Factors on working conditions and prolonged fatigue among physicians in Japan

  • Koji Wada
  • Mayuri Arimatsu
  • Toru Yoshikawa
  • Susumu Oda
  • Hatsumi Taniguchi
  • Toshiaki Higashi
  • Yoshiharu Aizawa
Original Article



Fatigue among physicians could affect patients’ safety and physicians’ health. Fatigue could be caused by unfavorable working conditions. However, there have been no studies on the working conditions and fatigue among physicians in Japan. The objective of this study was to determine the factors on working conditions associated with prolonged fatigue among physicians in Japan.


A questionnaire was mailed to physicians who graduated from one of the medical schools in Japan and who have had more than 3 years of experience in clinical practice. They were asked to assess 10 different aspects of their working conditions using a 5-point Likert scale. Prolonged fatigue was measured using the checklist of individual strength questionnaire. Multiple regression analysis was used to examine the multivariate relationship between the variables and prolonged fatigue. Data from 377 men and 101 women were analyzed in this study.


For both male and female physicians, a harder workload was positively associated and better career satisfaction was negatively associated with prolonged fatigue. Prolonged fatigue was negatively associated with better relationships with other physicians and staff for male physicians and less personal time for female physicians. The adjusted variance in prolonged fatigue related to exposure variables was 26 and 29% in men and in women, respectively.


The result of this study suggested that it is desirable to take these factors into consideration in the management of prolonged fatigue among physicians in Japan.


Prolonged fatigue Physicians Workload Career satisfaction Relationship 



We gratefully acknowledge the respondents to this study. This study was partly funded with a grant from the Health Science Center, Sagamihara, Japan. The authors also thank Robert E Brandt for editing the manuscript.


  1. Aratake Y, Tanaka K, Wada K, Watanabe M, Katoh N, Sakata Y, Aizawa Y (2007) Development of Japanese version of checklist of individual strength in working population. J Occup Health 49:453–460PubMedCrossRefGoogle Scholar
  2. Bell DJ, Bringman J, Bush A, Phillips OP (2006) Job satisfaction among obstetrician-gynecologists: a comparison between private practice physicians and academic physicians. Am J Obstet Gynecol 195:1474–1478PubMedGoogle Scholar
  3. Beurskens AJ, Bultmann U, Kant I, Vercoulen JH, Bleijenberg G, Swaen GM (2000) Fatigue among working people: validity of a questionnaire measure. Occup Environ Med 57:353–357PubMedCrossRefGoogle Scholar
  4. Bovier PA, Perneger TV (2003) Predictors of work satisfaction among physicians. Eur J Public Health 13:299–305PubMedCrossRefGoogle Scholar
  5. Bultmann U, de Vries M, Beurskens AJ, Bleijenburg G, Vercoulen JH, Kant I (2000) Measurement of prolonged fatigue in the working population: determination of a cutoff point for the check list of individual strength. J Occup Health Psychol 5:411–416PubMedCrossRefGoogle Scholar
  6. Comeau M (2007) Professional satisfaction among Canadian physicians: a retrospective look at survey results. Available at: http://www.nationalphysiciansurvey.ca/nps/reports/PDF-e/Professional_Satisfaction_26-01-07.pdf. Accessed 21 April 2007
  7. Ehara A (2005a) Lawsuits associated with medical malpractice in Japan: rate of lawsuits was very low in pediatrics, although many children visit emergency rooms. Pediatrics 115:1792–1793PubMedCrossRefGoogle Scholar
  8. Ehara A (2005b) Only 2.5 pediatricians per pediatric department of Japanese hospital: Can each hospital continue to provide a pediatric emergency service? Available at: http://www.bmj.com/cgi/eletters/331/7518/648#117657. Accessed 12 May 2007
  9. Faragher EB, Cass M, Cooper CL (2005) The relationship between job satisfaction and health: a meta-analysis. Occup Environ Med 62:105–112PubMedCrossRefGoogle Scholar
  10. Fletcher KE, Underwood W, Davis SQ, Mangrulkar RS, McMahon LF, Saint S (2005) Effects of work hour reduction on residents’ lives: a systematic review. JAMA 294:1088–1100PubMedCrossRefGoogle Scholar
  11. Gaba DM, Howard SK (2002) Patient safety: fatigue among clinicians and the safety of patients. N Engl J Med 347:1249–1255PubMedCrossRefGoogle Scholar
  12. Hirashiki J (2006) Female physicians and international women’s association. Available at: http://medical.radionikkei.jp/igakushoten/final/pdf/060612.pdf. Accessed 12 May 2007
  13. Janssen N, Kant IJ, Swaen GM, Janssen PP, Schroer CA (2003) Fatigue as a predictor of sickness absence: results from the Maastricht cohort study on fatigue at work. Occup Environ Med 60(Suppl 1):i71–i76PubMedCrossRefGoogle Scholar
  14. Klazinga N, van Bolderen A (2003) Epimetheus’ responsibility: resident working hours and system redesign. Int J Qual Health Care 15:109–110PubMedCrossRefGoogle Scholar
  15. Komatsu H (2006) Collapsing health care services (Iryouhoukai) (in Japanese). Asahi News Press, TokyoGoogle Scholar
  16. Landon BE, Reschovsky J, Blumenthal D (2003) Changes in career satisfaction among primary care and specialist physicians, 1997–2001. JAMA 289:442–449PubMedCrossRefGoogle Scholar
  17. Landon BE, Reschovsky JD, Pham HH, Blumenthal D (2006) Leaving medicine the consequences of physician dissatisfaction. Med Care 44:234–242PubMedCrossRefGoogle Scholar
  18. Li J, Yang W, Cho SI (2006) Gender differences in job strain, effort-reward imbalance, and health functioning among Chinese physicians. Soc Sci Med 62:1066–1077PubMedCrossRefGoogle Scholar
  19. Linzer M, Konrad TR, Douglas J, McMurray JE, Pathman DE, Williams ES, Schwartz MD, Gerrity M, Scheckler W, Bigby JA, Rhodes E (2000) Managed care, time pressure, and physician job satisfaction: results from the physician worklife study. J Gen Intern Med 15:441–450PubMedCrossRefGoogle Scholar
  20. Mechanic D (2003) Physician discontent: challenges and opportunities. JAMA 290:941–946PubMedCrossRefGoogle Scholar
  21. McMurray JE, Williams E, Schwartz MD, Douglas J, Van Kirk J, Konrad TR, Gerrity M, Bigby JA, Linzer M, SGIM Career Satisfaction Study Group (1997) Physician job satisfaction: Developing a model using qualitative data. J Gen Intern Med 12:711–714CrossRefGoogle Scholar
  22. Ministry of Health, Labour, Welfare, Japan (2006a) Average salary by occupation in Japan. Available at: http://wwwdbtk.mhlw.go.jp/toukei/kouhyo/data-rou4/data18/03.xls. Accessed 12 April 2007
  23. Ministry of Health, Labour and Welfare, Japan (2006b) A report of a working committee on the number of medical doctors. Available at: http://www.mhlw.go.jp/shingi/2006/07/dl/s0728-9c.pdf. Accessed January 11 2007
  24. Nowak D (2006) Doctors on strike-the crisis in German health care delivery. N Engl J Med 355:1520–1522PubMedCrossRefGoogle Scholar
  25. Nylenna M, Gulbrandsen P, Forde R, Aasland OG (2005) Unhappy doctors? A longitudinal study of life and job satisfaction among Norwegian doctors 1994–2002. BMC Health Serv Res 5:44PubMedCrossRefGoogle Scholar
  26. Organization for Economical Co-operation and Development (2006) OECD Health data. Available at: http://www.oecd.org/document/30/0,2340,en_2649_34631_12968734_1_1_1_1,00.html. Accessed April 29 2007
  27. Owens JA, Veasey SC, Rosen RC (2001) Physician, heal thyself: sleep, fatigue, and medical education. Sleep 24:493–494PubMedGoogle Scholar
  28. Robinson GE (2004) STUDENTJAMA. Career satisfaction in female physicians. JAMA 291:635PubMedCrossRefGoogle Scholar
  29. Shugerman R, Linzer M, Nelson K, Douglas J, Williams R, Konrad R, Career Satisfaction Study Group (2001) Pediatric generalists and subspecialists: determinants of career satisfaction. Pediatrics 108:E40PubMedCrossRefGoogle Scholar
  30. Smith R (2001) Why are doctors so unhappy? There are probably many causes, some of them deep. BMJ 322:1073–1074PubMedCrossRefGoogle Scholar
  31. SPSS (2004) SPSS for Windows Version 13.0. SPSS Inc, ChicagoGoogle Scholar
  32. Stoddard JJ, Hargraves JL, Reed M, Vratil A (2001) Managed care, professional autonomy, and income: effects on physician career satisfaction. J Gen Intern Med 16:675–684PubMedCrossRefGoogle Scholar
  33. Swaen GM, Van Amelsvoort LG, Bultmann U, Kant IJ (2003) Fatigue as a risk factor for being injured in an occupational accident: results from the Maastricht Cohort Study. Occup Environ Med 60(Suppl 1):i88–i92PubMedCrossRefGoogle Scholar
  34. The Japan Society of Obstetrics and Gynecology (2005) A survey of the number of obstetricians and gynecologists at teaching hospitals. Available at: http://www.jsog.or.jp/kaiin/html/arikata_report_feb05.html. Accessed January 9 2007
  35. Tu YK, Clerehugh V, Gilthorpe MS (2004) Collinearity in linear regression is a serious problem in oral health research. Eur J Oral Sci 112:389–397PubMedCrossRefGoogle Scholar
  36. van der Ploeg E, Kleber RJ (2003) Acute and prolonged job stressors among ambulance personnel: predictors of health symptoms. Occup Environ Med 60(Suppl 1):i40–i46PubMedCrossRefGoogle Scholar
  37. Veasey S, Rosen R, Barzansky B, Rosen I, Owens J (2002) Sleep loss and fatigue in residency training: a reappraisal. JAMA 288:1116–1124PubMedCrossRefGoogle Scholar
  38. Vercoulen JH, Swanink CM, Fennis JF, Galama JM, van der Meer JW, Bleijenberg G (1994) Dimensional assessment of prolonged fatigue syndrome. J Psychosom Res 38:383–392PubMedCrossRefGoogle Scholar
  39. Wada K, Kudo Y, Nagai M, Yoshikawa T, Narai R, Oda S, Satoh T, Aizawa Y (2007) Identification of priority action areas of occupational health for health care workers at hospitals with inpatient wards in Japan: a Delphi study. Kitasato Med J 37:98–101Google Scholar
  40. Wada K, Sakata Y, Theriault G, Aratake Y, Shimizu M, Tsutsumi A, Tanaka K, Aizawa Y (2008) Effort-reward imbalance and social support are associated with prolonged fatigue among medical residents in Japan. Int J Arch Occup Environ Health 81:331–336CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Koji Wada
    • 1
  • Mayuri Arimatsu
    • 2
  • Toru Yoshikawa
    • 3
  • Susumu Oda
    • 4
  • Hatsumi Taniguchi
    • 5
  • Toshiaki Higashi
    • 2
  • Yoshiharu Aizawa
    • 1
  1. 1.Department of Preventive Medicine and Public HealthKitasato University School of MedicineSagamihara, KanagawaJapan
  2. 2.Department of Work Systems and Health, The Institute of Industrial Ecological SciencesUniversity of Occupational and Environmental HealthKitakyushuJapan
  3. 3.Institute for Science of LabourKawasakiJapan
  4. 4.Fukuoka Occupational Health Promotion CenterFukuokaJapan
  5. 5.Department of MicrobiologyUniversity of Occupational and Environmental HealthKitakyushuJapan

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