We surveyed American and Canadian medical schools to assess the extent to which occupational health professionals provided services to their own institutions. Ninety-two of 155 schools (60 percent) responded to a mailed questionnaire. Forty-six (51 percent) of the respondents had an occupational health service distinct from an employee health service. Two thirds of the respondents provided occupational health services to business and industry. Such professionals based in nonclinical departments were more likely to provide educational and epidemiologic services for hospital employees than were professionals based in clinical departments. In those institutions with risk management, biohazards, or health and safety committees, less than one half of the occupational health professionals in those institutions were members of those committees. Five respondents felt that there were financial disincentives to providing occupational health services to their institution's employees. We conclude that academic-based occupational health professionals have inadequate input into the provision of such services at their own institutions.