An increasing number of suicides due to overwork among medical practitioners in Japan brings the brutal reality of their unhealthy working conditions to the fore.

On January 24, 2016, Aya Kimoto, a 37-year-old physician, was reported missing. She was eventually found lying dead on the pile of snow near her house. During the police investigation, it was found that the doctor had been clocking in more than 200 hours of overtime per month since the last four months. Suffering from depression and burnout, she decided to take her own life on that fateful day.

The statistics on physician suicide are frightening: Physicians are more likely to kill themselves than the common people. Kimoto was one of those many medical professionals who reportedly worked themselves to death in Japan every year. Infact, in Japan, karōshi (death from overwork) and karō jisatsu (suicide due to overwork) are becoming disturbingly common.

Doctors are calling themselves “slave doctors”. The punishingly-long working hours, shortage of physicians, particularly in the countryside and damaging work environment are driving medical professionals to their death. So widespread is the issue, that in Japan, if a death is judged karōshi, the victim’s family receives compensation from the government of around $20,000 per year and company payouts of up to $1.6 million.

But to make the victim’s death count as karōshi, the deceased must have worked for more than 100 hours of overtime in the month before their death, or 80 hours of overtime in two or more consecutive months in the previous six.

Table of Contents

About time

According to a report published by the Ministry of Health, Labour and Welfare (MHLW), Japanese physicians worked for approximately 66.4 hours per week in 2005. The ministry records from 2012 as well paints a grim picture, revealing that about 41.8 percent of hospital doctors worked for more than 60 hours per week; the highest among all workers. So, what’s the way out? In 2017, the Japanese government has proposed capping overtime at 80 hours per month. But is that enough to address the issue of doctors killing themselves?

In Japan, studies show that the prevailing overwork culture has been the primary cause for cardiac events as well as clinical depression, which ultimately leads physicians to end their lives. For doctors specialising in obstetrics and gynaecology, the situation is even more challenging because they are expected to work round the clock.

Besides, data collected from workers’ compensation certifications in 2016 showed that 80 hours or more of overtime per month clearly increases the number of cases of cerebrovascular/cardiovascular diseases, especially stroke which may eventually cause death. However, studies also show that about 39 percent of employees with mental disorders worked for less than 80 hours of overtime per month. Even so, they experienced burnout syndrome, profoundly impairing their effectiveness at work and quality of self-care. In the case of doctors, it adversely impacted patient care too, to some extent.

Ground realities

The Medical Practitioners’ Law in Japan sets a legal obligation for doctors to provide medical treatment to their patients. Besides, for Japanese doctors, their work is seishoku which means a ‘sacred profession’. Therefore, they are expected to save lives, even at the cost of personal wellbeing.

Moreover, Japanese patients have the privilege to see their doctors anytime anywhere owing to the National Medical Insurance system. This prompts Japanese doctors and medical students to work for extremely long hours – often likened to Kamikaze pilots, making deliberate suicidal crashes.

A Cross-Sectional Survey of Workload and Burnout among Japanese physicians working in stroke care, found that burnout is highly prevalent in physicians. About 41 percent of physicians in stroke care in Japan, for instance, experience burnout and work-related stress.

Global studies reveal that burnout is more common in physicians than in the general population. It can negatively impact a physician’s wellbeing and professional career, and lead to increased rates of substance use, depression and suicidality.

Burnout develops physical and emotional exhaustion besides reducing a sense of personal accomplishment among physician and doctors. Physicians, particularly in “frontline” specialties, including family medicine, internal medicine, emergency and neurology, are at the highest risk of burnout.

In clinical practice, karōshi, depression and burnout are overwork-related disorders commonly experienced by medical students and doctors. Specialised care that includes mental wellbeing is necessary in each case. Though some hospitals are reviewing their work systems to reduce doctors’ working hours, it is time Japan Medical Association (JMA) takes up the issue of long and unhealthy working hours among doctors. Death by overwork has to stop.