There's a conversation happening in boardrooms at health system-based occupational health programs — and if you haven't had it yet, you will.

It goes something like this: a new vendor, a new service line, a new capability gets proposed. And somewhere in the room, someone raises a concern. We can't do anything that takes business from our cardiology department. From our orthopedics group. From dermatology.

It's a legitimate institutional instinct. Health system board members are managing complex internal relationships, and specialty service lines are often protective of their turf.

But here's what that framing misses: occupational medicine has always practiced at the intersection of primary and specialty care. We've been doing it so long we've stopped calling it what it is.

We suture lacerations that don't need a surgeon or a dermatologist. We manage acute eye injuries that don't require an ophthalmology referral. We read and interpret audiograms, pulmonary function tests, and chest X-rays that in any other setting would route to a specialist. We manage sprains, minor fractures, and soft tissue injuries without defaulting to orthopedics. We do DOT physicals that require cardiovascular and neurological evaluation not available anywhere else in the system on a walk-in basis.

None of that has ever been considered a threat to the specialists down the hall. Because the care was appropriate to the setting, appropriate to the patient population, and — critically — not care the specialty was offering in any comparable way.

The same logic applies to cardiac stress testing in occupational health.

The context matters. Firefighter physicals under NFPA 1582 require stress testing. Worksite wellness programs, executive exams, health fairs, and disease management programs create demand for cardiac screening that cardiologists are not set up to meet — not in volume, not in turnaround, and not in the settings where occupational health actually operates. A four-to-six week wait for a cardiology appointment is not a viable option for an employer running annual firefighter exams or a two-day health fair event.

When a vendor can bring point-of-care stress testing at $200–$300 — administered by trained staff, with cardiologist interpretation available at $100 or the option to use your own physician — and can do it onsite and on schedule — that's not competition with cardiology. That's care that wasn't happening otherwise.

The board member who raised the concern deserves a direct answer: occupational medicine has always owned the scope of care appropriate to the workforce populations we serve. Expanding that scope with better tools, better economics, and better access is not mission creep. It is the mission.

This is a pattern, not an exception. The stress test example is one data point in a broader argument NAOHP has been making across several fronts this year:

MSK management. The most common driver of specialist over-referral in occ med is straightforward: APPs and less-experienced physicians don't have the orthopedic depth to manage MSK cases confidently when the clinical picture isn't clear. Without that depth, referral is the only available option. The Upswing virtual orthopedic curbside model solves that by bringing specialist expertise in at the decision point — giving the treating clinician the clinical grounding to manage the case through to resolution. The Connecticut State Health Plan outcomes data (35.9% MSK cost reduction, zero MSK-related ER visits) reflects what happens when occupational health retains the case rather than transferring it. → Run the Virtual Ortho Calculator

Clinical depth at the provider level. The reason programs struggle to hold scope isn't that the scope is inappropriate — it's that providers haven't had structured training in the clinical domains that define occupational medicine. Lacerations, eye injuries, MSK management, DOT interpretation, fitness-for-duty evaluation — these are learnable. They're also the difference between a program that owns its patient population and one that's a triage service. The OccMed Providers Course exists to close that gap. → Enroll here

New technology in the hands of the right clinicians. Cardiac stress testing is one example. The broader principle is that occupational medicine programs should be evaluating emerging point-of-care technology through an occupational lens — not waiting for specialty medicine to define what's appropriate for our settings and populations. Programs that build clinical capability and adopt the right tools will deliver measurably better care at lower cost. That story needs to be told to health system leadership, not suppressed in deference to specialty turf.

Reply to this email if you want to learn more about stress testing.

The programs that will define occupational medicine over the next decade are the ones willing to make this case clearly — to their boards, to their health system administrators, and to their employers.

The infrastructure to make that case — clinically, operationally, and financially — is what NAOHP is building.

— Larry