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Introduction An economic and demographic transition with an ageing workforce, evolving work organisation and new emerging risks is combined with a shortage of Occupational Physicians (OPs). This study aims to propose recommendations for future occupational health surveillance (OHS) and the role of OPs. Methods First, the PubMed, EU-OSHA and International Labour Organisation databases were screened for literature from 2006 to August 31, 2016, concerning OHS, return-to-work policies and risk management systems in Europe, Japan, Canada and other OECD countries. Second, a standardised mail survey was delivered to all members of the Belgian Professional Association of OPs. Results The literature review showed that European directives legally inspired countries to adapt their legislations and develop strategic OHS plans. Nevertheless, the comparison of OHS in different countries shows a varied landscape. The response rate of the survey was 54% (n=262). The results prompt a paradigm shift: Within 5 years, OPs must focus more on return–to–work (96.3%; 95% CI: 93.2% to 98.1%) and risk analyses (84.9%; 95% CI: 79.9% to 88.8%) while training occupational nurses (ONs) to execute routine occupational health examinations (46%; 95% CI: 39.8% to 52.4%). Similarly, a more standardised and multidisciplinary approach to risk assessment should be developed (74.7%; 95% CI: 68.8% to 79.8%). By 2030, OPs would be more specialised in toxicology, disability management, ionising radiation, etc. (42.2%; 95% CI: 36.2% to 48.5%), and ONs would be trained on risk assessments (74.8%; 95% CI: 68.9% to 79.9%) and health promotion (98%; 95% CI: 95.3% to 99.1%). OPs disagree that general practitioners (GPs) could solely execute occupational health examinations (81.7%; 95% CI: 76.4% to 86.1%). Discussion The role of OPs must be part of a trend toward evidence-based OHS (i.e., studying the effectiveness and efficiency of ‘fitness for the job assessments’), disability management and engagement with a wide network of stakeholders (such as ONs, GPs and health insurance organisations).