based medicine or, you know, the information you have available, uh, and your knowledge of medicine and knowledge of the law. So yeah. Uh, you know, That’s a great question. You know?

And a lot of people do get a bit edgy about it, but, actually, you know, um, overall, um, you know, it’s it’s quite a Quite quite a good position to be in because it’s it’s not you it’s not your responsibility. It’s not your owners, but you are advising based on your expertise.

Mat: And, um, what kind of skills do you need?

Sarwar: So, um, I think having a good all around Knowledge of medicine is important. [00:16:00] So that’s why, um, you know, even if you were applying for an s t u s t 3 position and applying for the training group, You do need kind of that, um, you know, 2 years post f y 2.

Um, uh, you know, GPs and psychiatrists and things make good patient, but having that all around knowledge. But ability to think outside the box and, let’s say, relearn Certain things that you’ve been conditioned over many years of medical school and and practicing in hospital medicine, um, and try to kind of think of things in a Slightly different way from a functional aspect, from an an ethical and law perspective rather than, oh, this person has this condition and needs this medication, And we need to check the bloods. We need to do a lot of the scan. It’s it’s quite quite different, so out of the box thinking. I think working autonomously is very important.

And so you are not often in a massive team on a ward round or in surgery theater with everybody around you. You would need to be kind of on your own a bit [00:17:00] more, but, obviously, there are clinics and there are lots of people around and there’s support if you need Great. You know, good good grasp of English written language. So report writing is important and being able to explain things in a nonmedical jargon, Um, it’s important and something that most people develop when they start entering into occupational medicine pretty quickly. And then I suppose, um, it’s just, uh, adaptability is probably the last thing I would say in the sense that, you know, sometimes you’ll read, Um, a a manager’s perspective, and then you’ve got the employee in front of you.

And, actually, things are very different. And being able to adapt and negotiate the scenario and problem solve Is is 1 of the biggest things that we do. And if you do it really well, you end up having, you know, very little complaints, lots of, Compliments. And, actually, you know, you’re the go to person. You can help and point things out and give the information to the right people and let them progress the case in the scenario.

Mat: [00:18:00] Um, you mentioned there’s different ways to get in and and maybe if I if I if I think if there’s a if there’s a An early career doctor, an f 2, an s t 1 thinking how how do they get in, or if it’s somebody who’s a much more senior doctors, how do they get in?

Sarwar: So, um, you know, there’s 3 broad routes into occupational medicine. So, um, you’ve got, uh, the NHS Training route, um, military. There’s a lot of occupational positions there. Um, but also you’ve got what we call the non training and Portfolio pathway.

Right? A lot of people, um, can do the basic qualification, diploma of occupational medicine, and that’s it. They do it. They, um, enter into the field. They practice occupational physician.

They don’t do any exams or anything else, and they’re quite happy and content. Okay? Other people who want to progress and they want to become a registrar and then end up becoming a consultant, you’ve got, uh, those 3 routes that I just mentioned. And, Um, the NHS training route, you would apply for a [00:19:00] number. There’s something called the National School of Occupational Health, and they do interviews.

So much like with most Have some form of interview, some form of CV exercise. If you’re successful, you get a training number and you’re ranked across the country, And then you can apply to certain areas. The good thing about patient medicine is that there’s actually a lot of industry posts as well. So you can take your NHS training number, And you can go to a company that doesn’t operate in your in in NHS. And you can if they’re if they’ve got an approved training process, you can essentially train with them, Which often happens in, you know, for example, uh, MediGold and some of the other big companies, they have training post that are approved, um, by by the GMC and by the faculty of occupation medicine.

And then there’s the other route, the portfolio pathway, which is what I’m doing, which is very flexible. It’s up to you how you want to do it. Essentially, the idea dear, is that you gather evidence, um, over 4 years full time equivalent of what a registrar would do. And at the end of the 4 years, You submit [00:20:00] it to the GMC. The GMC do the initial checks.

They then submit it to a faculty faculty occupational medicine. And then Once you get 2 green lights, you’re essentially the equivalent of a consultant, and you can call yourself a consultant. You join the specialist registrar. It used to be called the back Your way, but actually, it’s not really that anymore. It’s just an alternate way.

Um, and depending on where you are in your career and what you’re looking at, if you About to have kids and you’ve got a young family, you may decide that the portfolio pathway is a bit better. It’s more flexible. You can take breaks, for example, or you just stay at the op med level, for example. If you’re later on in your career and the last thing you wanna do is do more exams and CCT or whatever, then just at the art med level. Um, there’s also an intermediate level called AFON, which is where I’m at at the moment.

And that’s just when you’ve done the exit exams and you are Essentially, a staff grade equivalence. You’ve got the knowledge of a consultant, but you haven’t quite proved your competencies and become a credited specialist. Um, or you go the full whole hog. And a lot of people that are younger on in their [00:21:00] career, they do wanna progress to become a consultant. They’ve got the right resources around them, And they’re not afraid to do more exams and go for it.

So, you know, it’s really what you want to make of it. 1 thing I’ll say about the training post is that there is part time equivalents as well. So it’s not uncommon for people to do, you know, like a a an LF, uh, LF, uh, less than full time equivalent. Okay? Um, and then there’s, um, others that, you know, decide that very late on and, you know, there are registrars that are Trials that are well into their forties and fifties and they’re happy, but they just want to be, let’s say, tick boxed through the training rather than have all the responsibility of doing the portfolio path Like, um, like like I’m doing, which you it’s almost on you, and you have to be a bit more motivated to make sure that you gather the right evidence and get all the boxes ticked.

I hope

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Now on with

Sarwar: the show. How how how does

Mat: 1 gain experience? You know, let’s say you talked about the portfolio route if somebody’s working in another area or in general practice. I mean, where where do they go to find out what it’s like and gain the experience they need?

Sarwar: So there’s quite there’s several ways.

I mean, again, you might need to Take more initiative to find it, but every single NHS trust and NHS hospital has an occupational health department. I can guarantee you that they’re probably short Staff to a degree. We all know what the NHS hospitals are like and how health and well-being is the forefront and focus because at the moment, but there’s a lot of doctors that become burnt, telstra stressed, but also all the other staff. And, you know, because we deal with patients and safety critical essentially, it’s such stuff That we’re doing on a day to day, the need for Oh in NHS departments is huge. [00:23:00] So I would rock up to your local hospital, find the occupation department and say you would like to do some shadowing.

Could you even help out and sitting in some clearance and even do some, um, you know, reports under the supervision of someone like a registrar or consultant? That’s a good way of doing it. The other way is, um, going to somewhere like the sort of society of occupational medicine and asking them if there’s any kind of, For ways of getting shadowing, the Society of Occupational Medicine has a massive list of, um, private occupational health service companies that are willing to take people on. Um, for example, at MediGold, we do that as well. Um, and, yeah, you can come in and have, like, Taste a day or so and just see what it’s like sitting with an occupational physician.

Ask those questions, you know, and see what it you know, what a consultation looks like. See what the working day is like and, You know, what we do from, like, 8 30 to, like, 4 30 or whatever, um, and, you know, just gauge gain the experience that way. So there are a variety ways. Um, watching, uh, [00:24:00] you know, watching this podcast is a good way as well. Get get a little bit of an idea.

But also, there’s talks I’ve done for the Royal College of Physicians and SARS, the Society of Occupational Medicine with a career in occupational medicine where I do show what a report would look like and, You know, what of a typical day looks like, so you’re more than welcome to watch that, and and hopefully, we can provide link to that. Um, and that might just give you a bit of a flavor as well. But, um, Yeah. Lots of different ways to do it. Um, it’s a growing specialty.

Um, unfortunately, the old Scholars, um, are kind of and the consultants are starting to kind of, let’s say, reach the end of their career and retire, and there’s probably not enough coming through the other end. So, Actually, right now, you know, there’s a lot of scope for becoming an occupational physician, and a lot of companies and NHS training programs I’d jump at the opportunity to get people into the field. Um, and then the other thing just to note is that about I estimate about 75 to 80 Percent of occupational medicine is outside the NHS. It’s private [00:25:00] occupational health services. Okay?

So it’s 1 of those specialties where actually there’s a, You know, if you can’t get any luck from the NHS for shadowing or whatever, you know, reach out. Go outside of it, and you’ll see that there’s a lot of opportunity around you. How how does

Mat: this work that some of it is in NHS and a lot is outside of the NHS? What does that mean for you as an occupational?

Sarwar: So there’s kind of 3 types of occupational health, uh, in house.

So a large company, like, I don’t know, a large bank or a large The media company may have their own in house, um, you know, occupational health department, a consultant, a nurse, um, administrative staff, and, You know, a future occupational health technicians or something like that, and they look after their own staff. And that’s essentially what the NHS occupational health departments are. They look after their own staff. Some in house occupation health, um, um, do have external contracts. So you it’s not uncommon for an NHS department to look after, let’s say, the security company of the hospital as well and the ones that, you [00:26:00] know, do, like, some of the, you know, say, uh, corrying of, like, lab samples or whatever.

Okay. Um, and that’s not uncommon. Or some of our local NHS departments and the 1 that I look after has, like, local university and local teachers and things around the area who look To to us to provide that. You’ve then got the private occupational health services company, which is a large company that looks after many employees and companies All around from small and medium medium enterprises to absolutely large ones. There are companies that look after, for example, Google, Barclays, BBC.

There are other ones that look after slightly smaller ones, Morrisons. You know? So, you know, there there are there are those. And, um, you know, and that and it It can split into different kind of niches. So rail industry, oil and gas industry, um, factories, um, you know, working with weird and wonderful Chemicals are weird and wonderful biological substances, um, and and ones with vibration, ionizing radiation.

So [00:27:00] there’s such a Such a vault, raw variety. And then the last type of occupational help is independence. So if you get a good amount of experience, you’re at the kind of a form or an form level, You may decide that you want to look and also almost practice independently, and people will come to you for advice. And they need they have a specific case. They’ll come to you, and they’ll Ask you to do the assessment, or small nurse led companies may ask you as the doctor to do some assessments for them.

So that’s the kind of broad picture. Um, and because the NHS is kind of in house and the actual majority of all of our industry and the economy is actually outside the Chess is not unsurprising that 80 percent or so, probably more than that actually, is actually outside the NHS with occupational

Mat: medicine. Tell me about these levels. You you you refer to different levels. Was it sort of m 4 and a something?

What what are those

Sarwar: levels? So if you do the portfolio pathway, um, and, you know, with with the NHS training program, you’ve obviously [00:28:00] got the s t 3, s t 4, s t 5, s t 6. And then you CCT and become mvom, a consultant. Right? With the, uh, portfolio pathway, you kind of got 3 levels.

You’ve got the DIOC med, which is the basic you’re like a generalist. And, essentially, you get a diploma in occupational medicine, and you plan to set a generalist level. Um, I think normally with a better with the fact that occupational medicine, uh, recommend is that you would you would have some form of senior, uh, let’s say, contact or supervision When you’re practicing at your med level. If you do the exam and you do the exam, you don’t all the exams, you can get the normials a form, which is essentially I’m an associate of the faculty of occupational medicine. Um, that’s at quite a senior level.

The exams are pretty hard, and, obviously, you’ve got the knowledge of a consultant even though you haven’t done To become accredited. Um, and that’s kind of, let’s say, the middle grade version, and and it’s a good level that a lot of people because they don’t wanna go through Through the whole training or submit to all the evidence to GMC. So they just wanna do exams and get [00:29:00] a reasonable level. And then, obviously, you’ve got mFROM where you’re an accredited specialist. And whether you do the portfolio pathway or the NHS training pathway, whether you’re CCT or CSER, You’re still an inform.

You’re still a consultant. You’re still on the specialist register for the industry. And then I guess the last 1, which I’m sure most specialty have is a fellow. So you couldn’t become a fellow of occupation medicine when you’ve got a good level of experience and you contribute to the field and you get FFOM, Equivalent to FRCP or FRCGP or FRC cycle, whatever. So, you know, there there is that, and and and those are the kind of levels that you’re at.


Mat: Um, and, um, in terms of working then in the private sector and the NHS, so, you You know, in the NHS, we all we all are national terms and conditions. We all have the NHS pension. We all earn pretty much the same or we all work to the same band. So How how do salaries work in the private sector

Sarwar: then?

So, um, as you can probably imagine, um, in the private So there’s generally [00:30:00] more resources, more money involved. We charge slightly differently to the NHS. Um, so, You know, in general, uh, the income’s more and actually you generally get paid a lot more. Um, depending on your experience and seniority, the The the salary ranges will differ. Um, I think, you know, it’s not, um, hard for you to find out what the NHS, Uh, let’s say registrar ranges are in salary.

You can find it from the BMJ or wherever you can do your Google searching. But as a general guide to give you an idea, most, um, private industry companies, um, if you’re a Dioc med level, Can range something from, like, 80 to 85 k full time equivalent, um, but can go up to say, like, a hundred, hundred and 5 depending on your Experience, and you could have done a masters or something or have a lot of experience. But if you’re kind of at the a form, m form level, it’s not uncommon to get into a hundred and Hundred to a hundred and 20 k range. And, obviously, if you start becoming climbing up the [00:31:00] ladder, like medical directors, chief medical officers, Or like a senior consultant, uh, or, you know, you’re gonna deal with this particular niche of occupation medicine, so you’re quite a sought after commodity. Um, you know, you can really go for a hundred and 30 to a hundred and 50 plus.

Um, it really is the sky’s the limit. But, obviously, Uh, you know, you would take quite a few years and quite a bit of experience to get to that level. So that’s an idea. I mean, if you also wanted to say, like, locum, Um, you know, you can either do a per case rate. So if 1 for for 1 45 minute to to 60 minute, you might Have have a range, uh, of price, and I have to be a little bit careful because I don’t wanna set the price and get in trouble with the, uh, BMA and, uh, you know, cartel type thing.

But, You know, it’s that you would you would obviously have to find, you know, and make contacts and branch out and set up your own company or or, like, have contacts with that. But, yeah, it’s not uncommon for a, you know, a a single, uh, you know, a [00:32:00] single, um, uh, assessment To be charged at the rate what the op private occupational company would. Okay? So it can rate, you know, 2 2, 3, 4, 500 or whatever. It whatever.

It depends obviously on What your experience is and what your, um, let’s say, the the the need for that assessment and how complicated it is. Um, you can also go for day rates, and it’s not uncommon for recruiters to advertise, um, you know, anything from kind of 800 to a thousand pounds a day. You’d probably be expected do quite a few cases in that day, but, you know, you can do that and and recruiters there’s lots out there. There’s lots of occupational health recruiters As well as obviously the local agencies that we get contacted about for for hospital work in. So, you know, you feel free to kind of explore that and, you know, contact Crew to find out what the kind of going rate is, um, and you can always talk to, you know, and apply for roles, Uh, for the private industry ones, the big companies, and ask, you know, what’s the kind of salary expectation and what are you looking for?

Um, [00:33:00] there’s quite a lot of job specifications out there as well, so you can start ticking those boxes and building your CV towards that. Um, what are the

Mat: most challenging aspects of the job?

Sarwar: So, um, I think negotiation is key. What often can happen is, um, there’s a, uh, discrepancy or a misalignment of, Um, kind of perspectives between employee and employer. And, obviously, you or yourself as an OHP are you’re impartial.

You’re outside the box, and you’re kinda coming to this fresh. But Sometimes there’s a lot of disagreement between the employer and employee and work related stress and what’s happened. Sometimes, um, a challenge can be more to do with Stuff like, um, health and safety versus risk of discrimination against someone’s health. Um, and, you know, you know, employers can find it Quite difficult because they don’t wanna discriminate against that employee’s health, but they’re worried about the health and safety of that employee in the environment, but also their colleagues, the wider public, and what that [00:34:00] could mean. Um, I think some of the challenges, um, can be obviously with complex cases in mental health.

So having good experience in mental health, Um, you know, practice is useful, um, but it’s not impossible if you don’t have a lot, but you, you know, you can navigate your round a bit quick a bit easier. I think, um, the report writing and the grasp of English language if English is not your first language or you’re generally not that A greater word and stuff, that can be a bit of a learning curve, but, again, not impossible to overcome. Um, and I suppose, um, The other really is, um, and I found it. First of all, no 1 really knows what you do. That’s 1 of the reasons why I do this podcast.

There’s a little bit of stigma that you get whenever you leave an NHS training or go to, like, a nonconventional route of practicing and, you know, you Do and I did get a few kind of comments and questions asking about why you need the NHS, why you’re doing this, etcetera. Um, and that was a little bit of a challenge [00:35:00] at the beginning. Um, but you know what? You have to prioritize work and health and quality of life at the end of the day. And, actually, you know what?

Uh, you know, looking back at it now, Oh, I wouldn’t change my mind at all. And, actually, the people that were doubters are now both asking me questions about what I do and How I’m doing it and, you know, how have I got such a good work life balance and, you know, how do I get into it? You know? And and and it it does become like that. So, you know, going against the grain is a challenge, and and occupational medicine may be that because it’s just not that well known.

But it is becoming ever so Everson, only COVID shone a massive light on that. Um, and, uh, you know, in a way, there’s such a bad Situation with COVID has helped the field. It has helped occupational medicine. We’ve really started to get our voice heard and and, um, you know, I I hope that challenge, um, to become an OHP and and, uh, becomes less and less with with stuff like this, like podcast, Talking awareness and and and being able to, you know, enter the field and get trained [00:36:00] up. It it it’s

Mat: interesting.

You know, you talk about the People live in the NHS because there’s so many people that I talk to. The people are really interested in in whether it’s portfolio careers or nonstandard careers. We we We can call it what we want, but something other than the than the NHS training conveyor belt. Yeah. Because because the problem is The problem that I see and I’m old enough to remember the days before the conveyor belt, you know, the days where nobody knew what to do.

And we all we all we all traveled and we all did a range of different things. And then eventually, we found somewhere that we called home, and and that was celebrated. Whereas I think I I think that the the the the programs that exist at the moment are very much sort of shoehorning people onto a conveyor belt, You know, if all of these things, they get chopped off and disappeared, and a lot of people now are rebelling against that conveyor belt And they are looking for for things that are not your standard

Sarwar: NHS conveyor belt. No. You know?

And there’s [00:37:00] so many new fields that are coming through pharmaceutical, digital health as well, for example. You know, there’s a lot more out there. There’s a lot of report writing that I’ve seen as well, which is another area that you can go to medically, legal and stuff. But I think, uh, I guess, for me, the reason why I found occupational medicine so good is that you’re not totally letting go of medicine So then the interaction with people and taking histories and using medical knowledge, um, you are still doing a lot of That you still do come across, you’re still examined, you still will ask them, and and you will hear about their troubles that they’re having because The NHS waiting times are so long, for example, and they’re really struggling with work. And, you know, just that conversation about how they’re dealing at home, they really Appreciate it.

And they and and on honestly, they nobody gets 45 minutes to an hour with a doctor anymore, but they do with you. And they really do appreciate that. So you get that satisfaction. And and you still get to use your knowledge that I didn’t wanna let go of all of the experience that I had and go into something completely different, like run a [00:38:00] business or I just I still wanted to keep a hold of that training and still be a doctor, still be GMC registered, still appraise every year, still still have all of that. Um, but I didn’t you know, I wanted to go in a different way.

I wanted to get the work life balance. And, yeah, unfortunately, you know and many people may disagree with me, but I feel I felt at 1 stage, but particularly, unfortunately, when the Jeremy Hunt and the junior doctor strikes and stuff happened around 10 years ago, that was my turning where I said, like, actually, maybe I need to look outside the box, and, uh, I haven’t looked back. And if somebody is miserable in their career, I really Encourage you, first of all, to listen to this podcast, but also, you know, just look at Occupationalism. Give it give it a shot. Um, it it you will be surprised at the Flexibility in the work life balance and actually how well how much you all experience to date is still valuable.

It’s still very, very valuable, and you can use that really well. That consultant anesthetist, um, that I talked about [00:39:00] does diving medicine and compressed air medical. So all of their knowledge about the Physics of the body and Boyle’s law and Charles’ law and all of this, they still use it, and and they love it. And they’re really good at doing it. So, you know, you can you can make it what you will.

And and, um, you know, I strongly encourage it. And it’s it’s sad that it’s happened to the NHS, but at the same time, you know, We’ve got to look after ourselves. We don’t wanna get burnt out. We don’t wanna regret our career after 25, 30 years. And I promise you, and this is a promise, With occupational medicine, you will not regret that.

Everybody retires happy.

Mat: That feels like a good place to, um, finish that. Well, I’m I’m I’m convinced. So thank you very much.

Sarwar: I’m Yeah.

No worries. And as I said, um, there are resources out there and do look at the links. And, uh, you know, if if I can be of any help, you know, drop drop me a line. I’m more than happy on LinkedIn to to receive stuff. And I’m I’ve helped A lot of people into the field, and I hope to continue to do so.

[00:40:00] So, you know, absolutely, you know, go for occupational medicine is is My advice. Wonderful. Thank you

Mat: very much. No worries.

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