Perceived Progress of Physician Work Style Reform Among Resident Physicians in Japan: A Nationwide Multilevel Cross-Sectional Survey

Background: Japan implemented nationwide physician work style reform, including regulations on overtime work.Resident physicians are among the groups most affected by long working hours; however, little is known about their perceptions of the progress of these reforms.This study examined resident physicians' perceptions of physician work style reform and identified individual-and hospital-level factors associated with perceived insufficient progress.Methods: A nationwide cross-sectional questionnaire survey was conducted among resident physicians at 955 core specialty training hospitals accredited by the Japanese Medical Specialty Board.Responses were obtained from 200 hospitals, yielding 1,038 questionnaires (hospital response rate: 20.9%).The primary outcome was perceived insufficient progress of physician work style reform, defined as responses of "not progressing very much" or "not progressing at all."All 1,038 respondents from 200 hospitals were included in the multilevel analysis using hospital-specific random intercepts.Results: Overall, 70.6% of respondents perceived physician work style reform to be progressing, whereas 25.9% perceived insufficient progress and 3.5% selected "neither."Perceived insufficient reform progress was independently associated with postgraduate year 5 (odds ratio (OR), 2.63; 95% confidence interval (CI), 1.67-4.13),postgraduate year ≥ 6 (OR, 2.40; 95% CI, 1.40-4.10),working 60-79 hours per week (OR, 2.47; 95% CI, 1.03-5.90),working 80-99 hours per week (OR, 3.79; 95% CI, 1.39-10.33),and increasing night-duty frequency (1-4 duties/month: OR, 1.83; 95% CI, 1.11-3.02;5-8 duties/month: OR, 2.19; 95% CI, 1.22-3.94;≥9 duties/month: OR, 4.65; 95% CI, 1.58-13.67).No significant associations were observed between perceived reform progress and hospital ownership, hospital size, or regional classification.Conclusions: Resident physicians' perceptions of physician work style reform were associated primarily with working conditions rather than measured hospital characteristics.Even after accounting for clustering within hospitals, longer working hours and more frequent night duties remained independently associated with perceived insufficient implementation of physician work style reform.