【Aging, safety net and fiscal crisis in Japan】No.108: Overworked Doctors

Correcting hospital doctors' long working hours is becoming one of the most important issues in health reform. Overlooking doctors who are forced to work long hours directly leads to the impairment of medical care quality and patient safety. The management in university affiliated hospitals, national hospitals, and public hospitals has continued to rely on overworked doctors, in some cases at no cost. However, lawsuits have been filed against hospitals that do not pay appropriate premiums for overtime, as stipulated by the law. Therefore, the Ministry of Health, Labor, and Welfare is attempting to establish an upper limit on the number of overtime hours that doctors are allowed to work as well as a stricter wage payment rule.

According to the Ministry, among the full-time doctors employed at hospitals and clinics, 39% work more than 60 hours per week and 61% work less than 60 hours. The majority of doctors who work more than 60 hours per week are employed by hospitals. Figure 1 shows the percentage of hospital doctors by clinical department who work more than 60 hours per week. While the total average is 40.6%, the percentages for obstetrics, clinical residents, emergency, and surgery are 53.3%, 48.0%, 47.5%, and 46.6%, respectively.

Figure 2 is a breakdown of the average working hours per week for full-time hospital doctors by department. Their working hours are classified into three categories: clinical practice time, non-clinical practice time, and waiting time. Non-clinical practice time is devoted to education, research, conferences, management work, and so forth. Waiting time denotes the hours spent waiting for a first-aid patient to come to the hospital, and the time in which medical treatment is administered to the patient is included in clinical practice time. The average number of working hours for full-time hospital doctors is 57 hours 10 minutes, and the sum of non-clinical practice time and waiting time exceeds ten hours in every department.

Figure 3 indicates that the longer doctors work, the more time they spend waiting for patients. For example, the average number of working hours for doctors whose working hours per week exceed 80 hours is 91 hours 24 minutes, of which 16 hours and 13 minutes is waiting time.

Figure 1: Percentage of hospital doctors by clinical department, who work more than 60 hours per week

Source: Ministry of Health, Labor and Welfare

Figure 2: Breakdown of the average working hours per week for full-time hospital doctors by department

Figure 3: Breakdown of the number of working hours of overworked hospital doctors