A survey of the Fortune 500 companies reveals that contracting for occupational medicine services is frequent. Contacting is most used for services that are highly specialized and infrequently used. About two-thirds of large companies provide at least some routine occupational medicine services with employed physicians. An economic analysis suggests that for large plants, contracting for general occupational medicine services is usually not an effective strategy for saving money. Intangibles, such as integration of the occupational medicine department with all other health related corporate activities, are postulated to significantly influence corporate decision makers when they consider contracting for occupational medicine services.