(OPINION)Zenroren is opposed to bill to amend healthcare-related laws, which would lead to cutbacks on medical services and tolerate doctors’ log working hours

Obata Masako
President, National Confederation of Trade Unions (Zenroren)
March 24, 2021

On March 18, the Diet began discussing a bill to amend the Medical Care Act and related laws “to promote the securing of systems that will effectively provide quality and appropriate medical services.” Contrary to the title, the bill is problematic. Zenroren calls for it to be withdrawn.

1. The proposed amendment is ostensibly aimed at “establishing or improving measures to shorten the doctors’ long working hours and secure their health.” But we point out that the maximum working hours imposed on extra working hours or working hours on holidays for doctors, which is to be introduced in April 2024 (based on Article 141 of the Labor Standards Act), has a serious defect. Under the general rule (classified as level A), the maximum number of extra hours must be fewer 100 per month and 960 per year, which is already the level that can cause karoshi (death from overwork). But the maximum number of extra working hours is 100 per month and 1,860 per year for doctors for critical emergency care and those working for emergency care for patients to be treated as inpatients, home medical treatment, and medical institutions recognized as essential for advanced medical care (classified as level B), and for medical interns.

Data on doctors’ overtime work reveal that they endure the harsh working conditions -- 10 percent of them work 1,904 overtime hours per year. It’s not easy to add more doctors since it would take 10 years to train up new doctors. We cannot accept the plan that allows to double the maximum number of overtime hours without considering increasing the number of doctors to gradually decrease the maximum overtime hours. A Health, Labor and Welfare Ministry panel report on reforming the way doctors work says, “A doctor is a human before being a doctor. The present conditions of doctors, which raise concerns about the impact on their health and about possible karoshi, should be changed to create a society in which they can continue to work in good health and fulfill themselves” (March 2019). Where has this viewpoint gone? The question involved is not just about doctors. Forcing the exhausted doctors to work for people’s lives and health is also risky for patients.

Although the number of doctors is on the increase, the total number of doctors still falls short. So, the government should recognize the urgent need to increase the overall number of doctors. Particularly, there is a shortage of hospital doctors. The need is to set the goal of achieving the same level of working conditions in other sectors and to increase the pace of adding more doctors and make plans for shortening working hours for doctors in order to get them free from the excessively long working hours.

2. The proposed bill also includes reviewing the definition of the scope of healthcare-related jobs for amending the Radiology Technicians Act, the Law on Clinical Technologists, the Clinical Engineers Act, and the Paramedic Act. The bill is supposed to promote task shifting and sharing in order to reduce burdens for physicians.

But even in jobs other than medical doctors, workers are enduring heavy workloads and excessively long working hours and are calling for improvement in their workplace conditions. Shifting more burdens onto them is not the answer to the problems facing the workplace. The idea of asking such medical workers to assist doctors is raising concerns over the quality and the safety of medical treatment. It is not good to shift and share tasks easily at a time when all healthcare professionals are extremely busy.

3. The bill includes another problematic initiative: Government support to medical institutions’ efforts toward the realization of community-based healthcare plan. The plan is designed to reduce hospital beds by encouraging those hospitals which agree to restructure themselves into regional medical care support hospitals to create the Fund for Comprehensively Securing Regional Health and Long-term Care in return for preferential tax treatment. The assigning of doctors and nurses in accordance with the reduced number of hospital beds would remain intact.

In September 2019, the government put forward a plan to reduce the number of hospital beds at 424 municipal or public hospitals throughout the country, giving rise to strong protests from local governments and residents. The protests have been proven right by what has happened in the wake of the outbreak of the coronavirus. The importance of municipal and public hospitals has been reconfirmed as well as measures to curb the spread of infections. A national consensus has been built that expanding hospital beds with the need to respond to the pandemic instead of reducing them and increasing the numbers of doctors and nurses is a right policy. Given this situation, we must tolerate the government policy of continuing to reduce the hospital beds. We must question for whom the government exists.

As we need to realize a safe and secure healthcare system, and as we want to protect the health and living of all healthcare workers, we strongly demand that the present bill to amend the Medical Care Act be withdrawn and that the healthcare system be expanded and improved through increasing the numbers of doctors and nurses. We demand the government rewrite the bill to make clear the state responsibility and the direction of the relevant programs.

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