Occupational Health Career: What Does an Occupational Health Doctor Actually Do?

If you're considering a career in occupational medicine, one of the most common questions is:

"What does an Occupational Health Physician actually do day to day?"

The answer is: it depends.

One of the attractions of occupational medicine is the variety. You could spend part of your morning dealing with a straightforward management referral, then assess a worker with hand-arm vibration syndrome (HAVS), undertake an asbestos or lead medical, complete an ill-health retirement assessment, and finish the day with a health surveillance review e.g., audiometry/spirometry..

Your career can also evolve significantly over time. You don't necessarily have to choose one area of occupational medicine — you can develop additional competencies and qualifications alongside general occupational health practice.

What is a career in Occupational Health like?

Occupational medicine sits at the intersection of:

🩺 Clinical medicine 🏭 Workplace health ⚖️ Occupational health legislation 👨‍💼 Employer advice 🧑‍⚕️ Patient advocacy 🔬 Health surveillance 🛠️ Workplace risk management

Unlike many hospital specialties, you're often not simply asking:

"What disease does this person have?"

You're also asking:

"How does this person's health affect their ability to do this particular job, and what can reasonably be done to support them at work?"

That distinction is at the heart of occupational medicine.

A typical day in Occupational Health

There isn't really a single "typical" day.

A general occupational health clinic might contain a mixture of different assessments.

For example:

Of course, this is just an example. Some days might be entirely management referrals, while others could involve workplace visits, health surveillance or a day full of appointed doctor work.

1. Management Referrals

Management referrals are one of the most recognisable aspects of occupational medicine. This is likely what you will be largely doing day to day.

An employer may refer an employee because they have concerns about:

• Sickness absence
• Returning to work
• Performance potentially related to health
• A medical condition affecting work
• Workplace adjustments
• Long-term conditions
• Recurrent short-term absence
• Whether someone is fit to undertake particular duties
• Ill health retirement

The OH consultation is not simply about diagnosing the patient.

The important question is:

What does the employer need to know to make a reasonable management decision?

Some referrals are relatively straightforward.

For example:

A warehouse worker has been absent for six weeks following a lumbar disc prolapse. They have improved with physiotherapy and their GP expects them to return to work within the next few weeks.

Your assessment might explore:

• Current symptoms
• Functional limitations
• Treatment
• Expected recovery
• Job demands
• Potential adjustments
• Likely return-to-work timescale

The report might then provide practical advice about a phased return and temporary modification of duties.

These cases can be very rewarding because a relatively focused assessment can help someone return to work safely.

Complex management referrals

Then there are the cases that require considerably more thought.

For example:

An employee has been absent for 10 months with depression, chronic pain, perceived bullying, unresolved work grivance and significant family difficulties. They have had several treatments but remain unable to return to work. Their manager wants to know whether they are likely to return and whether reasonable adjustments could help.

Now you're considering:

• Multiple medical conditions
• Functional impairment
• Treatment and prognosis
• Workplace factors
• Psychosocial factors
• The employee's perception of work
• Reasonable adjustments
• Equality Act considerations
• Likely timescales
• Whether further medical information is required

These cases demonstrate why occupational medicine is much more than just ticking the box

HAVS Tier 4 Assessments

Another potential career pathway is developing expertise in hand-arm vibration syndrome (HAVS).

HAVS assessments can range from straightforward surveillance to more complex diagnostic assessments, i.e., HAVS Tier 4.

You will need to interpret the history very carefully in conjunction with the examination results to determine if HAVS is present.

The assessment will also involve advising on:

• Further exposure
• Workplace controls
• Further health surveillance
• Relevant referral
• Fitness for work
• Risk reduction

For doctors interested in the relationship between occupational exposure and disease, HAVS can be a particularly interesting area.

HSE Appointed Doctor – Asbestos, Lead, Ionising Radiation

Another specialist route is becoming an HSE Appointed Doctor for asbestos, and/or lead and/or ionising radiation medicals.

These assessments are particularly interesting because they combine clinical medicine with occupational exposure and regulatory requirements.

An asbestos medical may involve:

• Detailed occupational exposure history
• Respiratory symptoms
• Smoking history
• Respiratory examination
• Lung function testing
• Chest imaging where appropriate
• Review of previous occupational exposure
• Assessment against the relevant regulatory requirements

Lead medicals similarly involve consideration of:

• Occupational exposure
• Potential routes of exposure
• Symptoms
• Relevant clinical findings
• Biological monitoring results
• Workplace controls
• Individual susceptibility

This can provide an excellent opportunity to develop expertise in occupational toxicology.

IRMP Assessments

Another interesting area is working as an Independent Registered Medical Practitioner (IRMP) for ill-health retirement assessments.

These assessments are different from conventional management referrals and will vary depending on the pension scheme.

The question isn't simply:

"Is this person currently fit for work?"

Instead, the assessment considers the relevant ill-health retirement criteria and the person's likely ability to undertake the required employment or duties until retirement age, depending on the applicable pension scheme rules.

The assessment requires careful clinical reasoning and clear report writing.

It can be particularly interesting for doctors who enjoy independent assessment and medico-legal-style work.

OEUK Medical Examiner

For doctors interested in offshore medicine, becoming an OEUK medical examiner can provide another area of practice.

Offshore medical assessments involve consideration of whether an individual is medically suitable for offshore work which is a safety-critical environment.

The assessment may include:

• Medical history
• Cardiovascular assessment, where applicable
• Respiratory assessment, where applicable
• Musculoskeletal assessment, where applicable
• Vision
• Hearing, where applicable
• Urinalysis, where applicable
• BMI
• Job-specific considerations e.g., crane operators, rope workers

The environment is particularly important.

An individual who is perfectly capable of working in an office or on a construction site may not necessarily be suitable for a remote offshore environment with limited medical service

That is a recurring theme throughout occupational medicine:

Fitness is not absolute — it is related to the demands and environment of the job.

Health Surveillance

Health surveillance is another major component of occupational health practice.

It is particularly relevant where workers may be exposed to hazards/sensitisers that could cause occupational disease.

Depending on the workplace, this could involve surveillance relating to:

• Noise
• Vibration
• Respiratory hazards
• Skin exposure
• Chemicals e.g, chromium, nickel, mercury, VCM

The OH professional needs to understand not only the health assessment but also why the surveillance is being undertaken.

This means understanding:

Hazard → exposure → potential health effect → surveillance → interpretation → action

A good occupational physician should be able to identify when an abnormal finding may require further investigation or a change in workplace controls or referral e.g., LungsAtWork spiro referrals.

Pre-placement Assessments

Pre-placement assessments are another common part of occupational medicine.

An employer may want to know whether a prospective employee is medically suitable for a particular role.

This might involve jobs with:

• Safety-critical duties
• Night work
• Heavy physical demands
• Respiratory hazards
• Chemical exposure
• Driving
• Emergency response
• Specific regulatory requirements

The important principle is:

Assess the person against the actual requirements of the job.

Avoid making assumptions based purely on a diagnosis.

Someone with a medical condition may be perfectly capable of performing a particular job, particularly if appropriate adjustments can be made.

Combining Different Career Paths

One of the best things about occupational medicine is that you don't necessarily have to choose one area.

Your week could look completely different from day to day.

Which occupational health career path might suit you?

There isn't one "best" occupational medicine career.

It depends on what you enjoy.

The biggest attraction: variety

And within all of those assessments, you're dealing with different people, different workplaces and different clinical problems.

That variety can make occupational medicine a very rewarding career.

What type of OH work interests you?

Where can your career take you?

The DOccMed can be an excellent starting point, but it doesn't have to define the rest of your career.

Over time, you may choose to develop further through:

• MFOM
• Specialist occupational medicine training e.g., AFOM level
• Additional occupational health qualifications
• Health surveillance expertise
• Specialist regulatory roles
• Leadership and management
• Teaching
• Research

You may start with general management referrals and gradually develop specialist interests.

Final thoughts

If you're considering occupational medicine, don't think of the specialty as simply:

"Seeing people who are off sick and writing reports."

There is much more to it.

You can combine clinical medicine, workplace assessment, occupational disease, legislation, risk management, prevention and independent medical assessment.

And perhaps most importantly, you can build a career that suits your interests.

The flexibility and variety are two of the things that make occupational medicine such an interesting specialty.

If you're just starting out after the DOccMed, don't worry about having your entire career mapped out.

Get good general OH experience first.

Find good supervision.

See as many different types of cases and workplaces as possible.

Then, as you discover what you enjoy, build your specialist interests around it.