Photo/IllutrationNoriko Nakahara, center, whose husband, a pediatrician, killed himself due to overwork, and others explain their requests about doctors' work-style reforms at a news conference in March. (Asahi Shimbun file photo)

The Health, Labor and Welfare Ministry has drafted a plan to introduce regulatory limits on overtime hours for doctors working at medical institutions that will take effect in fiscal 2024.

For general hospital doctors, the ministry has proposed a cap of 100 hours of overtime a month and 960 hours per year, to keep the numbers below the so-called “karoshi line,” or the threshold for determining death from overwork, or karoshi, under the workers' compensation program.

As exceptions, however, doctors will be allowed to put in up to 1,860 hours of overtime per year if necessary to maintain community health care or in cases where intensive work is required for interns and doctors training to become specialists, among others, to acquire skills.

Some members of the ministry’s panel that has crafted the plan criticized the proposal to provide this exception, which would allow doctors to work nearly twice as many overtime hours as the karoshi line. The critics argued it was “a figure that defies common sense.”

But the panel responded to calls for flexibility from some members of the medical community who claimed that imposing a blanket limit on doctors’ overtime could leave some patients in rural areas without access to health care.

What should not be forgotten here is that the core problem that needs to be tackled is the state of health care in rural communities that are dependent on excessive overwork by hospital doctors.

The principal challenge is to find solutions to structural problems, including shortages of doctors in these areas.

The government should make all-out efforts to ensure that community health care can be maintained without such exceptions concerning doctors’ overtime.

Initially, the ministry said the limit on overtime for interns and doctors training to be specialists would be steadily lowered while that for doctors devoted to community health care would be scrapped by the end of fiscal 2035.

But the ministry went back on its commitment to the fiscal 2035 deadline in the final stage of drafting the plan by changing the phrase to “consider abolishing the exception in fiscal 2035 as a goal.”

The goal of terminating this exception at the end of fiscal 2035 is based on the assumption that the ministry will take measures in line with its initiatives to reform the local health care system and cure the problem of acute shortages of doctors in rural areas.

Using such a vague phrase to describe the goal is tantamount to admitting that it will be difficult to carry through the necessary reforms.

The exception will remain in place unless medical institutions are consolidated for greater efficiency while shortages of doctors in specific areas and hospital departments are alleviated. That would be unacceptable.

At many medical institutions, the actual work hours of doctors have not been properly managed. As a result, there is no sufficient data for debate on this issue.

The ministry says it will embark on taking steps to help medical institutions make their operations more efficient and improve the working conditions for doctors while grasping the realities of how they actually work, including their work hours.

The ministry should capitalize on the effects of these measures to reduce the overtime hours to be allowed for exceptional cases.

To protect the health of doctors in such exceptional cases, the medical institutions should be required to keep doctors from working for more than 28 hours in a row, with at least nine hours of rest required between their shifts. When they work more than 100 hours of overtime per month, the medical institutions should be required to ensure that industrial physicians and other experts interview them to offer guidance.

One major question is how to objectively assess the level of fatigue of doctors working long overtime hours. Another is how to secure replacements when certain doctors are ordered by other medical experts to take a rest. It is necessary to establish effective systems to deal with these problems.

The ministry has the responsibility to take stronger policy actions if necessary to protect the health of people working at medical institutions.

--The Asahi Shimbun, April 5