Health: occupational therapy, a profession under attack

Table of Contents

• 1 Loss of communication with businesses
• 2 Doctors called too late
• 3 Addressing growing psychosocial risks
• 4 Aging workforce
• 5 Declining numbers
• 6

They are doctors who are not quite like the others. They take care of their patients, listen to them, but they do not prescribe treatment, giving substance to the famous saying: prevention is better than cure. Their role? «Avoid any damage to workers’ health as a result of their work,” specifying the job code.

An essential preventive role that is nevertheless undermined by the profession at the same time steady decline in workforce and new demands appear. As for declining numbers, the overall demographic decline of doctors is not enough to explain it. The lack of occupational health teaching during medical examinations works against its appeal.

Jean-Michel Sterdyniak, occupational physician and general secretary of the SNPST (National Union of Occupational Health Professionals), also points to a series of reforms at a steady pace: «How do you want to ask doctors to commit especially who change their rules every two years and do not know what the future will be? I chose this path to preserve the health of workers, including the health of managers, tradesmen and business owners. Not serving employers to provide legal proof, especially during layoffs. »

Loss of communication with businesses

In fact, the missions of the profession are expanding. «They have to respond to many legal requests, such as visits after recovery after a occupational accident or illness», quotes Jorge Munoz, professor of sociology at the University of West Brittany. In addition to workplace activities, on-demand and regular visits, there are mid-career and end-of-career visits, reinforced monitoring of employees at risk, participation in vaccination campaigns, and the establishment of information leaflets about health risks, help with the development of the only professional risk assessment document (DUERP) etc.

They may also be asked to support public health messages for sports practice and quality nutrition, far removed from working conditions stricto sensu. «When I started in 1991 in the intercompany service where I work in Île-de-France, a full-time doctor looked after 3,200 employees. Today there are 6,000testifying to Jean-Michel Sterdyniak. Instead of providing solutions, the law adapts to the shortage of doctors by rotating visits every five years, which makes us lose contact with companies.»

Doctors called too late

Labor sociologist and teacher of future doctors at the Catholic faculty of Louvain, Belgium, Thomas Périlleux goes further: «These thousands of workers become anonymous masses. Some occupational doctors, forced to make shorter visits, think so their work will be meaningless », believes the author of the Raw work. Professional suffering, consultation for what? (1).

Similarly, workers are less familiar with doctors, their missions and resources, which is not without consequences. «They will ask little and late, with a health condition that has already deteriorated.Note by Jorge Munoz. In addition, the outsourcing of many functions limits the possibility of doctors being reclassified within the company.» This is followed by notices of incapacity which return the post to a sense of helplessness and often lead to the sensitivity of the relevant staff.

Since the 2011 reform, occupational physicians, however, can rely on multidisciplinary teams of IPRPs (professional risk prevention workers) – which include psychologists, ergonomists, toxicologists, etc. – apart from nurses able to make rounds. The latter then provides the most complex situations to doctors. «On paper, this helps doctors direct their activities to other activities. But of course, this generates additional coordination and management work,” emphasizes Jorge Munoz.

There is also a status problem: unlike doctors, the members of these teams are not defense personnel. «Their position in relation to employers is more delicate to ask worrying questions, and occupational doctors can ask them why the frequency of sick leave in their company is increasing.», referring to occupational therapist Anne-Michèle Chartier.

Addressing growing psychosocial risks

Another limitation appears with company information pages, which refer to the risks specific to each one and provide advice on preventive actions. They must be carried out within the year following subscription to the intercompany service and renewed every four years, an admirable but unachievable goal, even with the support of the IPRP.

«Technical assistants (called, from January 2025, prevention consultants) take care of this with pressure from intercompany services to make a kill, but these pages are often worthlessnotes Jean-Michel Sterdyniak. For one of these companies, whose working conditions are supposed to be excellent, forty employees came in three months to talk to me about bad treatment. There was even suicide and attempted suicide.»

The increase in psychosocial risks (RPS) makes the job more difficult. «There is no registry of occupational diseases linked to RPS, which is a big problem for doctors to argue at a legal level.notes Jorge Munoz. When talking about musculoskeletal disorders (MSD), it is easier to complain about limitations such as repetitive movements, weekends, posture, weights lifted, etc.RPS is concerned with the organizational aspect which management often sees as their special area. »

Aging workforce

Only doctors can establish the link between working conditions and psychological suffering. «It has completely exploded because of new work groupsnotes Jean-Michel Sterdyniak. When ten people from the same department entered my office, collapsed, with weight loss and sleep loss, to talk to me about their excessive workload, there is nothing personal in connecting work and suffering. The hardest part is finding the solution when, sometimes, my contact is the abusive employer. It sometimes requires a change of professional doctor. If it is rejected by the intercompany service, it goes elsewhere.» Increase in leaving age retired it will greatly increase the workload of doctors with an aging population, and therefore greater impact from MSDs and other work-related health problems.

By improving the attractiveness of the profession, through internships and teaching at the general core of medical studies, it would be possible to partially stop the demographic decline. Better informed GPs could refer their patients to occupational physicians to adjust their working conditions without losing valuable time for their health. «Public authorities should also take steps to ensure that employers better respect our recommendations to overcome the feeling of powerlessness.», suggests Jean-Michel Sterdyniak.

The doctor also mentions a change in the management of occupational health services: «The creation of regional occupational health organizations with national leadership would break with financial logic only as a result of legal security. They would unify the sector by bringing together inter-company services, independent services and the public service, and set occupational health objectives according to regional issues.»

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Declining numbers

There were 4,775 occupational physicians in regular practice in France in January 2023, according to the national council of the Order of Physicians. In 2022, there were 4,812.

The workforce is expected to fall by an average of 7% by 2030, and even 20% in the Poitou-Charentes region.

In 2022, there were 7.2 working physicians per 100,000 inhabitants, with strong differences by region: from 14.7 in Île-de-France to 6.5 in Burgundy and Aquitaine.

Middle age the post is 55 years old.

Vocational doctors mainly work in intercompany work suspension and health services (SPSTI) which follows 93% of employees, as well as within the so-called autonomous services integrated in large companies. In 2022, there were 193 intercompany services in France (a figure that has since fallen due to mergers), and 383 independent services.