Occupational medicine physicians face a conflict between the interests of the
patient and those of the employer. The physician’s ethical duty to the patient
has always been primary, but corporate pressures have sometimes prevailed
over patient interests. This leads employees and unions to distrust
occupational medicine physicians. In highly regulated industries such as
transportation, employers and employees may jointly pressure occupational
medicine physicians to ignore individual health conditions even though they
might endanger the public safety. These conflicts have resulted in the
extensive regulation of occupational medicine practice by state and federal
agencies to ensure that both employee health and the public’s interests are
The Occupational Safety and Health Administration (OSHA) is the basic source
of regulations governing workplace safety and occupational medicine practice.
OSHA regulations are supplemented by the ADA and specific workplace rules
from other agencies, such as the U.S. Department of Transportation (DOT).
Most states have their own regulations that complement the federal
regulations and, in some cases, substantially extend their requirements. These
regulations were originally targeted at large employers with internal
occupational medicine departments and corporate legal counsel. As small
employers have been pressured to comply with the rules, and as large
employers contract out occupational medicine services, many private
physicians and clinics are providing regulated occupational medical services.
These providers are predominantly family physicians and general internists
without specialty certification in occupational medicine. This section discusses
the OSHA rules that company and contract physicians must follow in their
occupational medicine practice.