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Longitudinal changes in working conditions and quality of life before and after implementation of work style reform
Gentaro Kumagai1, Tatsuro Saruga1, Eiji Sasaki1
1Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Background:
In Japan, a nationwide physician work style reform was implemented in April 2024 to regulate overtime hours and improve physicians' working conditions. Orthopedic surgeons represent a high-risk group for occupational burnout due to physically demanding procedures and frequent emergency duties; however, longitudinal evidence on the reform's real-world impact in this population remains limited.
Methods:
This longitudinal observational study included 79 full-time orthopedic surgeons affiliated with a university-affiliated hospital network who completed paired surveys in 2023 (pre-reform) and 2024 (post-reform). Outcomes included monthly overtime hours, health-related quality of life assessed by the EuroQol 5-Dimension (EQ-5D-5L) and 36-Item Short Form Health Survey (SF-36), and psychological well-being assessed by the Hospital Anxiety and Depression Scale (HADS). Statistical comparisons were performed using the Wilcoxon signed-rank test and McNemar test for paired categorical variables.
Results:
Monthly overtime hours showed a non-significant reduction from 49.2 ± 23.6 to 46.0 ± 22.1 h (P = 0.191), and the proportion working ≥80 overtime hours per month decreased from 10.1% to 7.6% (P = 0.774, McNemar test). HADS anxiety and depression scores did not change significantly. In contrast, EQ-5D scores improved significantly from 0.86 ± 0.10 to 0.89 ± 0.10 (P = 0.009). Among SF-36 subscales, role physical demonstrated a trend toward improvement (P = 0.054).
Conclusions:
The physician work style reform period was associated with a modest but statistically significant improvement in health-related QOL among orthopedic surgeons; however, given the absence of a control group, causal attribution to the reform itself cannot be established. It is noteworthy that the median EQ-5D score was unchanged, and the mean improvement was primarily driven by a reduction in low-scoring outliers, suggesting that the benefit was concentrated among physicians with the greatest baseline impairment. These findings suggest that regulation of working hours alone is insufficient to substantially improve physician well-being, and that broader organizational interventions are warranted.