Changing work styles among Japanese healthcare professionals

Recently, the increased prevalence of burnout and depression among physicians has become a serious issue worldwide and multiple measures have been proposed as solutions.1 However, “karoshi” has already become a cliche for tragic fatalities described among Japanese overworking people. Indeed, traditionally in Japan, most people work for long hours in a typical weekday and healthcare professionals are no exceptions.

Although there are differences in work hours between various clinical practices such as acute or chronic care hospitals or facilities, Japanese physicians and nurses tend to overwork and have increased prevalence of burnout.2 Further, since Japan introduced home‐based care as a core healthcare system in recent years, there is also an inevitable issue of work hours among home‐based healthcare professionals.

Another important issue is a higher prevalence of stress and burnout among home care helpers and family members. As these people have a fundamental role in supporting medical and home care, resolving this issue should be given higher priority. If only work hours among physicians and nurses are reduced, what we are doing is analogous to building a new house on unstable ground.

An expert committee of the Japanese Ministry of Health, Welfare and Labour presented their report to Mr Yasuhisa Shiozaki, the Japanese health minister in May 2017.3 The members of the committee were mostly healthcare professionals, and thus, the report reflects a proposal based on the vision of healthcare providers. It recommends the improvement in long work hours, work shifts, and work sharing.

It would seem mandatory to adopt the recommendations of the report, but there are also other issues to consider when handling the issue of work hours among healthcare professionals in Japan. Based on the statistics published by the OECD (Organization for Economic Co‐operation and Development) in 2015, the total amount of healthcare expenditures as a percentage of GDP (Gross Domestic Product) in Japan, which was estimated including chronic and home care costs in a way similar to the method of other countries, puts Japan ranked among the top three countries in the OECD.4

Thus, currently we cannot simply say that Japanese healthcare expenditures are lower than other high‐income countries. If work hours are to be reduced among individual healthcare professionals, there would be a need for greater expenditure pursuant to employing increased numbers of professionals.

Another consideration is the responsibility of physicians to care for their patients. This is also stipulated in the Japanese law for physicians. The altruism of Japanese physicians has long been the most precious resource in healthcare throughout Japan. Changing work styles might lead to reduced altruism with potentially harmful effects to patient care as its unintended consequence.

The report also recommends increasing the importance of the role of primary care in Japan. Sophisticated primary care physicians have skills to provide care for most patients and only send their patients to hospitals where this is indicated as appropriate clinically. Unfortunately, this specialty, primary care physicians, has not been promoted in the system hitherto. However, Japan now needs a paradigm shift to consolidate primary care to stabilize its healthcare foundations.

CONFLICT OF INTEREST

The authors have stated explicitly that there are no conflicts of interest in connection with this article.