It is time for reform: Results from a questionnaire survey on the current status of next generation HBP surgeons in Japan.

A questionnaire survey was designed and performed to assess the current status of "next generation" hepatobiliary and pancreatic (HBP) surgeons regarding surgical training, career, recruiting, and work-life balance in Japan. Using a valid email address, a questionnaire was sent to members of the Japanese Society of Hepato-Biliary-Pancreatic Surgeons (JSHBPS) who were under 45 years old. The questionnaire comprised 50 questions across the following four sections: (i) board certification of JSHBPS, (ii) research activity and overseas study, (iii) recruiting, and (iv) work-life balance. A questionnaire survey was sent to 1735 HBP surgeons and responses were received from 303 members (17.5%). In a survey with 303 respondents, over 45.9% were above 41 years old, 93.7% were male, and 91.0% were affiliated with university surgery departments. About 25.1% were JSHBPS board-certified, while 72.7% of uncertified doctors aspired for the certification. Research activity was deemed crucial by 74.9%. Recruitment targeting postgraduate years 1-5 was recommended, with the technical difficulty of surgery being the main reason for choosing HBP. Regarding work-life balance, excessive work and classical work style were regarded as a hindrance to the sustainability of working practices. This survey highlighted that next generation HBP surgeons are highly motivated to acquire advanced surgical skills and recognize the importance of research experience. However, they are facing long working hours and insufficient training opportunities. Fundamental reforms, such as revising the training curriculum, improving work styles, and enhancing recruitment, are necessary steps forward to ensure the sustainability of HBP surgery in Japan.