9.8 per cent of employees say they have no access to an occupational physician, and another 25.2 per cent do not know whether that access exists. That says a great deal, especially because which doctor you are dealing with around absence, prevention and reintegration matters a lot.
The distinction between an occupational physician (bedrijfsarts) and an occupational health doctor (arboarts) is important. An occupational physician is a BIG-registered specialist with statutory tasks in absence guidance and reintegration. An occupational health doctor, by contrast, is a qualified doctor without that specialisation who carries out these tasks under supervision. For employers, HR professionals and managers this difference is relevant, not least because of the statutory requirements around absence guidance.
In this article we set out clearly what the difference is, and what it means for the quality of care, for keeping absence under control and for sustainable employability.
Difference in training and title
The subject often causes confusion, because both doctors can be active in the field of absence and occupational health. Yet the difference matters, legally and in substance.
An occupational physician is a doctor who, after their medical degree, has completed an additional specialisation in work and health. They are registered as a specialist in the Dutch BIG register, with occupational medicine as their specialism. The title is therefore protected. According to Arboportaal on the occupational physician (in Dutch), this is the medical specialist in the field of work and health.
An occupational health doctor is in practice usually a qualified doctor working within occupational health services, but not registered as an occupational physician. The term is not a protected specialist title. That means the training, expertise and powers differ from those of a registered occupational physician.
For employers, that distinction matters when choosing an occupational health service or independent support. For employees it is relevant to know who they are speaking to and who ultimately gives the medical judgement. For physicians and occupational health teams, a clear division of roles matters in order to deliver care that is both good and legally sound.
What may each doctor do by law?
The biggest difference lies in statutory powers. The Working Conditions Act prescribes that for certain tasks an employer must obtain support from an occupational physician or occupational health service. Within that, there is work that a doctor without the specialisation may not carry out independently.
According to the explanation of the law on the occupational physician (in Dutch) and the NVAB position on qualified doctors assessing sickness reports (in Dutch), an occupational health doctor may not carry out these tasks independently. They work under the supervision of an occupational physician.
In concrete terms that means:
- the occupational physician may judge fitness for work independently;
- the occupational physician guides absence and reintegration from their own medical responsibility;
- the occupational physician can refer employees and request medical information, within the applicable rules;
- the occupational health doctor can support the guidance, but cannot give the final judgement independently where that requires an occupational physician's authority.
The Dutch government confirms this too, through its business portal on engaging an occupational health service or physician (in Dutch): an occupational health doctor may not judge an employee's fitness or unfitness for work independently.
The difference in the practice of absence guidance
In daily practice the differences are not only theoretical. They touch directly on the quality of guidance and on whether the steps of the process have been carried out in a legally sound way.
In cases of sickness absence, an employer has to work with the employee and the physician or service in line with the Gatekeeper Improvement Act. The occupational physician has a clear role in that, for instance in the problem analysis and in the medical advice on what an employee can bear and where they can be deployed. The government describes this in the rules and obligations during illness (in Dutch) and in the explanation of the Gatekeeper Improvement Act (in Dutch).
For employers this means it is not enough to check only whether "a doctor is involved". What matters is whether the right doctor gives the judgement at the right moment. When a doctor who is not registered as a specialist carries out tasks reserved for the occupational physician, that can cause problems later during reintegration or at an assessment by UWV.
For employees it means they may expect medical assessments about work and capacity to be made under the responsibility of a professional authorised to do so. That offers quality as well as clarity.
Anyone who wants to know more about the division of roles in practice can also read what an occupational physician actually does and how reintegration after long-term absence works.
Supervision and delegated tasks: when is it allowed?
An important part of the discussion is about delegating tasks. Because of the shortage of occupational physicians, qualified doctors, practice assistants and other professionals increasingly work alongside them in occupational healthcare. That is allowed, but not without conditions.
In 2025 the NVAB stressed again that a doctor without the specialisation may only carry out occupational medicine tasks under the guidance and supervision of an occupational physician. The Dutch Health and Youth Care Inspectorate describes the same in its explanation of the doctor for work and health (in Dutch).
Supervision means more than being "available in the background". The occupational physician remains ultimately responsible and must be demonstrably involved. That matters for the quality of care, and also for being able to account for it afterwards.
For employers it is therefore wise to check, in the contract with an occupational health service:
- who actually does the absence guidance;
- when a registered occupational physician is involved personally;
- how supervision is arranged;
- which tasks are delegated and which are not.
That fits the statutory duty to record arrangements in a basic contract. You can read more about that in what a basic occupational health contract is and what it must contain.
What this means for employers
For employers this comes down above all to quality, compliance and predictability. A lower rate or quick availability may look attractive, but if it is unclear who is authorised to give which judgement, that can turn out more expensive later.
Think of situations in which:
- the problem analysis did not come about in the right way;
- the advice on what someone can bear is insufficiently founded;
- an employee objects to the quality or independence of the guidance;
- UWV judges that the reintegration effort has been insufficient.
Because the occupational physician advises independently and is bound by medical confidentiality, this role also matters in the tension between employer and employee. The employer gets functional information, for instance what someone can still do, but no diagnosis. That protects the employee's privacy and at the same time helps shape a responsible return to work.
Employers would do well not only to ask whether a doctor is involved, but also:
- is this a registered occupational physician;
- how is access to the walk-in clinic arranged;
- how quickly can an employee be seen;
- how does the cooperation work around prevention, not only around absence.
That fits the wider obligations around working conditions and absence, as described in your obligations as an employer and the Working Conditions Act and what it means for employers.
What this means for employees
For employees the difference matters above all for trust, privacy and their legal position. Every employee has the right of access to an occupational physician, even without the employer's permission. That right exists so that complaints can be discussed early and absence prevented where possible.
In practice many employees do not know exactly where to go. According to figures the NVAB cites from the national working conditions survey, 9.8 per cent of employees say they have no access to an occupational physician, while 25.2 per cent do not know whether that access exists. That shows communication about this could be better.
It is good for employees to know:
- an occupational physician is independent of the employer;
- the physician is bound by medical confidentiality;
- you may discuss health questions in relation to work, even when you have not dropped out;
- you do not have to share medical details with your employer.
When you speak to an occupational health doctor within a service, it is reasonable to ask under whose supervision they work and when an occupational physician is personally involved. That is not a formality; it touches directly on the quality of the guidance.
Why this matters particularly now
The discussion is live partly because the Netherlands has had a shortage of occupational physicians for some time. According to the Dutch capacity body, around 258 new entrants are needed each year, while the actual intake falls below that. At the same time the outflow through retirement is high. As a result, the pressure towards delegating tasks and working together cleverly is increasing.
That does not make good arrangements less important, but more so. An occupational health doctor can do valuable work within a well-organised team, as long as supervision, responsibilities and decision points are clear. Delegating tasks is not wrong, but it does have to be set up carefully.
For organisations working on this, it helps to look more broadly at capacity and at how occupational healthcare is organised, for instance through the shortage of occupational physicians in the Netherlands and engaging an occupational physician: how it works and what it costs.
A practical distinction to test in advance
In summary: the job title alone does not say enough. You want to know what training someone has had, whether they are registered as an occupational physician, which tasks may be carried out independently and how supervision is arranged.
For employers that means: test your contract, your process and your points of contact. For employees it means: know that you have the right to an independent occupational physician. For physicians and occupational health teams it means: make responsibilities explicit and work within the professional and legal frameworks.
It is precisely that clarity of role that produces better guidance, clearer communication and less risk of mistakes in absence and reintegration.
Know which doctor you are working with: that makes the difference for absence, recovery and sustainable employability.
With a clear division of roles between occupational physician and occupational health doctor, you build reliable absence guidance, clear expectations and a safe basis for decisions about work and health.
Key takeaways
- An occupational physician is a recognised medical specialist with statutory powers of their own; an occupational health doctor always works under a physician's supervision.
- When choosing an occupational health provider, look further than speed and availability, and weigh powers, supervision and quality of guidance as well.
- Always have medical judgements about fitness for work, capacity and reintegration options made under the responsibility of an occupational physician.
- Record in the basic contract and in concrete working arrangements who carries out which tasks, when the physician is personally involved and how the cooperation runs.
- Make sure managers, HR and employees know what they may and may not ask and discuss, so that privacy and confidentiality are properly safeguarded.
- Making roles and responsibilities clear builds more trust in the process, better reintegration and room for prevention and sustainable employability.
By investing time now in clear arrangements and the right expertise at the table, you prevent arguments afterwards and build, together with us, towards healthy work, sustainable employability and predictable absence guidance.