Abstract
Objectives: This study aimed to identify career support systems for full-time occupational physicians in large companies in Japan with an established company-wide occupational health system. Methods: We conducted interviews with the supervising occupational physicians of target companies selected using the snowball sampling method and that met the inclusion criteria: (1) a company or corporate group with over 10,000 workers; (2) an assigned occupational physician who oversaw occupational physician services for the entire company; and (3) the company had more than 10 full-time occupational physicians. Results: We obtained responses from eight companies (six manufacturing and two railroad companies). All the companies had established a system to support expertise development of occupational physicians, give them greater responsibility, and follow their development in the company. Through the interviews, efforts of each company were described in the following four areas: (1) efforts of human resource development; (2) support for maintaining and improving expertise; (3) treatment in accordance with career stage; and (4) issues related to career support in companies. Conclusions: To provide high-quality, stable occupational health services to an entire company, it is necessary to create a situation where full-time staff can contribute for a long period and develop their careers in the process.
Introduction
In Japan, the Industrial Safety and Health Act requires that employers appoint an occupational physician exclusively for the workplaces where 1,000 or more workers are regularly employed or where 500 or more workers are regularly engaged in designated work1,2). Full-time occupational physicians assigned to such large workplaces devote most of their working hours to occupational health activities and the rest of their time to research or clinical services in their specific area, with the permission of the belonging company. Many of those physicians are certified as specialists in occupational medicine by the Japan Society for Occupational Health1) and build their careers as occupational physicians.
The Industrial Safety and Health Act requires that employers establish an occupational health management system at each workplace2). In recent years, however, increasing numbers of companies have assigned a supervising occupational physician3) to provide occupational health services that are consistent across the entire company (or corporate group) and to appoint occupational physicians at each workplace. Those companies have enhanced occupational health services by implementing health and productivity management programs promoted by the government4) and by improving risk management related to workers’ health. To provide stable occupational health services that cover an entire company, it is necessary to secure occupational physicians with expertise in occupational medicine on a continuous basis; such physicians need to understand the policies and systems of each company and respond appropriately to workers’ health issues.
Some physicians who specialize in occupational medicine establish independent offices5,6,7,8,9) and provide occupational health services to many companies through contractual occupational physician agreements. Recent amendments to the Industrial Safety and Health Act to enhance the role of occupational physicians (such as measures to prevent health problems caused by long working hours and stressful work conditions and reinforcing the right to make recommendations to employers) have increased the demand for the quality of occupational physicians among employers2,8). The increased numbers of such independent occupational physicians are thought to be due to the greater demand among employers for occupational physicians with expertise in occupational medicine — even if they work part-time at each workplace. The treatment of full-time occupational physicians provided by companies is improving9); however, more occupational physicians are choosing to become independent after having developed their expertise within companies. Many full-time occupational physicians leave their positions within 2 years owing to insufficient on-the-job training in their early careers10,11,12).
Under these circumstances, to provide consistent occupational health services throughout a company with a stable number of full-time occupational physicians, it is necessary to establish a support system. Such a system would enable occupational physicians at the company to build their careers, including guidance for those in their early careers and challenging opportunities later in their careers. However, no reports exist about such career support systems for occupational physicians in companies. Accordingly, we conducted the present study about the career support system for occupational physicians in Japanese companies that have established an occupational health system covering their entire business.
Methods
We selected our study subjects using the snowball sampling method. The inclusion criteria were as follows: (1) a company or corporate group with over 10,000 workers; (2) an assigned occupational physician who oversaw occupational physician services for the entire company (supervising occupational physician); and (3) the company had more than 10 full-time occupational physicians.
We interviewed the supervising occupational physician at the target companies. After obtaining consent for participation, two researchers conducted an approximately 1-hour online interview from August to September 2021 using Zoom videoconferencing software (Zoom Video Communications, Inc., San Francisco, CA, USA). The research team examined the interview items necessary to understand the entire picture of career support system of the target companies. We asked participants the following questions after confirm the structure and positioning of occupational health departments in the companies; “Talk about your programs that support the career development of full-time occupational physician, including efforts of human resource development and those for maintaining and improving expertise”; “talk about your system of treating occupational physicians according to their career stage”; and “talk about the issues you face in supporting the careers of occupational physicians”.
An itemized interview summary was prepared for each case to provide an entire picture of each company’s career support system and its background. From the video recording, a draft summary of the content was prepared by the researchers who participated in the interview. Details of the type of business and number of employees were added to the summary based on information from the official company website. It was finalized after the interviewee reviewed the facts and extent of possible disclosure.
The study was conducted with approval from the Research Ethics Review Committee of the University of Occupational and Environmental Health, Japan (Approval No. R3-011).
Results
Eight companies received requests and all of them agreed to be interviewed.
Overview of participating companies
The interviews were conducted with six manufacturing and two railroad companies (Table 1). The former comprised two electrical equipment companies, two chemical companies, one machinery company, and one automobile company. The number of employees managed by each company’s occupational health department exceeded 20,000; the greatest number was about 160,000 (company B).
Table 1. Outline of company and status of occupational health department
| Outline of company | Status of occupational health department |
|---|
| Type of industry | Number of employees covered | Number of full-time Ops | Structure and positioning of occupational health department |
|---|
| Company A | Manufacturing
(electrical equipment) | approx. 20,000 | 16 | ∙ A health care center has been established under the human resources and general affairs department at the head office; all OPs belong to that center and work in their respective district centers.
∙ The supervising OP is the chief medical officer and is responsible for managing all medical personnel. |
| Company B | Manufacturing
(electrical equipment) | approx. 160,000 | 43 | ∙ All occupational healths staff belong to the health management center of the company’s own health insurance association and provide services under contract.
∙ General OPs and deputy general OPs are assigned to the holding company’s head office and to each of its four companies.
∙ Area health management offices cover local areas efficiently; area general OPs are assigned there. |
| Company C | Manufacturing
(chemical) | approx. 44,000 | 14 | ∙ A health management promotion department has been established, under which health management support centers are assigned to each district center.
∙ All OPs are assigned to each center under the direction of the supervising OP.
∙ Cross-district teams set goals and conduct activities in a company-wide project. |
| Company D | Manufacturing
(chemical) | approx. 40,000 | 14 | ∙ A health support department has been as established under the general manager of the human resources and general affairs division at the head office; all OPs are affiliated with that department.
∙ A supervising OPs is assigned under supervision of the general manager.
∙ Works of OPs are divided into three categories: centralized work (head office consolidates occupational health work); on-site work (occupational health team at a specific office is responsible for some company-wide work; and on-site work (conducted at the office in accordance with laws and regulations).
∙ Various working groups study the unification of operations. |
| Company E | Manufacturing
(machinery) | approx. 45,000 | 32 | ∙ A health management center has been set up at each worksite that requires a dedicated OPs, and administrative duties as the center’s director are performed by administrative staff.
∙ A supervising OP, who provides opinions and proposals on company-wide measures, has been assigned.
∙ The company is gradually building company-wide rules and systems to eliminate differences in occupational health services provided at each worksite. |
| Company F | Manufacturing
(automobile) | approx. 74,000 | 16 | ∙ All full-time OPs belong to the Health and Safety Department at head office; under the supervising OPs, they visit worksites to provide occupational health services.
∙ Groups are formed according to worksite characteristics; leaders and sub-leaders are appointed within each group to discuss and resolve issues.
∙ Each OP is involved in at least one project for health measures identified by the company. |
| Company G | Railroad | approx. 53,000 | 30 | ∙ A health promotion center is responsible for company-wide health management of employees; the center’s director acts as a supervising OP.
∙ The center operates nine area health checkup centers, and full-time OPs work at each center. |
| Company H | Railroad | approx. 20,000 | 13 | ∙ An occupational health department has been established under the direct control of the chief executive officer and under the supervision of the department manager, who is also the supervising OP.
∙ Four health management offices are in charge of each area. |
OP, occupational physician.
In line with the inclusion criteria, all the companies had appointed occupational physicians to supervise occupational health services company-wide. Of the eight companies, six had an occupational health-related department at the head office for which all full-time occupational physicians worked (companies A, C, and E–H). One company had a health management center in its health insurance association, to which all full-time occupational physicians belonged; the center was assigned to company worksites on a contract basis (company B). Of the seven companies with a centralized organization for occupational physicians, six had established health management centers in their regions or workplaces and one full-time occupational physician managed that organization (companies A–C and F–H). With the remaining company, the full-time occupational physician belonged to the health management center at each worksite (company E).
The number of full-time occupational physicians on staff ranged from 14 to 43.
Career support programs for occupational physicians: (1) Efforts of human resource development
At most of the companies, human resource development was divided into efforts for inexperienced occupational physicians (such as those who had just joined the company) and support for their subsequent development (Table 2).
Table 2. Career support programs for OPs and treatment in accordance with career stage
| Programs of career support for OPs | Treatment in accordance with career stage |
|---|
| Efforts of human resource development | Support for maintaining and improving expertise | |
|---|
| Company A | ∙ OPs with short careers as physicians are hired and assigned to district centers to gain practical experience.
∙ OPs are appointed as leaders of midterm projects and receive training in management skills to improve their qualifications as OPs and managers. | ∙ Support is provided to OPs with specialization in various clinical fields so they can maintain and utilize it for the company. | ∙ There are four job grades, with the supervising OPs at the top.
∙ Promotion based on the number of years’ experience as a physician has recently been abolished.
∙ Treatment is based on work content and ability. |
| Company B | ∙ Inexperienced OPs are assigned to a large health management office with two OPs and then to a small health management office with one OP for career development.
∙ Respecting the career aspirations and individuality of each OP, such management duties as deputy supervising OPs are assigned. | ∙ OPs are assigned to departments specializing in specific health examinations for occupational hazards to expand their expertise.
∙ OPs are encouraged to participate in academic conferences and training sessions related to occupational health and subsidizes their expenses.
∙ In-house academic conferences are held. | ∙ Four job grades are available for OPs, and promotion is based on experience.
∙ For deputy general OPs and above, certification as an occupational medicine specialist or industrial health consultant is required.
∙ General OPs and above are promoted based on management skills, using evaluations from various professions and personnel evaluations.
∙ The salary system takes workload into account in addition to position and age. |
| Company C | ∙ The company clarify requirements for the competence of OPs and holds biannual target interviews to improve qualifications.
∙ Younger OPs are appointed as project leaders and members to gain experience in solving company-wide issues.
∙ OPs are encouraged to conduct research and the company establishes an in-house research ethics committee. | ∙ The company provides support to obtain certifications as occupational medicine specialists and industrial health consultants.
∙ The company supports participation in academic conferences.
∙ The company supports individual OPs to enhance their expertise in clinical field. | ∙ Three job grades according to the scope of work are available for OPs (the second grade corresponds to the manager of district centers).
∙ Salary is determined by job classification, graduation year, and performance evaluation. |
| Company D | ∙ The company provides opportunities for young OPs to perform tasks that impact the entire company or to be appointed as leaders of working groups or projects.
∙ OPs wishing to perform management duties can be assigned to supervising OPs at other affiliated companies. | ∙ The company provides financial support to participate in academic conferences and other supports to enhance expertise. | ∙ Three job grades are available and promotion is based on graduation year; the third grade takes into account degree of contribution.
∙ Salary is determined according to position and is set at a grade that ensures employment sustainability by referring to examples at other companies. |
| Company E | ∙ The supervising OPs directly provides introductory training and further guidance for OPs who have just joined the company.
∙ OPs are given the chance to participate in company-wide working groups as members or leaders according their expertise. | ∙ The company sets aside about 1 day a week for research and supports participation in conferences and training sessions for OPs. | ∙ Three job grade for nonmanagerial and four grade for managerial positions are available for OPs.
∙ The grade is determined according to graduation year on joining the company, and they are promoted if they have the appropriate ability for a higher grade.
∙ Evaluations are conducted by workplace management. |
| Company F | ∙ OPs are responsible for worksites with senior OPs for the first 1–3 years after joining the company, after which they are personally in charge of an office and gradually increase their responsibilities.
∙ Two-way interviews with the supervising OPs are held to provide opportunities for experience and development according to each OP’s wishes. | ∙ Research and training related to each OP’s expertise is part of their duties.
∙ OPs can have the chance to improve their expertise in their respective clinical fields In cooperation with company and university hospitals,. | ∙ OPs are hired as full-time contract employees for 1 year and then as regular employees; promotion is at four grades.
∙ Promotion is based on job performance and ability, and there is no annual promotion. |
| Company G | ∙ OPs are assigned to each worksite and can consult with senior OPs as needed.
∙ OPs can gain experience by participating in new projects as issues arise.
∙ A research ethics committee has been established to encourage academic activities so that OPs can make presentations at conferences using in-house data. | ∙ Half a day a week is set aside for research so that OPs can maintain and improve each area of expertise.
∙ The company supports participation in the Japanese Society of Traffic Medicine and other academic conferences in each specialty. | ∙ Five job grades are available for OPs.
∙ Promotion is based on graduation year up to the third level, but for higher levels, promotion is based on actual contribution. |
| Company H | ∙ No specific supervisor is assigned, but experienced OPs provide guidance to younger ones.
∙ The supervising OPs conducts a goal-setting interview and listens to the OPs’ career development wishes every 6 months.
∙ OPs in managerial positions have opportunities of in-house personnel evaluation training. | ∙ Support is provided for employees to obtain certifications as occupational medicine specialists and industrial health consultants. | Four job grades are available for OPs.
OPs can advance to a certain grade some time after graduation; the fourth grade (head of health management office) requires management skills. |
OP, Occupational physiciain.
For inexperienced occupational physicians, the basic approach was to establish a consultation system to support their activities and assign them — where possible — to worksites with multiple full-time occupational physicians (companies A and F) and to encourage consultation with senior occupational physicians (companies G and H).
Regarding support for subsequent development, company-wide working groups and projects were set up; by participating as leaders and members (companies C–E and G), occupational physicians were able to improve their planning skills and gain experience. At some companies (C, F, and H), the supervising occupational physician conducted regular one-on-one interviews with subordinate occupational physicians; they had opportunities for career development and could improve their skills and competencies according to their circumstances and wishes.
In cases where occupational physicians had to perform administrative duties as managers or in health management centers, they took advantage of in-house training opportunities to learn managerial duties (companies A and H) or were assigned as deputy supervising occupational physicians (company B) or supervising occupational physicians at affiliated companies (company D).
Career support programs for occupational physicians: (2) Efforts for maintaining and improving expertise
Most companies covered the costs for attending academic conferences, and some also provide support for obtaining certification as occupational medicine specialists issued by the Japan Society for Occupational Health, as well as licenses as industrial consultants based on the Industrial Safety and Health Act (companies B and H).
Some companies underlined the value of clinical expertise among occupational physicians and provided support to maintain and improve their skills as clinical specialists (companies A, C, and F).
Some companies emphasized the importance of research capabilities; they established research ethics committees and encouraged occupational physicians to participate in academic research (companies C and G).
Personnel treatment according to career stage
All the companies had job grades and a promotion system. Except for a few companies (A–C), lower job grades were based on the year of graduation from medical school; higher grades were based on evaluations of the physicians’ contributions and abilities. Most companies formulated their compensation decisions using job grade and age.
One company (B) evaluated performance and workload. To ensure its ability to retain occupational physicians, one company (D) used the compensation levels at other companies as a reference.
Issues related to career support for occupational physicians
A system was established for full-time occupational physicians to acquire necessary basic experience and improve their expertise in occupational health activities (Table 3). However, most companies identified the need to improve a broader range of skills and competencies, such as management and research skills (companies A, B, C, and F), clinical skills (company G), and research skills (company E). To enhance the improvement, a couple of companies considered the necessity of evaluation opportunities (company H) and tools (company E).
Table 3. Issues related to career support for occupational physicians
| Company A | ∙ Under the current system, skills of organizational management are required for OPs; thus, efforts are needed to improve such skills.
∙ There is variation in the willingness to improve the qualifications of OPs. |
| Company B | ∙ Few OPs have interest in and qualifications for managerial work.
∙ It is difficult to obtain understanding about the absence of OPs from the workplace owing to training to enhance expertise as OPs. |
| Company C | ∙ There is considerable variation among the OPs in terms of willingness to be involved in program planning and management tasks. |
| Company D | ∙ It is difficult to expand the scope of work under the management decision following internal company reforms, so a new mechanism to secure skillful OPs and motivate them is needed. |
| Company E | ∙ No system for career interviews or sheets is available for OPs in the company.
∙ OPs need to have academic competency, but it is difficult to secure guidance and experience opportunities within the company. |
| Company F | ∙ It is necessary to explain how the broad range of the activities of OPs are linked to company development taking advantage of an opportunity where expectations of management for OPs become high under the COVID-19 pandemic. |
| Company G | ∙ It is necessary to improve expertise in occupational medicine and the clinical skills required to assess fitness for duties regarding rail operations when considering a characteristic of the industry. |
| Company H | ∙ Evaluation opportunities for a wider range of competencies than skills are needed for career support. |
OP, occupational physician.
One company (B) addressed the challenge of balancing external training opportunities to improve the expertise of occupational physicians with minimizing the amount of time they were away from their work.
Discussion
To provide stable occupational health services in large Japanese companies with many workers and worksites, it is essential to establish a company-wide occupational health management system and secure necessary numbers of full-time, experienced occupational physicians. When considering recent demands on physicians with expertise in occupational medicine and recent career trends (noted in the Introduction), companies need to provide long-term support for the career development of occupational physicians, as well as initial support for expertise development.
The participating companies in the present study provided occupational health services to over 20,000 workers and appointed an occupational physician to supervise the services for the entire company. The companies established a system to train occupational physicians, supported their acquisition of expertise, gave them greater responsibility, and followed their development within the company. According to one study, companies that appoint experienced occupational physicians as supervising occupational physicians aim to secure qualified occupational physicians; they also aim to ensure stable, quality-assured occupational health services consistent with company or corporate group policy3). All the supervising occupational physicians interviewed in the present investigation were at companies with similar goals and were attempting to address issues to secure human resources.
From the results of the interviews, we addressed and discussed common issues in carrier support of occupational physicians among companies.
Provision of a variety of opportunities to maintain motivation and develop skills
We found that the eight companies supported young occupational physicians to develop or maintain competencies, including practical skills, at their early career stage. It is also necessary to devise ways to maintain the motivation of young occupational physicians and encourage them in formulating company-wide occupational health programs. Many companies provided training opportunities for occupational physicians by having them lead company-wide multidisciplinary projects from an early stage; if they have achieved a certain level of experience, they should be given leadership roles. Such efforts will enhance their planning skills, which is an important competency among professional occupational physicians11); the efforts will also give them the opportunity to take the initiative in activities based on corporate policies, collaborating with other professionals, and communicating with other departments.
When full-time occupational physicians work for a long period for a company, they may become concerned that they will be unable to acquire a broad range of skills that could be applied in other industries or companies; that could lead to job changes. Therefore, as observed in some company cases, it may be necessary to consider giving such physicians the chance to be responsible for workplaces with different characteristics within the company or corporate group; in that way, they may gain as much experience as possible in a variety of work.
The ability to conduct research can be regarded as necessary to clarify existing issues using company data and to provide evidence-based occupational health services13). Thus, we found that some companies encouraged research activities, supported conference and paper presentations, and established a system allowing ethical review within the company. However, it is often difficult for companies to provide education to improve such capabilities; thus, it is necessary to consider collaboration with universities or other research institutions.
Carrier support according to individual circumstances and wishes
In some companies, the supervising occupational physicians emphasized that support of career development would be provided according to the individual circumstances and wishes of each occupational physician. Occupational physicians with a medical license working at a company have various career options, such as changing jobs or opening their own private practices, based on their personal professional interests and life aspirations. By considering the wishes of occupational physicians, companies can maintain their ability to secure such staff. We observed cases where occupational physicians received support in the form of participation in academic conferences for a particular clinical specialty and granting permission for continuing clinical work in a medical institution.
However, doing so could lead to inconsistencies in contents and quality of provided occupational health services throughout the company. Therefore, it is important to reconcile the two perspectives of each occupational physician’s wishes and company policy. For an occupational physician to maintain their abilities in their clinical specialty is linked to maintaining their career identity as a physician; it is also related to enhancing their ability to respond to issues as a team in companies with many occupational physicians.
Development and improvement of competencies as managers
As observed in the present study, establishing an occupational health service organization for a company or corporate group demands an organizational manager. That manager’s duties include reporting to management, budget management, and staff management. The manager of such an occupational health organization could be a medical professional (usually an occupational physician) or a nonmedical manager. However, it is considered difficult for nonmedical managers to provide guidance for and evaluation of physicians; thus, such roles are ordinarily given to occupational physicians.
When operating an occupational health department, it is necessary for the supervising occupational physicians to improve their competencies as managers. Therefore, among the eight participating companies, the managerial hierarchy for occupational physicians allows them to gain experience as middle managers in supervising subordinates. It is also necessary to secure training opportunities for company managers. However, there are the issues of improving occupational physicians’ qualifications and motivation as managers in occupational health organizations, and of reflecting the qualifications to their promotion to managerial positions.
Treatment in accordance with career stage
Toward securing high-quality occupational physicians, we found many cases where efforts were being made to support enhanced competence; we also observed efforts to establish job grades and systems for promotion based on experience and performance. In such cases, there were many mid-career hires, and so companies often incorporated a system based on graduation year. Thus, promotion up to a certain level was based on experience and graduation year; however, for higher positions with more responsibility, evaluations by management and human resources departments were also involved in the decision making.
Regarding salaries, we found that most of the participating companies created salary charts for occupational physicians based on job grade and age; alternatively, they offered allowances for different workloads. In order to secure human resources, the salary structure should be competitive and acceptable. Occupational physicians’ salaries have been found to be improving; occupational physicians dissatisfied with their salaries are reportedly decreasing7).
Limitations
This study has several limitations. The interviewees were selected using the snowball sampling method from large companies in Japan that met our inclusion criteria, and the number of cases was only eight. Therefore, the generalizability of our findings may be limited, and it should be recognized as good examples of established systems. Further, we conducted the interviews only with the supervising occupational physician: some information was not permitted to be disclosed when we conformed the summaries to the interviewees; thus, the systems and structures at each company may not have been fully reflected.
Resolution of all the issues in career support of occupational physicians that were identified in this study requires understanding and support by corporate management of the companies. Although a significant number of full-time occupational physicians in Japan resign after a short period of time10), the companies surveyed in this study had relatively little turnover with occupational physicians. Therefore, we believe that the findings of this study on systems to support the career development of full-time occupational physicians in companies are valuable for other companies that establish occupational health system covering their entire business.
Conclusions
We found that various efforts were being made at the participating Japanese companies to support the career development of full-time occupational physicians. To provide high-quality, stable occupational health services to an entire company or group of companies, it is necessary to create a situation where full-time staff can contribute over a long period and develop their careers in the process. This is desirable for the well-being of the workers in such companies, as well as for the companies’ own development.
Acknowledgments
We would like to thank the supervising occupational physicians and other individuals at the participating companies who provided valuable information. We thank Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.
Sources of funding
This study was supported by Industrial Disease Clinical Research Grants from the Ministry of Health, Labour and Welfare, Government of Japan (170301).
Conflicts of interest
The authors declare that there are no conflicts of interest.
References
- 1. Mori K. Current Status and Issues for the Role of Occupational Health Physicians in Japan. JMA J. 2018; 1(1): 15-21.
- 2. Ojima J. Features of the Japanese Industrial Safety and Health Act: some key points regarding the organization of safety and health management. Ind Health. 2020; 58(5): 479-486.
- 3. Mori K, Nagata T, Kajiki S, Hino Y, Nagata M. Functions and positions of corporate occupational health managers in companywide occupational health management—an interview study with the corporate occupational health managers. Sangyo Eiseigaku Zasshi. 2013; 55(5): 145-153. in Japanese.
- 4. Mori K, Nagata T, Nagata M, et al. Development, success factors, and challenges of government-led health and productivity management initiatives in Japan. J Occup Environ Med. 2021; 63(1): 18-26.
- 5. Hino Y. Current status and its prospects of independent occupational physicians and consultants to corporations on health issues in Japan. Occup Health Rev. 2012; 25(3): 149-167. in Japanese.
- 6. Mori K. [Current status and issues in development of occupational physicians in Japan]. J UOEH. 2013; 35(Special_Issue)(suppl): 35-40. in Japanese.
- 7. Isse T, Nakamura H, Hachisuka K. [University of Occupational and Environmental Health, Japan: 2013 alumni physician statistics]. J UOEH. 2013; 35(suppl): 47-52. in Japanese.
- 8. Moriguchi J, Sakuragi S, Kitagawa Y, et al. Comparative study on the activities of part-time occupational physicians in Japan between 2008 and 2016: effects of the stress-check program. Ind Health. 2020; 58(3): 287-301.
- 9. Nakamura H, Isse T, Sakai A. Changes of working responsibilities and intentions of industrial physicians (Graduates of University of Occupational and Environmental Health, Japan) in a comparison between 2001, 2008 and 2015 questionnaire analyses. J UOEH. 2017; 39(1): 47-54. in Japanese.
- 10. Isse T, Nakamura H, Hachisuka K. [Turnover of full-time occupational physicians in Japan in the period 2002-2008: a component model survey]. Sangyo Eiseigaku Zasshi. 2012; 54(5): 174-183. in Japanese.
- 11. Koike S, Isse T, Kawaguchi H, Ogawa M. Retention among full-time occupational physicians in Japan. Occup Med (Lond). 2019; 69(2): 139-142.
- 12. Mori K, Nagata M, Hiraoka M, Kudo M, Nagata T, Kajiki S. Surveys on the competencies of specialist occupational physicians and effective methods for acquisition of competencies in Japan. J Occup Health. 2015; 57(2): 126-141.
- 13. Lalloo D, Demou E, Pahl N, Macdonald EB. Research and teaching activity in UK occupational physicians. Occup Med (Lond). 2020; 70(1): 64-67.
