Division of Health Policy and Management, Center for Community Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
Department of Public Health, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan.
BMC Public Health. 2024 Jan 12;24(1):164. doi: 10.1186/s12889-023-17531-5.
The culture of excessively long overtime work in Japan has not been recently addressed. New legislation on working hours, including a limitation on maximum overtime work for physicians, will be enforced in 2024. This study was performed to elucidate the working conditions of full-time hospital physicians and discuss various policy implications.
A facility survey and a physician survey regarding physicians' working conditions were conducted in July 2022. The facility survey was sent to all hospitals in Japan, and the physician survey was sent to all physicians working at half of the hospitals. The physicians were asked to report their working hours from 11 to 17 July 2022. In addition to descriptive statistics, a multivariate logistic regression analysis on the factors that lead to long working hours was conducted.
In total, 11,466 full-time hospital physicians were included in the analysis. Full-time hospital physicians worked 50.1 h per week. They spent 45.6 h (90.9%) at the main hospital and 4.6 h (9.1%) performing side work. They spent 43.8 h (87.5%) on clinical work and 6.3 h (12.5%) on activities outside clinical work, such as research, teaching, and other activities. Neurosurgeons worked the longest hours, followed by surgeons and emergency medicine physicians. In total, 20.4% of physicians were estimated to exceed the annual overtime limit of 960 h, and 3.9% were estimated to exceed the limit of 1860 h. A total of 13.3% and 2.0% exceeded this level only at their primary hospital, after excluding hours performing side work. Logistic regression analysis showed that male, younger age, working at a university hospital, working in clinical areas of practice with long working hours, and undergoing specialty training were associated with long working hours after controlling for other factors.
With the approaching application of overtime regulations to physicians, a certain reduction in working hours has been observed. However, many physicians still work longer hours than the designated upper limit of overtime. Work reform must be further promoted by streamlining work and task-shifting while securing the functions of university hospitals such as research, education, and supporting healthcare in communities.
日本长期存在过度加班的文化，但这一问题近期并未得到解决。新的工时立法，包括对医生最长加班时间的限制，将于 2024 年生效。本研究旨在阐明全职医院医生的工作状况，并探讨各种政策含义。
2022 年 7 月进行了医疗机构调查和医生工作状况调查。医疗机构调查向日本所有医院发送，医生调查向一半医院的所有医生发送。要求医生报告他们在 2022 年 7 月 11 日至 17 日期间的工作时间。除了描述性统计外，还对导致工作时间延长的因素进行了多变量逻辑回归分析。
共有 11466 名全职医院医生纳入分析。全职医院医生每周工作 50.1 小时。他们在主医院工作 45.6 小时（90.9%），在其他医院工作 4.6 小时（9.1%）。他们在临床工作上花费 43.8 小时（87.5%），在临床工作以外的活动上花费 6.3 小时（12.5%），如研究、教学和其他活动。神经外科医生工作时间最长，其次是外科医生和急诊医生。共有 20.4%的医生估计超过了 960 小时的年加班上限，3.9%的医生估计超过了 1860 小时的上限。在排除其他医院的工作时间后，共有 13.3%和 2.0%的医生仅在其主要医院就超过了这一水平。逻辑回归分析表明，男性、年龄较小、在大学医院工作、从事工作时间长的临床科室工作以及接受专科培训与控制其他因素后工作时间延长有关。
随着即将对医生实施加班规定，工作时间已经有所减少。然而，仍有许多医生的工作时间超过规定的加班上限。必须进一步推进工作改革，简化工作，转移任务，同时确保大学医院的功能，如研究、教育和支持社区医疗。
