Physicians’ Working Style Reform

Incumbent Prime Minister Shinzo Abe and his cabinet members launched in 2016 several audacious policies to boost Japan’s economy, which has been suffering economically for more than two decades. Surprisingly, it turned out that one of these policies was closely related to me i.e. “Working Style Reform” included “Physician”.

Incumbent Prime Minister Shinzo Abe and his cabinet members launched in 2016 several audacious policies to boost Japan’s economy, which has been suffering economically for more than two decades. Surprisingly, it turned out that one of these policies was closely related to me i.e. “Working Style Reform” included “Physician”. The policy was taken up in his cabinet meeting because Japan had been aware that we normally work very long which made Japan’s productivity lower than that of other advanced states.

First question – Do you know what “960”, which I have ignored for so long, means in Japanese labour society? It is the number of “Extra” working hours, on an annual basis, which is highly likely to be a cause of “Overwork Death”. This is often quoted and applied to verdicts in the court. For reference, our “Duty” working hours are “40 per week (Mon-Fri)” in general.

The second question – Do you know what “1,750” means? I confide only to you, namely, this is between you and me. Never share this with your friends on the web. It is “My” “Extra” working hours which I identified on calculation App.

But, there is no surprise because I was educated, graduating in 1991, in a way that being a physician was seen as not just an occupation but as a religious vocation. This gave us the belief that we have got to work tirelessly and endlessly for the patient (though you may eventually be a patient).

In 2017, I attended the ISQua conference in London and learned about the resident’s working hour regulation in the US from representatives of the ACGME (Accreditation Council for Graduate Medical Education). The ISQua conference is nice in a sense that all sorts of experts willing to share time with you.

You may be interested in the argument seen in the expert panel of the Ministry of Health on Physician’s Working Style Reform. In the 1st round session (-Mar 2019) it concluded that:

  1. Primarily, all the administrators of medical institution shall hold physician’s “Extra” working hour at 960 or less.
  2. Exceptional working hours are allowed, to the maximum of 1,860* on annual basis, only in institutions in regions with a shortage of physicians and institutions which provides advanced treatment, on the premise of strict health check-up for physician. Concurrently, endeavours to shorten the working hour are also required.

*Government recent survey showed that approximately 10% of Japanese hospital have physicians who work for hours longer than 1,860hrs/yr. Vice chair of the panel resigned in opposition to approving “1,860” as the hours officially acknowledged.

The regulation including the principle and exception will come into effect in 2024 with an interim period (2019-2023) for every adjustment in medical fronts.

Now, we are getting into the 2nd round of discussion and raising the question – “How can we reduce physicians’ working hours?”. It is said, believed or even “begged” that “Task shifting” to other professionals i.g. nurse, pharmacist, technician, administrative staff etc. will work.

The Ministry of Health announced that it would reinforce current education and certification program of “Expert nurse of specified risky procedures” which is supposed to work effectively in “Task shifting”. However, nobody knows if the government’s earnest wish will be fulfilled. We may recall and say in 2024 that it was just a “Voice”.

Regardless of future climate on this issue, it is obvious now for Japanese healthcare society to keep on walking the rocky road ahead.

To be honest, I was invited to a study meeting of a regional physician’s society to be held in coming August to deliver a lecture on this issue. I will feel guilty at a podium of the meeting room for being a “Bad Role Model”. So, “1,750” has to remain “a secret” between you and me.

Shin Ushiro M.D., Ph.D.

Professor and director, Deputy Patient Safety Officer, Kyushu University Hospital

Executive Board Member, Japan Council for Quality Health Care (JQ)

Reference

1) Panel report on “Physicians’ Working Style Reform”, Ministry of Health, Labour and Welfare (MHLW)(in Japanese);

https://www.mhlw.go.jp/stf/new page_04273.html 

2) Ministry’s web site for “Study panel for “Physicians’ Working Style Reform”, Ministry of Health, Labour and Welfare (MHLW)(in Japanese);

https://www.mhlw.go.jp/stf/shingi/other-isei_469190.html

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