Optimal Working Hours in the 2024 Physician Work Reform: Insights from a Residency Program Director

The recently instituted Japan 2024 physician workstyle reform imposed upper limits on monthly overtime hours. However, the interpretation of these limits by different training hospitals for postgraduate medical trainees (PGY1-2) and their supervisors remains unclear. This study aimed to quantify program directors' perceptions of the "optimal" monthly overtime hours for: (1) achieving educational milestones (Q1), (2) maintaining trainees' well-being (Q2), and (3) complying with trainees' limits through supervisors' workload (Q3), and to compare urban and rural hospitals. We conducted a cross-sectional, web-based survey of all accredited postgraduate training programs (N = 644) between March 1 and April 30, 2024. Program directors responded to three single-choice questions, selecting a monthly overtime band (none, 10, 20, …100 h/month). Hospitals were classified as urban or rural based on the Ministry of Health, Labor, and Welfare criteria. Linear trends across categories were tested using the Cochran-Armitage trend test. A total of 151 directors responded (response rate: 23%). Across Q1-Q3, 40 h/month was the most frequently selected time (21-23%). However, the proportion endorsing ≥ 60 h/month was significantly higher in urban than in rural hospitals (Q1: 43% vs 23%, p = 0.0347; Q2: 34% vs 23%, p = 0.0419; Q3: 40% vs 27%, p = 0.0405). Notably, urban programs were twice as likely to consider ≥ 80 h/month appropriate for both trainees' well-being (21% vs 6%, p = 0.0066) and supervisors (21% vs 7%, p = 0.0137). Although 40 h/month is the most frequent response by program directors, those from urban hospitals more commonly viewed extended hours acceptable, even exceeding the "A tier" limit of 45 h. Policy initiatives should tailor workload mitigation and task-shifting strategies to urban hospitals to safeguard the well-being of trainees and supervisors.