title: Report from the Committee for Improving the Work Environment of Japanese Surgeons: survey on effects of the fee revision for medical services provided by surgeons.
abstract: OBJECTIVE
  The aim of this study was to achieve improvements in the work environment of Japanese surgeons and shortage of surgeons.
  
  
  METHODS
  Questionnaires were distributed to selected Japanese surgical Society (JSS) members. Retrospective analysis was conducted comparing the current 2011 survey with previous 2007 survey. To examine the influence of 2010 revision of the fee for medical services performed by surgeons, we distributed a second questionnaire to directors of hospitals and administrators of clerks belonging to official institutes in JSS. Collective data were analyzed retrospectively.
  
  
  RESULTS
  The main potential causes for the shortage of surgeons in Japan were long hours (72.8 %), excessive emergency surgeries (69.4 %), and high risk of lawsuit (67.7 %). Mean weekly working hours of surgeons in national or public university hospitals and private university hospitals were 96.2 and 85.6, respectively. Approximately 70 % of surgeons were forced to do hardworking tasks, possibly leading to death from overwork. Of note, approximately 25 % of surgeons had over time of more than 100 h a week, coinciding to the number of hours that might lead to death from fatigue, described in the Japanese labor law. Although the total medical service fee in hospitals, especially in large-scale hospitals with more than 500 beds, increased markedly after 2010 revision of the fee for medical services performed by surgeons, few hospitals gave perquisites and/or incentives to surgeons.
  
  
  CONCLUSIONS
  To prevent and avoid collapse of the surgical specialty in Japan, an improvement in the work environment of surgeons by initiation of the JSS would be required as soon as possible.
authors.affiliation: Department of Surgery, Kochi Medical School, Kochi University, Kohasu, Okocho, Nankoku, Kochi, 783-8505, Japan, hanazaki@kochi-u.ac.jp.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hanazaki
authors.forename: Ryuji
authors.initials: R
authors.lastname: Tominaga
authors.forename: Masaki
authors.initials: M
authors.lastname: Nio
authors.forename: Tadashi
authors.initials: T
authors.lastname: Iwanaka
authors.forename: Kae
authors.initials: K
authors.lastname: Okoshi
authors.forename: Koichi
authors.initials: K
authors.lastname: Kaneko
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nagano
authors.forename: Takahiro
authors.initials: T
authors.lastname: Nishida
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nishida
authors.forename: Ken
authors.initials: K
authors.lastname: Hoshino
authors.forename: Tadaaki
authors.initials: T
authors.lastname: Maehara
authors.forename: Munetaka
authors.initials: M
authors.lastname: Masuda
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Matsufuji
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yanaga
authors.forename: Koichi
authors.initials: K
authors.lastname: Tabayashi
authors.forename: Susumu
authors.initials: S
authors.lastname: Satomi
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
mesh_terms: D018588:Fee-for-Service Plans / Q000639:trends*; D013502:General Surgery; D006801:Humans; D007564:Japan; D016272:Occupational Health; D010816:Physician Incentive Plans / Q000639:trends*; D010820:Physicians / Q000523:psychology* / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014940:Work Schedule Tolerance / Q000523:psychology; D000078329:Workforce