“Safety-sensitive” workers, also termed “safety-critical” workers, have been subject to fitness to work assessments due to concerns that a performance error may result in worker injury, injury to coworkers or the general public, and/or disruption of equipment, production or the environment. However, there exists an additional category of “decision-critical” workers, distinct from “safety-sensitive” workers, in whom impairment may impact workplace performance, relationships, attendance, reliability and quality. Adverse consequences in these latter areas may not be immediately apparent, but a potential “orbit of harm” nevertheless exists. Workplace consequences arising from impairment in “decision-critical” workers differ from those in “safety-sensitive” personnel. Despite their importance in the occupational context, “decision-critical” workers have not previously been differentiated from other workers in the published literature, and we now outline an approach to fitness to work assessment in this group.
To obtain baseline information with respect to occupational medicine practice in Canada, a questionnaire survey of members of the Occupational and Environmental Medical Association of Canada was carried out by mail in 1993. One hundred eighty-six responses were received (56% of the membership). The average age of the respondents was 49.5, 12% were female, and 55% worked full-time in occupational medicine. Practice types included corporate settings (58%), clinics (23%), government agencies (14%), worker's compensation boards (7%) and academic settings (5%). Sixty percent had some formal training in occupational medicine, and 46% had occupational medicine certification by either the Royal College of Physicians and Surgeons of Canada, the Canadian Board of Occupational Medicine, or the American Board of Preventive Medicine. Younger physicians were more likely to be female and have gone directly into occupational medicine. Women were more likely to be working full-time in occupational medicine but worked fewer hours per week. Those physicians with specialty qualifications were older and more likely to be working full-time in occupational medicine and be active in professional activities. The Association intends to continue surveying its members on a triennial basis, identifying trends in the practice profiles and continuing education needs.
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