Reforms aimed at improving the working conditions of doctors took effect this month.
The new regulations set an overtime limit for employed doctors at 960 hours per year (for an average of 80 hours a month), in principle.
But in the case of hospitals that play a core role in regional healthcare or accept a high number of interns, the annual limit on overtime was capped at 1,860 hours.
The reform drive should mark a start for changing the dependency of regional healthcare systems on physicians’ excessive workloads.
Even though the Ministry of Health, Labor and Welfare said fewer hospitals than expected applied for the overwork limit exemption, medical institutions have a duty to swiftly resolve the problem of overworked doctors.
Every medical institution needs to share the recognition that protecting the health of doctors is vital for sustaining the overall quality and safety of healthcare services.
In rural areas, many hospitals rely on physicians dispatched on a part-time basis from local university hospitals, but some university hospitals are apparently pulling their doctors back. A close watch must be kept to gauge the impact on regional healthcare.
A 2022 survey by the health ministry found that 21 percent of employed physicians worked overtime beyond the 960-hour annual limit, and 4 percent worked more than 1,920 hours of overtime a year. Although these ratios have roughly halved since 2019, the burden on some doctors is clearly excessive.
There are lingering doubts about whether the data accurately reflects reality. It has been pointed out that “shuku nicchoku,” or on-call night and day duty typically involving minimal active labor, and “jiko kensan” (self-improvement)--learning and doing research while engaged in primary duties, such as medical practice, that are aimed at acquiring knowledge and enhancing their skills on their own--are used as loopholes for long work hours.
Night and day on-call shifts, allowed only for “light or short-duration duties,” are not counted as work hours. Hospitals granted permission from a labor standard inspection office for this type of work arrangement, in which doctors are required to be available to respond to work calls or emergencies, increased from 144 cases in 2020 to 1,369 in 2022.
Regulators should ensure strict application of the related labor standards, closely monitor the realities of how this arrangement is used at hospitals and, if necessary, revoke permission if actual conditions deviate significantly from the specifics described in the applications.
In reality, there are hospitals that try to treat actual work performed by doctors as “self-improvement.” First of all, it is necessary to implement clear standards according to the regulations.
Young doctors, especially those aiming to become specialists, are often required to engage in “self-improvement” activities beyond routine clinical practice, such as presenting at academic conferences. This can blur the lines between work and personal development.
In a tragic case in 2022, a doctor working for a hospital in Kobe committed suicide due to overwork after logging about 200 hours of overtime in the month before his death, which was officially recognized as work-related. The bereaved family filed a lawsuit seeking compensation, but there is a difference in perception between the family and the hospital, which claims that the time spent on self-improvement was also included.
The underlying issue of doctor shortages in rural areas, which contributes to excessive workloads, remains unresolved.
Health minister Keizo Takemi has mentioned the approach of assigning doctors by region and expressed his intention to compile specific plans to introduce such a system by the end of the year.
But whether the medical community will support a regional assignment approach to address the shortage of doctors in rural areas remains to be seen.
We hope the government and the medical community will engage in constructive discussions on this idea to find a format that meets regional medical needs and is also acceptable for physicians.
--The Asahi Shimbun, April 26
EDITORIAL: Move to improve doctors’ working conditions sure to pay dividends
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26.04.2024
Reforms aimed at improving the working conditions of doctors took effect this month.
The new regulations set an overtime limit for employed doctors at 960 hours per year (for an average of 80 hours a month), in principle.
But in the case of hospitals that play a core role in regional healthcare or accept a high number of interns, the annual limit on overtime was capped at 1,860 hours.
The reform drive should mark a start for changing the dependency of regional healthcare systems on physicians’ excessive workloads.
Even though the Ministry of Health, Labor and Welfare said fewer hospitals than expected applied for the overwork limit exemption, medical institutions have a duty to swiftly resolve the problem of overworked doctors.
Every medical institution needs to share the recognition that protecting the health of doctors is vital for sustaining the overall quality and safety of healthcare services.
In rural areas, many hospitals rely on physicians dispatched on a part-time basis from local university........
© The Asahi Shimbun
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