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The current situation in which the medical system is sustained by the severely long working hours of physicians who are employed by medical institutions cannot be described as healthy. It is important for each medical institution to strive to reform doctors’ work-life balance and for the government to strengthen its guidance.
The reform of doctors’ work style, which regulates the overtime hours of physicians employed at medical institutions, will come into effect in April. Because of its significant impact, the implementation of these changes was postponed for five years under the legislation for work-life balance reform that came into effect in 2019.
Physicians who are employed by medical facilities provide treatment day and night, and they are regularly required to work long hours. Some quit the profession due to mental and physical exhaustion, creating a vicious cycle that has led to an even greater shortage of physicians.
The pillar of the reform of doctors’ work-life balance is to set a ceiling on overtime hours, which are currently not limited. In principle, the maximum is 960 hours per year, and hospitals will be penalized if that level is exceeded. Medical institutions will also be obliged to provide health management for doctors, including guidance to physicians who work long hours.
If doctors remain fatigued, their ability to concentrate may decline, which could lead to mistakes in medical care. Medical institutions have a responsibility to prevent doctors from overworking.
In contrast, the ceiling on the overtime hours of doctors and resident physicians at hospitals responsible for regional medical services will be set at 1,860 hours per year, as an exception. This decision was said to take into account the difficulty of securing doctors in regional areas, as well as the wishes of young doctors who want to acquire skills.
However, this ceiling is equivalent to 155 hours of overtime per month, far exceeding the 80 hours monthly that is considered to be the danger line for death from overwork. Doubt cannot be dispelled as to whether this standard will actually protect the health of physicians, as it seems to endorse overwork.
According to a survey by the Health, Labor and Welfare Ministry, 21% of full-time hospital physicians worked more than 960 hours of overtime in 2022, and 4% worked more than 1,860 hours. Although both of these figures were half the levels in 2019, there is no doubt that some physicians are still overburdened.
The growing movement not to count the duty in which doctors are on standby during the night and days facilities are closed as working hours cannot be ignored. An increasing number of hospitals are applying for permission to implement this special measure under the Labor Standards Law.
In addition, it is customary to exclude from working hours the time spent attending study sessions or writing papers. Such activities are viewed as “self-improvement.”
Unless these practices are changed, reforms to the way physicians work may end up being meaningless. It is essential that the government strictly supervise the entire medical community.
Doctors tend to stay away from such specialties as emergency medicine and obstetrics because these fields have rather irregular work schedules. The concentration of physicians in urban areas is a long-standing issue. The government needs to consider comprehensive measures, including improving the working conditions of doctors who are employed by medical institutions and increasing the number of students accepted at medical schools.
