Occupational Health Services in Germany: Major Regional Differences, an Aging Medical Workforce

3 min.

Introduction

The Occupational Safety Act requires every company, regardless of size or industry, to provide an occupational physician for its employees. This is far more than just a legal obligation. Occupational physicians assess workplaces for health risks, help employees return to work after long-term illness, carry out preventive medical examinations, and advise companies on occupational health and safety matters. Based on data from the German Medical Association and the state medical associations, we analyzed how this legal requirement compares with the actual level of care. Nationwide, each of the roughly 4,200 occupational physicians working in Germany is responsible for just under 11,000 employees on average. In some federal states, the figure is over 16,000.

A Few Hundred Experts for Millions of Employees

Looking at the absolute numbers of occupational physicians in the individual federal states, some regions show limited staffing levels. In Saarland there are around 49 specialists, in Mecklenburg-Western Pomerania 52, in Thuringia 62, and in Bremen 64. The highest absolute numbers are in North Rhine-Westphalia (877 occupational physicians), Baden-Württemberg (624), and Bavaria (587). Together, these three states account for almost half of all specialists working nationwide.

Up to four times as many employees per occupational physician, depending on the state

Across Germany, the approximately 46 million employees are served by a total of 4,202 occupational physicians. That equals 9.14 specialists per 100,000 employees. However, the distribution across the federal states is highly uneven. With 21.9 occupational physicians per 100,000 employees, Hamburg has the highest density, followed by Bremen (14.34), Saxony-Anhalt (13.21), and Berlin (11.57). At the other end of the scale are Saxony (5.00), Thuringia (6.18), and Brandenburg (6.21). There are only between one-third and one-quarter as many specialists per employee there as in Hamburg.

In several states, one specialist supports more than 15,000 employees.

This is also reflected in the absolute caseload per specialist. On average, an occupational physician in Germany supports 10,943 employees. The lowest ratios—meaning the federal states where each occupational physician is responsible for the fewest employees—are Hamburg (4,565), Bremen (6,972), Saxony-Anhalt (7,567), and Berlin (8,637). The federal states with the highest number of employees per occupational physician are Bavaria (13,410), Mecklenburg-Western Pomerania (14,433), Brandenburg (16,096), Thuringia (16,193), and Saxony (18,137). This means that in some places, up to 18,000 people are assigned to one occupational physician.

One third of occupational physicians is nearing retirement

Besides the current supply situation, the age of the roughly 4,200 occupational physicians is particularly decisive for how the situation will develop in the future. The specialists who will retire in the coming years will no longer be available afterward. Given the low number of new professionals, it is no longer expected that the resulting gaps will be fully closed.
In Germany, more than 65 percent of occupational physicians are at least 50 years old. In Hamburg, this share is particularly high at 78.33 percent. The situation is similar in the North Rhine Medical Association, which represents part of North Rhine-Westphalia. Here, the figure is 79 percent. In some other regions, the share of older occupational physicians is lower. These include Brandenburg at 61.97 percent, Mecklenburg-Western Pomerania and Baden-Württemberg at 63.50 and 63.6 percent.

Nationwide, 33.15 percent of occupational physicians are 60 years old or older. The share is particularly high in the North Rhine Medical Association: there, 57.62 percent of registered specialists are in this age group. In Saarland (51 percent) and Hamburg (50 percent) as well, more than one in two occupational physicians is at least 60 years old. The lowest shares are in Mecklenburg-Western Pomerania (30.77 percent), Rhineland-Palatinate (30.66 percent) and Saxony-Anhalt (24.46 percent).

Only seven out of 100 occupational physicians are under 40

The share of young professionals in occupational medicine is very low. Only around 7.5 percent of occupational health physicians are under 40. In no federal state do young occupational health physicians make up more than ten percent. The fewest young occupational health physicians are in Hamburg (5.33 percent), Lower Saxony (6.07 percent) and Saxony-Anhalt (6.15 percent). The highest shares of young professionals are in Saarland (8.16 percent), Mecklenburg-Western Pomerania (9.62 percent) and Brandenburg (9.86 percent).

"Occupational health physicians are much more than just a legal requirement for companies. They conduct preventive medical examinations, assess whether employees are fit for certain tasks, support reintegration after long-term illness, and advise on designing safe and health-promoting working conditions. Especially in industries with physically demanding work, shift work, or high psychological stress, reliable access to occupational medical care is crucial. If there are not enough specialists, preventive examinations and reintegration processes are delayed, with tangible consequences for occupational safety. We are seeing companies increasingly rely on efficiency through digitalization in response to these bottlenecks, for example to make appointment scheduling and capacity management in occupational physician services more efficient digitally. A reliable booking system is therefore not only needed today, but will become essential as the shortage of skilled professionals continues to grow," says Lucian Holtwiesche, Co-Founder of anny.

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