David P. Gilkey, DC, PhD, CPE, DACBOH
Editor's note: Dr. Gilkey, a 1979 graduate of Los Angeles College of Chiropractic, is the past president of the ACA's Council on Occupational Health, and secretary of the ACA's American Chiropractic Board of Occupational Health, of which he is a diplomate. He has a master's degree in environmental policy and management from the University of Denver, where he also received his certificate in environmental health and safety management.
Industrial consulting to America's workplaces now entails expert knowledge in the fields of environmental health and safety (EHS) compliance, operations, prevention, and cost containment, as well as cost-effective medical and chiropractic management. The chiropractic occupational health and safety physician is now afforded an opportunity to fulfill many roles in this diverse field. Industry has great challenges with out-of-control health related costs for epidemic CTD and back injury claims. Valuable resources must be allocated for environmental health and safety regulations despite the corporate downsizing and contracted budgets.
- The cost of compliance alone to business and industry for EHS laws, rules, and regulations is over $46 billion per year (Friedman, 1993; Laws, 1996).
- Back injuries and CTD related costs have risen to $60 billion/year (Labar, 1994; Khalil, et al., 1993).
- The prevalence of CTDs has exploded by a 770 percent increase from 1982 to 1992 with no curtailment in sight (BNA, 1994).
- In 1993 over 302,000 cases of CTDs were reported costing over $20 billion to manage (BNA, 1994; NIOSH, 1995).
Back injuries continue to plague business and industry at epidemic proportions.
- The National Safety Council (NSC) reports that 770,000 back injuries were reported in 1994, with an additional 60,000 neck injuries. These two types of injuries represent 26 percent of the 3.2 million disabling worker injuries occurring that year (NSC, 1994).
- The economic impact of injury and illness to American businesses is over $110 billion annually; this equates to an average of $940 per worker in America (NSC, 1994).
The solution to curtail this continued blood-letting of America's workers and businesses is through well-planned and instituted EHS programs that reduce and eliminate preventable injury and illness in the workplace. Chiropractic occupational health (OH) physicians have the opportunity to prosper through providing desperately needed EHS services that can save valuable business resources while improving the health and well being of workers and the public.
Traditional roles of OH physicians, safety professionals, and industrial hygienists have been limited and generally separate. Today's industries, regulatory overlap, and marketplace forces have brought these disciplines closer together. No single health care professional is better equipped to offer the broad spectrum of needed services for the multitude of industry challenges than the chiropractic occupational health and safety physician.
Traditional roles filled by OH physicians have been broadened as the specialty of occupational health has established itself. Training, both in chiropractic and in medicine, has greatly improved the scope and definition of what physicians do in today's workplace. In chiropractic, the diplomate postgraduate education and training program in occupational health and safety provides the familiarity needed to navigate the maze of overlapping fields and topics:
- The Fields of Occupational Health and Safety -- an overview
- Pre-placement/Biomechanical Stress Index -- developed in chiropractic
- Biomechanics/Ergonomics -- basic and advanced
- Injury Prevention -- philosophy and practice
- Sitting in the Workplace -- special ergonomic needs
- Physical Rehabilitation -- related to work injuries
- Stress Management -- related to the workplace
- Cumulative Trauma Disorders -- prevention and treatment
- Chemical and Environmental Hazards -- industry's newest challenges
- Chronic Pain -- the multidiscipline approach
- Narrative Report Writing -- a comprehensive format
- Occupational Multidiscipline Teams -- understanding team players
- Legal Considerations in Occupational Health -- OSHA, ADA, confidentiality, and reporting requirements
- Independent Medical Examiner's Role 15. Communications -- special emphasis on interdisciplinary needs
- Safety Engineering -- an overview of strategies and programs
- On-site Industrial Class or Individual Project -- actual experience
This postgraduate program is designed to train the chiropractic doctor as a consultant, advocate, and valuable resource to industry for the paramount purpose of injury and illness prevention. Specific educational goals have been established to develop skills and knowledge for:
- interdisciplinary problem solving for workplace hazards;
- interdisciplinary language development for communication;
- team interaction and dynamics for goal accomplishment;
- synthesis and application of illness and injury evaluation, analysis, and prevention in the workplace.
Working to solve and manage EHS challenges facing business and industry can be exciting and rewarding. Chiropractic OH physicians should have more presence and diversity in this huge industry.
A recent article by Dr. Joe Sweere, ("The Employer Holds the Key to the Doors of Managed Care," Dynamic Chiropractic, May 6, 1996), outlined the challenges to chiropractic to ensure our participation in the nation's future health care systems. Dr. Sweere discussed the presence of a paradigm shift from "crisis intervention to prevention," and the need for skill development in preventative services, loss source analysis, worksite hazard analysis, management and worker education, ergonomics, preventive chiropractic care, communication skills, government relations, and physical rehabilitation. EHS training, education, and skill development is the key to making friends and influencing people -- the decision makers in industry, that is!
Bibliography
Bureau of National Affairs (1994). Ergonomics: A 770% increase. Occupational Safety and Health Reporter, 24, 1794.
Friedman FB (1993). Practical Guide to Environmental Management. Washington, D. C.: Environmental Law Institute.
Kahlil TM, Abdel-Moty EM, Rosomoff RS, Rosomoff HL. (1993). Ergonomics in Back Pain. NY: Van Nostrand Reinhold.
Labar G. (1994, April). Ergonomics can't wait any longer. Occupational Hazards, 33.
Laws J. (Ed.). (1996, January). OSHA Act high cost criticized. Occupational Health and Safety, 12.
National Institute for Occupational Safety and Health. (1995). Cumulative trauma disorders in the workplace, bibliography. U.S. Department of Health and Human Services.
National Safety Council. (1994). Accident facts. Itasca, IL: NSC.
David Gilkey, DC, DABCO, DACBOH, FICC
Westminster, Colorado
davidpgi@csn.net
