Where does that leave me, the medical student who wants to be a primary care provider, but is worried she is going to burn out before the work begins?

When people ask me about my plans for medical residency, I sure don't tell people, "Oh, occupational and environmental physician!" the way one might say oncologist or cardiologist. They don't have that in American Girl or Playmobil and Richard Scarry: They have fireman and doctor coat and Huckle Cat. When my class got one of its few lectures on occupational health, it was in a short introductory epidemiology case study series thrown in a few free blocks during a course on host defense. An occupational physician was teaching us during the microbiologists' breaks to visit their labs and do lunch. Physical and mental health is formed by experience of the shift work environment, but the vast majority of students never work a job mandating a lunch break until they train on the hospital wards. How can we conceive of ourselves as workers--health care workers represented by a union, the SEIU's Committee of Interns and Residents, no less -- responding to a labor shortage with this knowledge deficit?

Working on my master's in public health, I specialized in occupational and environmental health and learned clinical skills I worry I will not be able to use again until I finish my planned residency in primary care. There is almost never time to ask patients about their jobs in a 15-minute "patient encounter." Work injury and underinsurance causes poverty as often as work helps one escape it. Patient care is patient disease is patient work: Eventually you're going to come across workplace-related asthma and musculoskeletal injury and stress after you rule out everything else (and not, one hopes, a career in primary care). If you don't have time to ask patients about their work, you do not get a correct diagnosis--and you do not get compensation, which a 2012 study from the University of California-Davis found was woefully inefficient cost-sharing. There were roughly 4,600 workplace fatalities in 2011, something like twelve workers a day, or 3.5 of every 100,000 workers in the United States. 729 of these workers were born outside the United States. 666 died from simple, fixable problems like slips, trips, and falls. Statistically speaking, it is more dangerous to be a commercial fisherman than to be a first responder, but the same is true of a camel going through the eye of a needle. And we need doctors aware of worker poverty in long-term jobs from which they can alleviate doctor shortages.

Occupational medicine, with its social conscience and its great lifestyle for good money, is the best-kept secret in American medicine. Salaries are higher than for most primary care specialties, hours are better, and burnout rates are lower --because these doctors know that they practice medicine right. Occupational medicine rethinks primary care by doing medicine the humane way: by providing doctors and patients with a financial and administrative safety net. Most occupational health patients are insured by their employers and covered by worker's compensation, which improves patient care, as well as physicians' lifestyles, as they do not bear the administrative fallout. The specialty is both good for the worker receiving the service and good to the one providing it. Expanding insurance was the whole goal of Obamacare, and we would do best to expand that vision further by expanding how we train our residents in preventive and occupational medicine.