Editorials

Efforts needed to reduce doctors' working hours

A draft proposal capping the overtime hours of doctors working in medical institutions was submitted during a recent meeting of a panel of experts at the Health, Labor and Welfare Ministry. It condones up to 2,000 hours of overtime a year — or some 160 hours a month — for doctors at certain institutions providing crucial medical services to the local community, such as emergency treatment. While the logic behind the proposed cap is that such levels of overtime are vital to sustain the services provided at those institutions, 160 hours is twice the amount of overtime linked to death from overwork under a health ministry guideline. It must be carefully reviewed whether such a lax regulation is sufficient to protect the health of medical professionals.

The “work-style reform” legislation enacted last year set the first-ever legal limit on overtime, capping it at 720 hours a year and less than 100 hours a month, with the rule to be gradually enforced beginning this April. However, medical doctors will be exempt from the overtime cap for five years — given that under the medical practitioners law, doctors are in principle not allowed to reject patients’ requests for treatment. The proposal shown to the health ministry panel concerns overtime regulations for doctors beginning in 2024.

According to the proposal, the total overtime hours for doctors in general will be set at 960 hours a year (including work on off-duty days) and less than 100 hours a month. However, it calls for a much looser overtime regulation for doctors working at certain designated institutions that provide emergency treatment, perinatal care and specialized care like advanced cancer treatment — at up to 1,900 to 2,000 hours annually — on condition that measures will be taken to ensure the health of such doctors, such as a requirement that they must have at least nine hours of rest between work shifts and never work more than 28 hours at a single stretch. The regulation is set to be in place through fiscal 2035.

The long hours and heavy workload of doctors at hospitals and other medical institutions in Japan have long been considered a serious problem. Some hospitals have been found to have agreements with their labor unions allowing their staff to work more than 200 hours of overtime a month — or have gotten staff to work overtime well beyond such labor agreements. The problem also came into focus during the controversy over Tokyo Medical University’s discrimination against female applicants to its medical school — which shed light on the issue of many women doctors finding it hard to continue with their career after having children due to the excessively long work hours at hospitals.

A health ministry survey shows that up to 40 percent of doctors at medical institutions work more than 80 hours of overtime a month — one of the thresholds under health ministry guidelines that link employee deaths to overwork. About 20 percent of the doctors put in more than 1,440 hours of overtime a year — including some 10 percent who clock 1,920 hours (double the 960-hour threshold) or more. Many of the hospitals providing emergency treatment and university-run institutions are believed to employ doctors who work such excessive overtime. During a December meeting of the health ministry panel, a member who heads a hospital operator reportedly said that only about 30 percent of medical institutions cap a doctor’s continuous work shift at less than 28 hours.

Behind the proposed annual overtime cap of up to 2,000 hours is the current situation in which many doctors indeed log such long overtime hours — and the concern that in order to sustain the operation of many crucial medical institutions, such doctors’ hours cannot be radically reduced within the next five years to 2024. However, that would mean condoning the status quo of the doctors’ heavy workload and long hours until the mid-2030s.

The overtime regulation is supposed to be introduced as a measure to stop overwork that imperils employees’ physical and mental health, and it would be ironic that such a regulation effectively authorizes the doctors’ heavy workload as something inevitable and allow overtime hours up to double the level associated with the risk of death from overwork. One wonders if a different standard should be applied for protecting the health of medical doctors than for workers in general.

Other measures are being considered for reducing hospital doctors’ workload, such as delegating tasks currently performed by doctors to other hospital staff when possible. Along with such efforts, more steps to protect the health of doctors should be explored, including a more effective regulation to reduce their overtime hours.