The relevance of occupational medicine to primary care in the 21st century.

The relatively infrequent incidence of dramatic outbreaks of occupational disease, as occurred in the past, along with economic downturns, have lowered the medical altitude of the workplace as a risk factor for or determinant of disease and disability. However, in 2007 alone, there were more than 4 million nonfatal occupational illnesses in the United States. Equally relevant is the explosion in 2010 at a coal mine in West Virginia that left 29 workers dead. Not to be overlooked are the ongoing challenges to medical practitioners of managing workers' compensation cases. At the same time, the convergence of demographic changes, changes in the workplace structure, and emerging technologies are reinforcing the views of occupational medicine clinicians and other practitioners that occupational health must be integrated into primary care systems and that total separation of work-caused and nonwork-caused care is counterproductive and arbitrary. Therefore, basic principles, concepts, and procedures of occupational medicine must be integrated into the substrate of information and experience upon which students must depend on entering a medical career.