323 - Employers in the exam room: navigating ethical issues in occupational medicine

Session Description: Occupational medicine is unique in that providers must navigate the competing priorities of injured workers and employers. While open communication between parties can facilitate return to work, studies show that occupational medicine providers frequently experience ethical conflicts. Providers may experience pressure from employers to underrecord the severity of injuries or to delay or avoid treatments that make injuries OSHA recordable. However, there is little evidence on how employers exert this influence, how it impacts patient care and provider wellbeing, and the practice and policy implications. We will present findings from a pilot study examining employer influence on workers’ compensation care in Colorado, including an under-documented phenomenon of employer representatives attempting to accompany injured workers into exam rooms. We will present cases based on interviews with providers, discuss the interview findings and practice implications, and propose policy reforms.

Educational Gaps: We will identify ethical challenges that occupational medicine providers face and discuss strategies for limiting undue employer influence on workers’ compensation care.

Is this session being sponsored by an ACOEM Section or Component?: No

Has this session previously been presented?: No

The AOHC 2026 theme is Healthy workers. Healthy world: Appropriate employer support of injured workers may positively influence patient outcomes. Inappropriate employer influence may adversely affect injured workers, resulting in delayed, inadequate, or denied care. Occupational medicine providers who are subject to pressure from employers of injured workers or from their own employers may experience moral distress and dissatisfaction with occupational medicine practice. The ethical challenges explored in this pilot study may prompt providers to leave the field, further reducing the workforce of occupational medicine providers. Our session will examine the phenomenon of undue employer influence on occupational medicine care and present findings from a pilot study examining how this inappropriate pressure impacts patient care and provider wellbeing. The discussion may help develop policies to promote the safety and health of these workers and reduce ethical conflicts for occupational medicine providers.