Short-Term Effects of Workstyle Reform for Japanese Doctors on Their Surgical Productivity

The purpose of this study was to evaluate whether the workstyle reform, aimed at improving physician health and safety, achieved a secondary goal of enhancing surgical productivity by applying the Malmquist Index (MI) model. We hypothesized that the reform would lead to a significant improvement in surgical total factor productivity in the short term.

We conducted a retrospective observational study at a university hospital, analyzing 1,557 surgical procedures performed by 72 surgeons from April 1 through May 31 in 2023 and 2024. A non-radial, non-oriented MI model was applied under variable returns-to-scale assumptions. Each decision-making unit (DMU) was defined as the most senior-ranking surgeon for a given procedure. Inputs included (1) the number of assisting physicians and (2) the duration of surgery from skin incision to closure. The output was defined as the surgical fee assigned to each procedure. Surgical procedures in 2023 were defined as before workstyle reform, and those in 2024 were after workstyle reform. Inputs and outputs were aggregated for each DMU per year. The primary outcome was the Malmquist Index, with secondary outcomes being the catch-up (CU) and frontier-shift (FS) effects.

There was no statistically significant change in overall surgical productivity between 2023 and 2024 (p = 0.39). Neither the catch-up effect nor the frontier-shift effect showed a significant deviation from zero.

The workstyle reform in 2024 in Japan did not lead to a measurable change in fee-based surgical productivity in its first two months at the tertiary hospital. Neither frontier-shift nor catch-up effect was significant.