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Allowing more doctors to work less than full time could reduce burnout, says royal college

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l5778 (Published 27 September 2019) Cite this as: BMJ 2019;366:l5778

Rapid Response:

Attempt to solve the shortage of doctors in Japan

It has been suggested that burnout could be prevented by working less than full time (LTFT) [1,2]. In Japan, rather than LTFT, there is not even a proper system of working time management. This presents problems particularly in the medical field, so it is necessary to tackle this issue in order to overcome the problem of a shortage of doctors and their poor working conditions.

According to the revision of the Japanese Labour Standards Act in 2019, the upper limit of overtime was set to 100 hours per month for regular workers (corresponding to a total weekly working time of about 65 hours), but doctors are exempted from this. As a future plan for 2024, doctors’ upper limit of overtime working will be 1860 hours per year (corresponding to a total weekly working time of about 80 hours). This limit is almost the same as the working hours’ regulations for British junior doctors and American residents. In Japan, this regulation applies to all positions of doctors, including residents, general practitioners, and consultants.

Japanese doctors are required to work a lot, but not because the number of doctors is low. The number of doctors per 1,000 inhabitants was 2.4 in Japan in 2016[3]. Although this is insufficient, this number is not much less than the level of 2.6 in the US and 2.9 in the UK[3]. The main reason for the long working hours is that there are many hospitals, beds, and long lengths of stay in hospital in Japan. The number of hospital beds per 1000 inhabitants in Japan was 13.1 in 2017, while in the UK it was 2.5 and in the US 2.8[4]. The length of hospital stay is also long; the average hospital stay in Japan was 16.2 days in 2017 compared with 5.9 days in the UK and 5.5 days in the US[5]. Japanese doctors thus have to see a large number of hospitalised patients.

The Japanese government has taken a step to improve this situation. On September 26, the Ministry of Health, Labour and Welfare decided to request the merger of 424 public hospitals that were judged to have poor medical treatment outcomes, and announced the names of these hospitals. The purpose of this merger is to reduce the high medical expenses due to the large number of hospitals. Medical expenses in Japan are 42.6 trillion yen (about 320 billion pounds), which is one of the major causes of Japan’s financial deficit. The number of doctors can be consolidated by reducing the number of hospitals and the number of beds. However, even if the number of hospitals is reduced by half, the number of doctors per bed still cannot reach a level like that in the UK and the US.

The downside of the above-mentioned policy is that accessibility will be reduced when hospitals are merged. However, the Japanese emergency system is excellent, with an average arrival time of 8.5 minutes and an average time until hospital admission of 39.3 minutes in 2017. When consolidation is promoted, the average time until admission will be extended. In addition, public hospitals are targeted, so it is expected that citizens will oppose their merger. Indeed, in 2009, the mayor of Choshi City, who declared that the local hospital would be shut down due to a shortage of doctors, was dismissed by a recall by the local citizens. With this precedent, the mayors of other Japanese cities are reluctant to shut down hospitals.

However, we should try to reduce working hours by consolidating hospitals and changing the way that doctors work. Reducing working time can reduce doctor burnout and provide better service to patients.

Competing interests: None declared.

References
1. Abi Rimmer. Allowing more doctors to work less than full time could reduce burnout, says royal college. BMJ 2019;366:l5778
2. Royal College of Physicians of Edinburgh. Survey results: a survey by the Royal College of Physicians of Edinburgh’s Trainees and Members’ Committee on less than full-time training. www.rcpe.ac.uk/sites/default/files/ltft_report_final.pdf. (Accessed on 30 September 2019)
3. OECD (2019), Doctors (indicator). doi: 10.1787/4355e1ec-en (Accessed on 30 September 2019)
4. OECD (2019), Hospital beds (indicator). doi: 10.1787/0191328e-en (Accessed on 30 September 2019)
5. OECD (2019), Length of hospital stay (indicator). doi: 10.1787/8dda6b7a-en (Accessed on 30 September 2019)

Competing interests: No competing interests

01 October 2019
Shotaro Doki
Occupational health physician
University of Tsukuba
1-1-1 Tennodai, Tsukuba, Ibaraki, Japan