This paper reviews the circumstances, current situation, and issues for Japanese occupational health physicians and discusses future developments. The Industrial Safety and Health Act requires workplaces that regularly employ 50 or more workers to appoint one occupational health physician. Their duties have been expanded by amendments to the Act, and they now have increased authority. Under these conditions, the occupational health physicians not only comply with laws and regulations but also follow a professional code of ethics. After the Act was amended in 1996, occupational health physicians had to complete additional training requirements. Basic training courses are provided by the Japan Medical Association (JMA) and the University of Occupational and Environmental Health, Japan. Most of the occupational health physicians certified by the JMA do not spend enough time on occupational health. Many Japanese occupational health work issues can be separated into issues of exposure, labor, and the occupational health system. Occupational health is characterized by changing needs because of new industrial structures and technological innovations. Given occupational health physicians’ expanding duties and professional development, they need to collaborate with one other and other occupational health staff to meet society’s expectations.