Company doctors: standards of care and legitimacy: a case study from Canada.

Company doctors have been criticized for poor standards of care and bias towards their employers interests. This paper reports on interviews with 24 company doctors in the province of Ontario, Canada. It uses company doctors' accounts of their work and careers to highlight aspects of corporate medicine which may help to produce questionable standards of care and present obstacles to doctors' attempts to increase their legitimacy. Apparent variations in the quality of care in contract practice and full-time employment in a company are discussed and it is suggested that greater attention may need to be devoted to improving the standards of care in smaller companies. Patterns of recruitment, doctors' beliefs about the changing nature of occupational medicine, as well as contradictory definitions of the proper sphere of occupational medicine may also have an effect on standards of care and the degree of legitimacy accorded to company doctors. The responses of doctors to charges of bias are discussed and it is suggested that they may neglect the major reason for such charges--that they are employed by companies and are thereby constrained to favour their employers' interests. The paper proposes the need for further research on standards of occupational medical care, whether these vary with respect to context of practice and whether there are appreciable differences in standards of practice among doctors employed by companies, unions, universities and government. Modest proposals for future health policy are also indicated.