Need for more occupational doctors and wider remit

Research has revealed that Lithuania lags significantly behind other EU Member States in terms of the number of occupational doctors practising in the country. In addition, such doctors carry out fewer functions than they should to comply with international standards, with data analysis and consultation on ergonomic issues among the most neglected activities. The study shows that social partners need to have greater awareness regarding the important role and benefits of occupational health.

Research methodology

An assessment of occupational health services was commissioned and carried out in Lithuania in 2007, based on the findings of a qualitative survey of professionals and of statistical calculations made in compliance with national legislation. The survey covered occupational health professionals whose activities are directly related to the practice of occupational doctors in Lithuania. This criterion enabled the research to maintain a proper level of professionalism. The study involved specially developed questionnaires that ensured the anonymity of respondents.

A total of 28 respondents were interviewed from healthcare institutions, such as hospitals, clinics and health services in companies. Also among the research respondents were representatives from executive authorities – namely, the Ministry of Health (Sveikatos apsaugos ministerija, SAM), the State Environmental Health Centre (Valstybinis aplinkos sveikatos centras, VASC) and the National Labour Inspectorate (Valstybinė darbo inspekcija, VDI). In addition, the interview respondents included representatives from science and education institutions, such as the Kaunas University of Medicine (Kauno medicinos universitas, KMU), the Faculty of Medicine of Vilnius University (Vilniaus universiteto Medicinos fakultetas (VUMF) and the Occupational Medicine Centre at the Institute of Hygiene (Higienos instituto Darbo medicinos centras, HIDMC).

The statistical assessment was carried out in compliance with the requirements of model provisions for occupational health and safety services. It was also based on information from Statistics Lithuania (Statistikos departamentas prie Lietuvos Respublikos Vyriausybės) on the actual number of employees in Lithuanian enterprises according to company size and field of economic activity. The model provisions stipulate certain requirements for companies concerning occupational doctors, subject to the size and economic activity of the enterprise.

Research results

Assessing the role of occupational doctors

The study investigated which functions are supposed to be carried out by independent occupational doctors and which activities are undertaken in reality. The professionals interviewed gave different opinions on the functions that should be performed by occupational doctors. All of the respondents agreed that such doctors should monitor, under statutory procedure, employees’ health at work and identify diseases caused by occupational activities and external factors. Many respondents considered that occupational doctors should also evaluate incapacity or capacity for work. Furthermore, a small number of the respondents stated that occupational doctors should manage occupational health services, organise the operations of a multidisciplinary team, provide consultation concerning the implementation of legislation on health and safety at work, and advise on issues pertaining to safe labour organisation.

Nature of functions

According to the respondents, independently practising occupational doctors in Lithuania – regardless of whether they work in a company or a healthcare institution – carry out fewer functions than they are supposed to. Major differences between what, according to professionals, occupational doctors practising in a company health service should do and what they are doing in reality are observed in areas such as:

• analysis and interpretation of research data – the gap between what should be done and what is being done was assessed as amounting to 75 percentage points;

• consulting on matching jobs to employees’ needs – the gap in this regard was 57 percentage points;

• occupational health training and awareness raising – 57 percentage points;

• participation in employee health enhancing programmes – 57 percentage points.

Meanwhile, significant differences between what, according to professionals, occupational doctors practising in a healthcare institution should do and what they are doing in reality are observed in areas such as:

• analysis and interpretation of research data – the gap between what should be done and what is being done was assessed as amounting to 72 percentage points;

• consulting on ergonomic issues – the gap in this regard was 57 percentage points;

• participation in employee health enhancing programmes – 54 percentage points;

• consulting on using personal safety measures – 54 percentage points;

• monitoring of employees’ health as part of an established procedure – 50 percentage points.

Overall, it may be summarised that occupational doctors – whether practising in a company health service or in a healthcare institution – undertake fewer functions than they are expected to in the case of all of the above activities, except for the evaluation of workers’ capacity or incapacity for work. According to the professionals interviewed, occupational doctors pay the least attention to the analysis and interpretation of research data, as well as to consulting, awareness raising and health enhancing activities.

Need to increase number of occupational doctors

Moreover, the number of independently operating occupational doctors is insufficient, both as regards health services in companies (according to 93% of those interviewed) and healthcare institutions (89%). In 2007, some 142 enterprises in Lithuania should have offered the services of a total of 170 occupational doctors, in line with the model provisions for occupational health and safety services. Instead, only 22 occupational doctors were working in Lithuania, according to the research.

Compared with other EU Member States, Lithuania ranks the lowest in terms of the number of occupational doctors for every 1,000 employees. For example, one occupational doctor for every 1,000 employees is available in the Czech Republic and Latvia, while the proportion is 0.4–0.6 of a doctor for every 1,000 employees in Austria, Finland, France, Hungary, Italy and Norway. However, in Lithuania, this number amounts to only 0.015 of a doctor for every 1,000 employees.

According to the research authors, in the drafting of the National Strategy for Occupational Health and Safety, an urgent need exists to provide for the means to increase the number of occupational doctors in health services in companies and healthcare institutions. In order to achieve this aim, it is necessary to raise awareness firstly in the business community regarding the area of occupational health. Roundtable discussions should be held with the social partners to highlight the functions of occupational doctors and their role in – as well as the economic benefits for – corporate activities.

Inga Blažienė, Institute of Labour and Social Research