French Law Expanded Occupational Doctors’ Duties, But Time and Staffing Gaps Kept Practice Unchanged

When France passed a sweeping prevention law in August 2021, the intention was clear: occupational health services would no longer focus narrowly on workplace risks but would become active contributors to public health, running vaccination and screening campaigns, promoting physical activity, and supporting workers with disabilities. The reform, which came into force on 31 March 2022, wrote these missions directly into the French Labour Code. Yet a new qualitative study from Normandy suggests that changing the law on paper is a very different matter from changing what doctors actually do in their consulting rooms, and that the gap between regulatory ambition and daily practice is shaped less by willingness than by the stubborn realities of time, staffing and professional identity.

The study, published in Public Health in Practice, was led by Babacarsy Diop and colleagues, who interviewed ten occupational physicians practising in Normandy between November 2024 and March 2025. Using individual semi-structured interviews lasting between 30 and 70 minutes, the researchers explored how these doctors perceived the 2021 reform, what barriers they encountered in implementing its expanded missions, and what health promotion activities they actually carried out. The interviews were analysed thematically, with coding conducted concurrently with data collection and refined through repeated discussion between the first author and the research supervisor. By the seventh interview, no new major themes were emerging, which the team took as a sign that thematic saturation had been reached.

The demographic backdrop to the reform is essential for understanding why implementation has proved difficult. Over recent decades, successive reforms have progressively expanded the missions of occupational medicine in France, strengthening prevention and workplace interventions, while the workforce of occupational physicians has been shrinking. In 2019, approximately 4,000 occupational physicians were practising for a working population of more than 25 million people. The 2021 law therefore arrived in a specialty already stretched thin, asking a declining cadre of doctors to take on a visibly broader mandate that formally linked occupational health to national public health objectives for the first time in such explicit terms.

What the interviews revealed was a profession caught between acceptance and ambivalence. Several participants considered the contribution of occupational physicians to public health genuinely relevant, particularly when it could be connected to workers’ health, but they questioned where these new missions should sit in the hierarchy of their responsibilities. Prevention of occupational risks and support for continued employment remained, for most, the non-negotiable core of the job. One physician with more than twenty years of experience put it bluntly: the expanded missions were very relevant but should not be a priority, because employers needed to understand that occupational physicians were there first and foremost to provide occupational health, and drifting too far risked moving away from their role. Another linked the question of priorities directly to workforce shortages, arguing that with so few specialists in occupational risks available, all other professions could contribute to public health while the specialty kept its focus.

The barriers the physicians described were overwhelmingly organisational rather than ideological. Limited time was the most recurrent obstacle, tied to heavy workloads, staffing constraints and consultations dominated by complex or urgent occupational health problems that left little room for additional health promotion activities. One participant described the arithmetic starkly: in a 20 to 30 minute consultation, often dealing with an active problem, there was simply no time to address broader public health topics, even when those problems sometimes had a public health dimension. Another drew the logical conclusion that if more consultations were added, public health would be set aside in favour of occupational health, which remained the core activity. Beyond time, participants pointed to difficulties coordinating with other healthcare professionals, the absence of clearly identified networks or contacts, and broader organisational failures to support change.

The facilitators that might have eased this transition were, for the most part, hypothetical. Dedicated time, additional medical and nursing staff, multidisciplinary involvement, training resources and improved coordination with external stakeholders were described as desirable conditions rather than measures the physicians had actually experienced. A few participants did report existing multidisciplinary support or specifically allocated resources, but these were exceptions. The dominant account of implementation was that it rested on the internal organisation of each service and the individual initiative of each physician. One participant summarised the sentiment with a phrase that captures the study’s central finding: the law was changed and then practitioners were told to organise themselves, with no particular support, when what would really matter was having someone trained within the service.

Training emerged as a striking gap. Most participants reported little or no specific support for integrating the public health missions introduced or reinforced by the reform, and where training had occurred, it mainly concerned other areas of occupational health. The physicians expressed clear needs: updated information, clearer objectives, practical tools and support for translating new missions into concrete action. One described the situation as a matter of know-how they simply did not have, requiring training, objectives and tools that were not being provided. Interestingly, no single preferred training format emerged from the interviews; what participants emphasised instead was the need for updated content directly applicable to practice, rather than any particular delivery method.

Perhaps the most revealing finding concerned continuity rather than change. Several participants reported little or no change in their activity that could be directly attributed to the reform, and some missions now explicitly enshrined in the regulatory framework were described as having already formed part of their practice. Vaccination, disability awareness activities and screening were all cited as pre-existing, generally embedded within individual consultations or routine occupational health work rather than launched as specific programmes after the law. One physician noted that vaccination, disability awareness and screening were all in place before the law of 2 August 2021. This suggests the reform may have formalised or increased the visibility of practices that already existed, rather than immediately transforming what occupational physicians do, although the authors caution that the study captured retrospective perceptions rather than objective before-and-after measurements.

The health promotion practices that did occur varied considerably between physicians and according to the situations encountered. Physical activity and smoking were addressed during consultations, sometimes systematically during periodic visits but often depending on the clinical or occupational context; physical activity was notably discussed in relation to musculoskeletal disorders, cardiovascular risk factors or psychological difficulties. Vaccination and screening practices also varied, with several participants prioritising interventions related to occupational risks and considering interventions aimed at the general population as more appropriately the domain of general practitioners, though some intervened beyond that boundary when patients had difficulty accessing healthcare. Disability-related work was generally handled through individual situations, including information about disability recognition, workplace adjustments and support for continued employment. Formal evaluation appeared limited, with several participants reporting no specific indicators of effectiveness.

The authors are careful about the limits of their findings. The sample was small, and nine of the ten participants worked within the same occupational health service, albeit across geographically distinct centres, which limits the transferability of the conclusions to occupational physicians in France as a whole. Recruitment relied on voluntary participation, creating potential self-selection bias, the interviews were not audio-recorded, and the initial coding was performed by a single researcher. The interviews were also conducted by an occupational medicine resident undertaking his first qualitative study, whose professional relationships with most participants may have influenced the data. Nevertheless, the study offers a valuable, contextualised window into how frontline physicians experience regulatory change, and its central message resonates far beyond France: expanding professional missions by law does not, by itself, translate into new practice. Without dedicated time, adequate staffing, practical training and organisational support, even well-intentioned reforms risk formalising what already exists rather than building what they promise, leaving the negotiation of professional boundaries to individual doctors working within systems that have not changed around them.

Subject of Research: Occupational physicians' perceptions of role change following France's 2021 occupational health prevention reform

Article Title: Occupational physicians’ perceptions of professional role change following health policy reform in France: A qualitative study

Article References: Diop, B., Fourreau, E., Clin, B., & Boulanger, M. (2026). Occupational physicians’ perceptions of professional role change following health policy reform in France: A qualitative study. Public Health in Practice, 12, Article 100872. https://doi.org/10.1016/j.puhip.2026.100872

Image Credits: AI Generated

DOI: 10.1016/j.puhip.2026.100872

Keywords: occupational medicine, health policy reform, France, qualitative research, health promotion, workplace prevention, professional role boundaries, implementation barriers, vaccination, screening, public health, physician workload