To the Editor: What exactly is an occupational medicine physician? Is it an individual who is residency-trained and board-certified in the specialty? Is it an individual who completed a residency and is board-certified in another field, but took a 2-week course and has a special interest in occupational medicine? Is it an individual who never completed residency training in any specialty but practices in an occupational medicine setting? At the present time, we would submit that the American College of Occupational and Environmental Medicine (ACOEM) defines anyone with a valid medical license and the money to pay the annual dues as an occupational medicine physician. Even better-if this same individual makes a few presentations and sits on a couple of committees, they may well be eligible to become an ACOEM fellow. The Residency Review Committee for Preventive Medicine may not be too far behind ACOEM in terms of definition flexibility. It appears that they have or are about to certify one or more "executive residency programs." One of these programs advertises: "Are you interested in being board certified in occupational medicine by the American Board of Preventive Medicine ... But you do not feel able to leave your job for a year to be in a residency program.... Then {our} Practicum Residency Year External Track may be for you. The offer the prospective applicant an opportunity to take a few courses through the mail and then complete the practicum year requirements with a commitment of "three days a month-dates to be negotiated." Rather than striving to improve the current training programs and increase the reputation of our field, we are actively undermining the credibility and appeal of existing residencies. Ask yourself the following questions: How many other major medical colleges/societies would permit a physician not board-certified in the field to become a fellow? An informal survey of 21 such organizations (eg, pediatrics, orthopedics, cardiology, surgery, gastroenterology) revealed none-many of these groups required board certification just to become a member! What would be the response if you approached one of the other American Board of Medical Specialties certifying boards and announced that you were interested in attaining board certification (in cardiology for example); and would like to do your training on three Saturdays a month while continuing in your current full-time job? Clearly, you would be laughed out of the building! Where does the charade stop? When will we finally realize that "the emperor has no clothes." Please understand that we are not advocating taking any titles or certificates away from those who already have them. In addition we understand and empathize with those who would like to obtain board certification in this field and are applying to the "executive programs." At the same time we feel that it is the responsibility of ACOEM, Accreditation Council for Graduate Medical Education, The American Board of Preventive Medicine, and the residency programs to define criteria (consistent with those of other subspecialty organizations) that will ensure that fellowship and board certification in our field continue to have some meaning and value. We submit that the reputation of our entire subspecialty is on the line. Significant remediation is required if we are to maintain any level of respect amongst our colleagues and the public. We appreciate that the issues and questions raised above are highly sensitive. We expect and would invite comments from all interested parties on what we feel to be a crucial issue for all occupational medicine practitioners. Michael D. Goldstein, MD, MPH Craig H. Friedmann, MD, MBA, MPH Peter D. Griffin, MD, MPH Julia U. Halberg, MD, MS, MPH Penns Park, PA