Table 4.

Exemplar Quotes of the Free-Text Responses to the Question Regarding Expectations or Concerns About Physician Working Hour Restrictions (N = 216).

Theme	Subtheme and exemplar quotes
Expectations	Improved physician well-being “I hope that the number of physician ‘karoshi’ a will decrease.” Improved quality of patient care “(Physicians) … can be more responsible” Overall “It would be a step toward ideal reform.” Increased number of physicians “I expect an increase in the number of physicians…” Renewal of the medical care system “Hopefully a new medical care system will be established.” Improved quality of physicians “Quality of physicians is expected to improve.” Restoration of physician dignity “I would like to see reforms so that physicians can feel pride and honor.” Management should be retained within the physicians community “(Physician working hour restrictions will be) … very good. Physicians should take the necessary action through reform.” Improved quality of medical education “(Physician working hour restrictions will) … lead to improved quality of medical education.” Stabilization of the medical care system “(Desire for) stable medical care system.” Patient care as before “(I would prefer) … to be able to see the physician as before.”
Concerns	Deterioration in quality of patient care “Physicians need to complete their work in a short time to avoid overtime working, which can lead to poor (patient care)…” Questioning the system of regulating physician working hours “(Physician working hour restrictions) are due to be introduced, but I think they will only end up increasing ‘Sabisu Zangyo’. b ” Deterioration of physician well-being “I am concerned that some hospitals are likely to become ‘burakku kigyo’. c ” Physician shortage “Will it cause a shortage of physicians?” Deterioration in the quality of medical education “Young physicians would not be able to learn at home. They would have to learn in the field of medicine.” Unforeseen impact “There will be adverse effects somewhere along the line with (physician working hour restrictions)” Deterioration in the quality of physicians “(Physician working hour restrictions) could cause problems with quality of clinicians.”
Others	Unsure “I am not familiar with the actual situation (regarding physicians’ working environment).” Irrelevant to me “I don’t have any serious diseases, so for me the regulation of physicians’ working hours is not really relevant.” Generalization “Physicians are human beings too.” Increased number of physicians “The number of physicians should be increased.” Patient engagement “I feel that patient attitudes need to change for physicians to be healthier, so we should work together to change the way they work.” Need to improve medical education “The working environment for physicians needs to be improved, while at the same time the level of their technical skills needs to be raised.” Improved quality of patient care by other means “I would like to see the workload of physicians reduced through the establishment of a new associate medical qualification, AI practice, …” Efficient medical care “More efficient methods of medical treatment are required.” Physician overwork and mental health “(Physicians) tend to lose their minds because of the poor working conditions that are commonplace…” Strengthening the healthcare system “The functions of medical institutions should be clarified in conjunction with work-style reforms of physicians … and the management system should be strengthened.” Effectiveness varies by hospital “I guess (the effectiveness of the physicians’ working hour restrictions) depends on something like the nature of each hospital. Physicians and nurses at my hospital are kind.” Healthcare versus small business in society “I am uncomfortable with the fact that only the healthcare sector is highlighted in general, as any occupation has problems of their (working) environment, income, education, etc There are unimaginable occupations in small and medium-sized enterprises, but they are not highlighted.” Physician salaries “(Physicians) may be underpaid.” Patient-centered care “I believe that healthcare services should be tailored to the patient's needs.”

^akaroshi means death due to overwork.

^bsabisu zangyo means working overtime unpaid.

^cburakku kigyo means exploitative company.