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 properly protected.

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.