Factors contributing to physician overwork in 80 Saiseikai hospitals of Japan

Abstract Background Physician overwork and burnout is a prevalent problem worldwide that is hazardous to both the physician’s health and healthcare quality and safety in hospitals. The aim of this study was to estimate how much time physicians spend on various work activities and to what extent these activities contribute to the total number of working hours, so as to find an effective way to reduce the number of overtime hours. Methods Surveys were conducted on fulltime physicians of 80 Saiseikai hospitals. For those activities showing a significant positive association with the number of total working hours, the hospital-based time for one patient-day, which is the daily number of hours spent by all physicians in the hospital for one patient, was analyzed in association with the number of patient-days per physician in the hospital. The time spent by a physician for each work activity was also analyzed in association with the number of patient-days per physician, after controlling for sex, age, department and position as covariates. Results Analysis of 1,837 physicians showed that most work activities had a significant positive association with the total number of working hours. In general, the time spent on direct and indirect inpatient services were greater than other work activities. The hospital-based time for one patient-day showed a significant inverse association with the number of patient-days per physician in all work activities, except that of working in surgical operation room. On the other hand, individual physicians tended to spend a similar amount of time regardless of the number of patient-days per physician in the hospital. In hospitals with a relative shortage of physicians, physicians tended to spend less time on each patient, whereas in hospitals with a relative surplus of physicians, physicians tended to spend more time, presumably more than necessary, on patient services. Conclusion Improvement in efficiency, such as by reducing the time interval between patient services, seems promising in hospitals with a relative surplus of physicians. Time could also be saved by implementing newer methods of information technology or by shifting a part of tasks to other health professionals and clericals.