New Overtime Limits to Result in a Code Red for Hospitals across Japan
New Overtime Limits to Result in a Code Red for Hospitals across Japan
From April 1, 2024 most physicians will no longer be able to work more than approximately 4 hours of overtime every day; Will it lead to concierge medicine?
What’s new: Similar to how new limits on the amount of overtime for package delivery drivers are going into effect from April 1, 2024 (see “The So-Called "2024 Problem" in Logistics Weighs Heavy on Japan, Inc.”), from the same date the upper limit on overtime work for doctors will be capped at only 960 hours per year in principle. That works out to about 4 hours of overtime work per day. As an exception physicians at hospitals that provide emergency and other urgent care, as well as novice physicians at the stage of their training when they must gain intensive case experience in a short period, will have their overtime hours limited to 1,860 hours per year, almost double the general rule.
Why it matters: The new limits on overtime may help to prevent sleep deprived doctors from attempting surgery while in a zombie-like state, but, given how hospitals are dependent upon the status quo which is predicated upon relying on physicians to work extremely long hours, it is questionable whether the current medical care delivery system can be maintained without major changes after April 1, 2024.
In the sub-specialties of obstetrics and gynecology, where 24-hour and emergency services are required, at present there simply are not enough physicians to cover the existing workload without putting in more than the amount of overtime limited by the impending new labor laws.
The new government-imposed constraints are going to make it difficult for such clinics to secure doctors and continue to provide service at night and emergency care. In extreme cases entire departments or clinics as a whole may disappear completely, leaving certain geographies without enough medical personnel to provide care to children.
Local hospitals may become unable to fill their doctor shortages due to poor coordination with the university hospitals and other hospitals that lend them doctors. Thus, patients diagnosed with cancer or other diseases at their local hospital may end up having to wait a long time before they can undergo surgery. Certain local hospitals are not going to be able to maintain a 24-hour emergency system—especially at night.
Physicians and hospital managers warn that many patients will no longer be able to choose freely a hospital and when they want to see a doctor, which is still the norm in Japan.
By the numbers: Since records have been kept Japan’s doctors have been expected to clock-in dangerously high amounts of overtime.
According to a survey conducted by the Ministry of Health, Labor, and Welfare in 2019, about 10% of doctors working at hospitals worked more than 1,860 hours of overtime per year. That’s more than 8 hours per day! At more than a few institutions the annual amount of overtime exceeded 3,000 hours, revealing that there are many Japanese doctors who do not go home and, essentially, live at the hospital.
At about the same time as the above survey was implemented, Dr. Masatoshi Ishikawa, founder of Mame Clinic Group and a visiting faculty member of the Health Service Development and Research Center, University of Tsukuba, conducted a survey of obstetricians and gynecologists. The results showed that 65.5% of the physicians worked more than 960 hours of overtime per year, and 27.1% worked more than 1,920 hours per year.
Lingering concerns: While Japan’s healthcare system may need to seek a second opinion, there is no doubt that the new overtime restrictions are going to shock the system of healthcare delivery throughout the country.
"Due to reforms in the way doctors work, patients with serious illnesses such as cancer may not be able to undergo surgery immediately, and patients may not be able to visit hospitals as easily as they have in the past.” - Dr. Yasushi Takahashi, a professor at the Graduate School of International University of Health and Welfare in Tokyo
Many doctors, who rely on overtime pay to make ends meet, are worried about a potential loss of income. For physicians who have been supplementing their salaries with part-time jobs that offer good conditions, the inability to work part-time will directly lead to a decrease in their income.
Doctors in their 30s and 40s with children who are just entering high school and college routinely depend upon overtime from part-time jobs during nights and holidays to earn money for their children's education.
What’s next: The new rules will be implemented in only 13 months, but their long-term effects are likely to be felt for years to come. If access to physicians becomes severely restricted, Japan may see the rise of “concierge medicine” similar to how—for a fee—affluent patients in the U.S. now can simply purchase access to a doctor to bypass the hoi polloi in the metaphorical waiting room.
“This reform will have significant short-term side effects. However, if reforms are not made now, the number of doctors in surgery, emergency medicine, and obstetrics will decrease, and in the mid- to long-term, Japan's surgical, emergency, and obstetrics departments will collapse." - Dr. Yasushi Takahashi
Changing the way doctors work may help to improve the work-life balance of physicians, but there will, most likely, need to be a rebalancing of the number of specialists that choose certain specialties that are prone to an excessive workload.
Link to Japanese Source: https://toyokeizai.net/articles/-/648903
#physicianovertime #overtime #laborlaw #worklifebalance #occupationalphysician #workinghours #obstetrics #gynecology #hospitalphysicians #医師の働き方改革 #働き方改革 #勤務医 #残業 #長時間労働 #産婦人科医
Do you foresee Japanese having to go to other countries to get surgery, like Canadians do now?