Editor's choice: evidence-not event-based practice.

This issue is concerned with the provision of occupational health services and the people who provide it; in other words, the effectiveness of occupational health workers and the effects of that work on their health. Continuing the theme, this issue also publishes a number of original papers which examine the effects of health care work on health care workers. Whilst there are undoubtedly changes taking place within the health service, the changes within the occupational health sector are arguably much greater. They probably always have been, because they reflect the huge changes that take place continuously within industry and the private sector. But do we as occupational health workers change as quickly as our employers? Possibly not, but we need to, and the consequences of not doing so are already visible. The editorial by Bunn et al. [1] examines the phenomenon of physician assistants in North America, an issue highlighted by the papers of Nicholson [2] and Hooker [3]. 'Physician assistants' as a concept was probably previously unknown to many of us, myself included. It is one option, however, which might allow physicians to spread their specialist skills further whilst also retaking a strategic role. This is important if we are going to reach more workers and achieve the national targets. One of the great attractions of our speciality is the opportunity to practise in a wide variety of environments and non-clinical areas. This is not to detract from the importance of clinical occupational medicine, but a chance to develop expertise in fields as far flung as toxicology, ergonomics and human resource issues has undoubtedly attracted some highly talented physicians to the speciality in the past. But in recent years, in the UK, it appears that occupational physicians have handed the strategic and policy mantle to non-physician managers. The increasing number of itinerant specialist occupational physicians who earn their money as hands hired purely to sort out absence and retirement issues may not be a healthy option for our speciality in the long run. Persuading employers of our worth in non-clinical areas is an age-old battle, and one that we have lost in the last 20 years. The challenge therefore is to use options such as physician assistants to enable us to increase our sphere of influence and do the important things rather than simply the urgent ones. One growth area for occupational health in the UK is NHSPlus, still …