Bridging the Gap: The Urgent Need for Occupational Medicine in Modern Healthcare

For several years, I have asked Royal College–accredited Occupational Medicine specialists across Canada three specific questions. Despite the seniority and expertise of those asked, the responses have consistently failed to engage with the substance of the problem.

Those questions were not rhetorical. They were intended to test whether healthcare systems—and the specialty itself—recognize the true scope of occupational risk within clinical work.

First, are Occupational Medicine specialists meaningfully involved in providing occupational health services to hospitals and healthcare facilities?

Second, have they assessed physicians, surgeons, dentists, dental hygienists, dental assistants, physician assistants, or other healthcare professionals with musculoskeletal or other health conditions that are occupationally associated with, or caused by, work in clinical environments?

Third, what barriers prevent Occupational Medicine physicians from being directly involved in the assessment, prevention, and long-term care of their healthcare colleagues?

The lack of clear, consistent answers is revealing. It points to a structural blind spot in how healthcare governs occupational risk.

The Default Explanation — and Its Limitations

In Canada, the most common explanation offered is that physicians are not employees of hospitals, and therefore hospitals do not see occupational health responsibility toward them.

This explanation is frequently repeated, rarely interrogated, and operationally convenient. But it is insufficient.

Occupational exposure does not depend on employment status. Hazard does not disappear because a worker is incorporated, contracted, or paid differently. And duty of care cannot be reduced to payroll classification.

This reasoning also collapses under international comparison. In jurisdictions where Occupational Medicine is embedded through legislation or governance—most notably in parts of the UK and Europe—physician occupational health is treated as a system responsibility, not a contractual anomaly.

The Canadian model is not inevitable. It reflects governance choices.

What Is Actually Happening in Healthcare

To understand the problem, it is necessary to distinguish what is visible from what is ignored.

Healthcare systems focus heavily on what can be seen and managed at the individual level:

• Fitness-for-work decisions

• Sick leave and accommodation

• Return-to-work planning

• Referral to family physicians or general practitioners

These activities are necessary, but they are not preventive. They respond to outcomes, not causes.

Meanwhile, the occupational realities of healthcare work continue largely unmanaged:

• Sustained and repetitive ergonomic loading

• Forced and static postures during procedures

• Shift work and circadian disruption

• Exposure to cytotoxic agents, anesthetic gases, radiation, and biological hazards

• Chronic psychosocial stress, moral injury, and organizational pressure

Over time, these exposures accumulate.

The Iceberg Problem in Healthcare

This layered failure is best understood as an iceberg problem. What healthcare sees—burnout, injury, early exit—is only the visible tip. The unmanaged exposures and governance gaps below the surface are where Occupational Medicine belongs. I refer to this as the Razavi Iceberg.

Above the surface are the symptoms healthcare is accustomed to managing. Below the surface are the conditions that make those symptoms inevitable.

By the time clinicians present with chronic pain, disability, or burnout, prevention opportunities have already been missed. At that stage, systems default to accommodation or exit rather than redesign.

This is not a failure of individual resilience. It is a failure of system design.

Why the Loss Is Greatest in High-Risk Environments

Hospitals and healthcare facilities are among the most complex and hazard-dense workplaces in the modern economy. They combine physical risk, cognitive load, emotional intensity, and time pressure in ways few industries match.

In most high-risk sectors, Occupational Medicine is embedded to govern exposure, inform prevention, and sustain work ability over time. In healthcare, that expertise is often absent or marginal.

The result is normalization of harm. Musculoskeletal injury is accepted as “part of the job.” Burnout is reframed as a personal coping issue. Career attrition becomes an expected outcome rather than a system failure.

The longer Occupational Medicine remains excluded from healthcare governance, the more entrenched these outcomes become.

A Missed Opportunity for the Specialty

This is also a missed opportunity for Occupational Medicine itself.

When the specialty is confined to fitness-for-work opinions and return-to-work decisions, its preventive and systems-based mandate is diminished. Occupational Medicine is uniquely positioned to:

• Conduct exposure-informed assessment

• Guide job and system redesign

• Support long-term work ability

• Protect careers across decades, not episodes

Where Occupational Medicine involvement is mandated by law or policy, its influence and impact expand accordingly. Where it is optional, it remains reactive and peripheral.

Healthcare has absorbed the cost of that marginalization.

This Is a Governance Issue, Not an Employment Issue

The central question is not whether physicians are employees.

The real question is whether healthcare systems are willing to accept responsibility for the occupational conditions they create.

Exposure accumulates regardless of contract type. Disease often declares itself years after exposure begins. Prevention requires authority, structure, and accountability—not goodwill.

Other high-risk sectors understand this. Healthcare has exempted itself.

Why Mandated Occupational Medicine Matters

Embedding Occupational Medicine into healthcare governance—through legislation, joint health and safety committees, and system-level design—would shift the focus from reaction to prevention.

The benefits are neither theoretical nor abstract:

• Reduced occupational injury and disability

• Earlier identification of hazardous work patterns

• Improved career longevity for clinicians

• Lower downstream compensation and replacement costs

• A safer, more sustainable healthcare workforce

These outcomes have already been demonstrated in systems that treat occupational health as infrastructure, not an afterthought.

Healthy Careers Require Healthy Systems

Burnout, musculoskeletal injury, and occupational disease among healthcare professionals are not anomalies. They are predictable consequences of unmanaged exposure and weak governance.

No amount of individual resilience can compensate for structural neglect.

If healthcare systems continue to treat clinician health as incidental or contractual, they will continue to lose skilled professionals prematurely—and at significant human and economic cost.

Healthy careers require healthy systems. Occupational Medicine must be embedded where risk is generated, not applied after damage is done

Occupational Medicine must be part of that system by design, not by exception.