To the Editor.
—We agree with Cullen1 on the need for a formal discipline of clinical occupational medicine with its corresponding agenda for clinical research in the field. We further agree with the importance of training primary care specialists in occupational health.Clinical occupational medicine has been the training focus of our National Institute for Occupational Safety and Health—supported residency program in occupational medicine since 1981. Interestingly, this focus has been criticized by at least one site visitor as resulting in individuals leaving the program as "nonspecialists." Nevertheless, we remain convinced of the appropriateness of training occupational medicine clinicians, with specific expertise in the prevention, diagnosis, and treatment of work-related health problems.We are unclear as to whether the university and hospital-based referral clinic described by Cullen, irrespective of clinical department, provides an "ideal" opportunity to acquire much preventive expertise. Guidotti2 has previously pointed out many of