Photo/Illutration Officials of the Association of Japan Medical Colleges, including Chairman Kotaro Yokote, second from right, present the results of their survey of university hospital doctors' work styles at the education ministry in Tokyo’s Chiyoda Ward. (Kazuya Goto)

Thirty percent of university hospital doctors are expected to be putting in overtime beyond the “threshold for death from overwork,” according to a study by the Association of Japan Medical Colleges.

The threshold is used in Japan as a standard for recognizing deaths as being work-related.

The association released the results on April 18 of its study on the work styles of doctors at 81 university hospitals across Japan as commissioned by the education ministry.

The study found overtime work in fiscal 2024 is expected to exceed 960 hours a year for a maximum of 15,000 or so doctors, who account for about 30 percent of all medical practitioners on the payrolls of university hospitals.

They will be working more than an equivalent of 80 overtime hours a month, one of the thresholds used to recognize “karoshi,” or death from overwork.

“Japan’s health care system has, so far, relied on doctors working long hours,” said Kotaro Yokote, a Chiba University professor who heads the AJMC, which organizes medical faculty deans and university hospital directors across the country. “Patients certainly wouldn’t want worn-out doctors to perform surgeries on them.

“The problem cannot be addressed solely by improving work efficiency, however. There is a need to acquire staff who will take on part of the doctors’ duties as well.”

The survey was taken ahead of the planned fiscal 2024 start of a government-led “work-style reform” initiative for medical practitioners.

Under the reform, regulations will be introduced in fiscal 2024 to limit the extra hours that doctors work, including on holidays, to a maximum of 960 hours a year, in principle, and 1,860 hours a year in exceptional cases.

Such an exception may be granted, for example, to hospitals that are contributing to community health care.

All the university hospitals plan to request applications for the overtime exception, AJMC officials said.

Many of the university hospital doctors play a role in community health care, including by working several days a week for other institutions.

Among other questions, the survey asked the university hospitals how aware they are of the way the doctors on their payrolls are working and what measures they are taking for the work-style reform initiative.

The university hospitals, however, have not been sufficiently aware of their doctors’ working hours, and it has become standard for the university hospital doctors to work long hours. That could increase the caseload of medical mishaps, partly because doctors are not getting enough sleep.

The study also showed that shorter working hours could result, among other things, in poorer quality of education and research and less research output.

The study included a survey of 981 university hospital doctors who held the title of assistant professor, who are supposed to be playing a central role in research. 

The survey showed that about half were spending only between one and five hours a week on research. Fifteen percent were not spending any time at all on it.

However, duty doctors are being assigned from among limited numbers of available staff, meaning the doctors are spending long hours on patient consultations and running short of time for education and research.

AJMC officials said measures should be taken to shorten the doctors’ working hours, including by improving their working conditions, hiring additional personnel, reassigning doctors’ duties to others and reducing the doctors’ workloads.

They called for a need, among other things, to develop and hire staff who can assist doctors in patient consultations and research; promote task shifts for transferring part of the doctors’ duties to nurses; introduce information and communication technologies for supporting research; and assist the purchasing of state-of-the-art medical equipment.

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