I appreciate the thoughts and endeavors of my colleagues at Arizona who have, among federally funded occupational medicine residency programs, placed perhaps the greatest emphasis on clinical experience and expertise. I think, however, that they have somewhat misunderstood the teaching-research model that we have evolved at Yale and thereby underrated its potential to serve the ends we commonly seek.
Although our Occupational Medicine Program is, indeed, nested within a major tertiary care medical center, our clinics have not drawn primarily from within this referral center but rather have used the base to draw, broadly, from without. Over 95% of all patients are seen first (and exclusively) as outpatients; over 80% have never previously been to Yale. We see, in our own "specialty," a spectrum of pathology similar to that seen by other specialists—a population referred for possible/probable occupational disease. Not surprisingly, we see both an extraordinary range of illness and