Physician qualifications under the noise standard

May 10, 2016

Laurie Wells, [Au.D.,] Chair

Council for Accreditation in

Occupational Hearing Conservation

[Recipient address omitted]

Dear [Dr.] Wells:

Thank you for your email inquiry to the Occupational Safety and Health Administration's (OSHA) Directorate of Enforcement Programs. You requested clarification of the term "physician" as it pertains to OSHA's audiometric testing program under the Noise standard, 29 CFR 1910.95. This letter constitutes OSHA's interpretation only of the requirements herein, and may not be applicable to any questions not delineated within your original correspondence. Your paraphrased statement and question are presented below, followed by our response.

Background: OSHA's Noise standard, paragraphs 1910.95(g)(3), (g)(7)(iii), (g)(8)(ii) and (g)(9), all reference "physician" or "other physician" when stating those professionals who are qualified to administer the audiometric testing program. Audiologists, otolaryngologists, Doctors of Medicine (MDs) and Doctors of Osteopathy (DOs) all have specialized medical training, but the term "physician" is not specifically defined.

Question: Within the context of the intended definition of a "physician" under 29 CFR 1910.95 what credentials would qualify a person to perform the duties that are specifically ascribed to physicians by the standard?

Response: As you stated in your inquiry, various paragraphs of the Noise standard, 29 CFR 1910.95, outline duties relating to the audiometric testing program that are expected to be performed by individuals with certain professional training, expertise, certification or licensure. As an example, paragraph 1910.95(g)(3) outlines requirements for audiometric testing which, as stated in the standard, can be conducted by "...a licensed or certified audiologist, otolaryngologist, or other physician, or by a technician who is certified by the Council [for] Accreditation in Occupational Hearing Conservation, or who has satisfactorily demonstrated competence in administering audiometric examinations..."

In the preamble to the 1983, Occupational Noise Exposure, Hearing Conservation Amendment, Final Rule, OSHA stated "that all persons who can demonstrate 'competency in administering tests and in the use and care of audiometers may administer audiometric tests required by the standard.' (46 FR 42625)." [(48 FR 9753).] Further, the [preamble clarified] that persons may learn how to administer the audiometric tests by either completing "a training course administered by a training institution certified by the Council [for] Accreditation in Occupational Hearing Conservation or a course given by another recognized training organization, and to receive a certificate upon completion of the course." [(48 FR 9754).] Notwithstanding, if the audiometric testing is performed by someone who qualifies as a "technician," but meets none of the other professional designations under this section, that individual, the technician, must be responsible to an audiologist, otolaryngologist or physician. 1910.95(g)(3).

The audiometric testing program involves several other responsibilities, as you know, that go beyond the administration of the testing. For instance, the audiometric testing results must be reviewed, interpreted, and decisions must be made (determining existence of hearing impairment, making referrals for additional medical exams, etc.). As such, the standard is clear in stating duties that must be performed only by individuals that meet certain professional qualifications (i.e., as audiologists, otolaryngologists and/or other physicians). Where the standard ascribes duties to multiple professional categories, individuals meeting the professional licensure/certification/training requirements for any of those professions would qualify to perform those duties.

Where the standard ascribes a particular duty only to a physician, the expectation is that the individual performing that duty will meet the qualifications of an allopathic or osteopathic physician. OSHA's usage of the word "physician," when not otherwise qualified, always refers to allopathic or osteopathic physicians and not to chiropractic physicians, doctors of naturopathy or optometry. As an example, at 29 CFR 1910.95(g)(9), the standard states, [t]he physician will be allowed, based on his/her judgement to determine when an annual audiogram can be substituted for the baseline audiogram. Due to the limited language used in this section, not all persons with a doctoral degree would qualify to make this judgement. An [otolaryngologist] is one (but not the only) type of physician who would qualify to perform this limited function.

Other physicians, e.g., graduates from a school listed in the World Directory of Medical Schools, who are licensed by a Board of Medicine of the Federation of State Medical Boards, and have the requisite training or competency to practice medicine, could also qualify. In most cases, these individuals will have earned either an MD or DO degree. The educational degree designation may differ for degrees earned outside the United States. Individuals who regard themselves as "physicians" based on other qualifications would be evaluated based on their particular state or professional licensing board(s) to determine whether their professional scope allows that person to provide or be delegated the responsibility to provide the services described by the OSHA Noise standard.

Thank you for your interest in occupational safety and health. We hope you find this information helpful. OSHA requirements are set by statute, standards, and regulations. Our letters of interpretation do not create new or additional requirements but rather explain these requirements and how they apply to particular circumstances. This letter constitutes OSHA's interpretation of the requirements discussed. From time to time, letters are affected when the Agency updates a standard, a legal decision impacts a standard, or changes in technology affect the interpretation. To assure that you are using the correct information and guidance, please consult OSHA's website at https://www.osha.gov.

If you have any further questions, please feel free to contact the Office of Health Enforcement at (202) 693-2190.

Sincerely,

Thomas Galassi, Director

Directorate of Enforcement Programs

[Corrections 7/20/2017]