Association between mental health and duty hours of postgraduate residents in Japan: a nationwide cross-sectional study

Abstract

The new duty hour (DH) limit for doctors in Japan will begin in 2024, setting the maximum DHs for postgraduate residents at approximately 80 h weekly. To set appropriate limits, understanding the association between DHs and psychological health is necessary. Thus, we assessed the relationship between residents’ psychological health and DHs. We conducted a cross-sectional study involving examinees of the General Medicine In-training Examination 2020. Mental health outcomes were measured dichotomously using the Patient Health Questionnaire-2 for depression and Mini-Z 2.0, for burnout, stress, and satisfaction. Weekly DHs were measured in seven categories at 10-h intervals. The prevalence ratios (PRs) between the DH categories were estimated for each outcome. Of the 6045 residents who provided data on DHs and psychological outcomes, 37.3% showed signs of depression, 21.6% experienced burn out, and 39.2% were highly stressed. In contrast, 62.3% were highly satisfied with their training. Proportions of burnout were higher among residents in Category 6 (≥ 90 and < 100 h; PR 1.36; 95% CI 1.11–1.66) and Category 7 (≥ 100 h; PR 1.36; 95% CI 1.10–1.68) compared with residents in Category 3 (≥ 60 and < 70 h; reference). The results partially support the weekly 80-h DH limit in terms of resident well-being.

Program Directors’ Perspectives on Duty Hours Following the Physicians’ Work Style Reforms in Japan

“…Despite previous studies suggesting optimal overtime duty hours as 80–100 per month (C5) for resident physicians, 3,4,5 our survey revealed that residency program directors now lean towards a much lower limit of 40 hours per month (C3), highlighting a significant evidence-practice gap. This conservative shift, likely influenced by the impending reforms and anticipation of stricter overtime enforcement, suggests a preemptive adjustment for compliance, and also raises concerns regarding the quality of clinical training.…”

“…2 Previous research indicates that 60-65 duty hours per week (80-100 overtime duty hours per month) may provide the optimal balance for residents' education, well-being, and patient safety. 3,4,5 This study assessed the impact of physician's work style reforms on clinical resident physicians' environments, in Japan by examining residency program directors' perceptions of optimal overtime duty hours toward training efficacy and trainee well-being.…”

Association between mentorship and mental health among junior residents: A nationwide cross‐sectional study in Japan

“…We collected covariates, through the self‐reported clinical training environment survey soon after GM‐ITE completion. We obtained individual resident variables: sex, PGY 1 or 2, number of emergency department duties per month, average number of inpatients under their care, 19 and duty hours worked per week 20 . Hospital variables such as hospital type, 21 location, 22 and number of beds 23 were collected from the Residency Electronic Information System website 24 and the Foundation for the Promotion of Medical Training website 25 .…”

The effects of resident work hours on well‐being, performance, and education: A review from a Japanese perspective

“…For instance, Ogawa et al 37 found that in a sample of 1241 firstyear residents in Japan, those working 80-100 h weekly, or more than 100 h weekly, had three and seven times higher risk of developing depressive symptoms, respectively, compared to those working 60 h. In a large cross-sectional study of 6000 residents in Japan published in 2022, working more than 90 h weekly was associated with a higher prevalence of burnout and depressive symptoms. 38 Studies conducted in Canada, France, and Taiwan have similarly reported that extended work hours (70-80 h or more weekly) for residents are linked to a greater incidence of burnout. [39][40][41] Two key points warrant attention regarding the impact of weekly work hours on mental health.…”

“…Although these early pre‐ and post‐intervention studies were limited in size, with fewer than 200 participants, subsequent large observational studies and studies conducted in other countries have validated these findings. For instance, Ogawa et al 37 found that in a sample of 1241 first‐year residents in Japan, those working 80–100 h weekly, or more than 100 h weekly, had three and seven times higher risk of developing depressive symptoms, respectively, compared to those working 60 h. In a large cross‐sectional study of 6000 residents in Japan published in 2022, working more than 90 h weekly was associated with a higher prevalence of burnout and depressive symptoms 38 . Studies conducted in Canada, France, and Taiwan have similarly reported that extended work hours (70–80 h or more weekly) for residents are linked to a greater incidence of burnout 39–41 …”