As Prime Minister Shinzo Abe’s administration pushes to pass labor reform bills in the current Diet session, many major hospitals in the Chubu region are concerned that the bills, which include a cap on the working hours of doctors, could lead to a deterioration in medical services in rural regions.
While experts are looking to improve working conditions for doctors to rectify problems with overwork, most hospitals say it will become difficult to maintain the quality of services with such a serious shortage of doctors, especially outside urban areas.
The bills, if passed, will limit doctors’ overtime to 45 hours per month in principle. Under the current law, doctors can work virtually without limit if their employer and the labor union sign an Article 36 agreement, which allows workers to work overtime or on holidays.
Some hospitals set the limit of monthly overtime in the agreement to over 100 hours, and there are cases where even that limit is ignored. In November the Labor Standards Inspection Office asked Nagoya City East Medical Center to rectify the working conditions of its doctors, as four doctors at the hospital had been working more than the maximum overtime of 150 hours per month set in the labor-management agreement. One of them was found to have worked 178 hours of overtime in a month.
The long working hours of doctors is said to be largely attributable to the Medical Practitioners’ Law, which sets a legal obligation for doctors to provide medical treatment. That provision means doctors are basically unable to refuse to treat patients when requested, while their professional ethics also discourages many doctors from thinking they can leave patients unattended. The health ministry began discussing reevaluation of the legal obligation in light of planned reforms to the working style of doctors.
According to a survey conducted by Chunichi Shimbun on emergency hospitals in six prefectures in the Chubu region, 22 of the 39 hospitals that responded said they are concerned they might not be able to maintain the quality of their services if they were to operate under the new rules. None of the hospitals expressed support for the cap on doctors’ working hours, the survey showed.
Some hospitals are reviewing their work systems to reduce doctors’ working hours.
Japanese Red Cross Society Suwa Hospital in Suwa, Nagano Prefecture, introduced a rule in December requiring doctors to only explain conditions and treatments to patients between 8:30 a.m. and 5 p.m. on weekdays, except for emergencies. The hospital also posted signs advising patients about the rule. At the hospital, priority used to be given to patients’ convenience and doctors sometimes had to come to the hospital on days off for patient consultations. “In order to maintain regional medical service, we decided to set a certain standard and ask for understanding by patients and their families,” said a hospital official.
Fujita Health University Hospital in Toyoake, Aichi Prefecture, is counting on nurse practitioners who are authorized to engage in certain medical practices without being instructed by doctors. Currently 17 nurse practitioners work at the hospital, conducting such medical activities as arterial blood collection and ultrasound examinations, and operating artificial respirators. “They are contributing to reducing doctors’ burdens, as doctors don’t have to go to patient wards as much as they used to,” said Zenichi Morise, 55, deputy head of the hospital.
The hospital hopes to increase the number of nurse practitioners, but some nurses might be discouraged from completing the two-year graduate school program required to obtain the certification by having to forgo pay during their studies.
Most hospitals, meanwhile, have not yet been able to come up with concrete measures to cope with the expected reduction in doctors’ work hours.
“It is difficult to resolve the problem of doctors’ overwork when they are required to deal with patients night and day,” said an official of a hospital in Gifu Prefecture, referring to doctors’ legal obligations. Another official at a hospital in a mountainous area said: “Doctors are concentrated in urban areas and we don’t have enough doctors to fill shifts.”
“All the hospitals are struggling to conduct reforms forced on them by the central government,” a senior official of a hospital in Aichi Prefecture said. “If the situation remains as is, rural medicine could collapse.”
Tadashi Matsumaru, a lawyer well-versed in doctors’ working conditions, said forcing doctors to work beyond the so-called karōshi (death by overwork) line — 80 hours of overtime per month — is a serious problem in terms of maintaining their physical and mental health.
“Hospitals should be aware that doctors are workers like in any other sector,” Matsumaru said. “The government should urgently take measures to boost the number of doctors in regions where they are needed, because that is essential to reduce doctors’ work hours and maintain quality of service at the same time.”
This section, appearing Tuesdays, features topics and issues from the Chubu region covered by the Chunichi Shimbun. The original article was published May 6.