The occupational physician (OP) has nowadays to face health and safety of migrant workers on new ethical, scientific, epidemiologic and legislative basis. Objective of our contribution is to describe area of interventions and perspectives in good medical practices for OP when dealing with migrant workers. Risk assessment should focus on differences of immigrants versus natives as regards exposures and effects, quality of and access to health services, organizational issues. Health surveillance should take into account cultural, educational, religious, life style differences, as well as susceptibility; time must be dedicated by the OP to search and evaluate such differences. Counselling, health promotion and case management are part of good medical practice. The professional role of the OP is depicted, trying to identify weaknesses and strengths, as well as priorities for intervention especially in applied research. In conclusion, migrant workers may suffer from occupational health inequalities. By means of good medical practices in risk assessment, health surveillance, fitness for work and health promotion, OP can proactively improve migrant workers' health and guarantee same levels of protection and prevention in workplaces as for the natives.