Skip to main content
Log in

Factors on working conditions and prolonged fatigue among physicians in Japan

  • Original Article
  • Published:
International Archives of Occupational and Environmental Health Aims and scope Submit manuscript



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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others


  • 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 49:453–460

    Article  PubMed  Google Scholar 

  • 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 195:1474–1478

    PubMed  Google Scholar 

  • 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 57:353–357

    Article  PubMed  CAS  Google Scholar 

  • Bovier PA, Perneger TV (2003) Predictors of work satisfaction among physicians. Eur J Public Health 13:299–305

    Article  PubMed  Google Scholar 

  • 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 5:411–416

    Article  PubMed  CAS  Google Scholar 

  • Comeau M (2007) Professional satisfaction among Canadian physicians: a retrospective look at survey results. Available at: Accessed 21 April 2007

  • 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 115:1792–1793

    Article  PubMed  Google Scholar 

  • 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: Accessed 12 May 2007

  • Faragher EB, Cass M, Cooper CL (2005) The relationship between job satisfaction and health: a meta-analysis. Occup Environ Med 62:105–112

    Article  PubMed  CAS  Google Scholar 

  • 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 294:1088–1100

    Article  PubMed  CAS  Google Scholar 

  • Gaba DM, Howard SK (2002) Patient safety: fatigue among clinicians and the safety of patients. N Engl J Med 347:1249–1255

    Article  PubMed  Google Scholar 

  • Hirashiki J (2006) Female physicians and international women’s association. Available at: Accessed 12 May 2007

  • 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–i76

    Article  PubMed  Google Scholar 

  • Klazinga N, van Bolderen A (2003) Epimetheus’ responsibility: resident working hours and system redesign. Int J Qual Health Care 15:109–110

    Article  PubMed  Google Scholar 

  • Komatsu H (2006) Collapsing health care services (Iryouhoukai) (in Japanese). Asahi News Press, Tokyo

    Google Scholar 

  • Landon BE, Reschovsky J, Blumenthal D (2003) Changes in career satisfaction among primary care and specialist physicians, 1997–2001. JAMA 289:442–449

    Article  PubMed  Google Scholar 

  • Landon BE, Reschovsky JD, Pham HH, Blumenthal D (2006) Leaving medicine the consequences of physician dissatisfaction. Med Care 44:234–242

    Article  PubMed  Google Scholar 

  • Li J, Yang W, Cho SI (2006) Gender differences in job strain, effort-reward imbalance, and health functioning among Chinese physicians. Soc Sci Med 62:1066–1077

    Article  PubMed  Google Scholar 

  • 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 15:441–450

    Article  PubMed  CAS  Google Scholar 

  • Mechanic D (2003) Physician discontent: challenges and opportunities. JAMA 290:941–946

    Article  PubMed  Google Scholar 

  • 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 12:711–714

    Article  Google Scholar 

  • Ministry of Health, Labour, Welfare, Japan (2006a) Average salary by occupation in Japan. Available at: Accessed 12 April 2007

  • Ministry of Health, Labour and Welfare, Japan (2006b) A report of a working committee on the number of medical doctors. Available at: Accessed January 11 2007

  • Nowak D (2006) Doctors on strike-the crisis in German health care delivery. N Engl J Med 355:1520–1522

    Article  PubMed  CAS  Google Scholar 

  • 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 5:44

    Article  PubMed  Google Scholar 

  • Organization for Economical Co-operation and Development (2006) OECD Health data. Available at:,2340,en_2649_34631_12968734_1_1_1_1,00.html. Accessed April 29 2007

  • Owens JA, Veasey SC, Rosen RC (2001) Physician, heal thyself: sleep, fatigue, and medical education. Sleep 24:493–494

    PubMed  CAS  Google Scholar 

  • Robinson GE (2004) STUDENTJAMA. Career satisfaction in female physicians. JAMA 291:635

    Article  PubMed  CAS  Google Scholar 

  • 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:E40

    Article  PubMed  CAS  Google Scholar 

  • Smith R (2001) Why are doctors so unhappy? There are probably many causes, some of them deep. BMJ 322:1073–1074

    Article  PubMed  CAS  Google Scholar 

  • SPSS (2004) SPSS for Windows Version 13.0. SPSS Inc, Chicago

    Google Scholar 

  • Stoddard JJ, Hargraves JL, Reed M, Vratil A (2001) Managed care, professional autonomy, and income: effects on physician career satisfaction. J Gen Intern Med 16:675–684

    Article  PubMed  CAS  Google Scholar 

  • 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–i92

    Article  PubMed  Google Scholar 

  • The Japan Society of Obstetrics and Gynecology (2005) A survey of the number of obstetricians and gynecologists at teaching hospitals. Available at: Accessed January 9 2007

  • Tu YK, Clerehugh V, Gilthorpe MS (2004) Collinearity in linear regression is a serious problem in oral health research. Eur J Oral Sci 112:389–397

    Article  PubMed  Google Scholar 

  • 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–i46

    Article  PubMed  Google Scholar 

  • Veasey S, Rosen R, Barzansky B, Rosen I, Owens J (2002) Sleep loss and fatigue in residency training: a reappraisal. JAMA 288:1116–1124

    Article  PubMed  Google Scholar 

  • Vercoulen JH, Swanink CM, Fennis JF, Galama JM, van der Meer JW, Bleijenberg G (1994) Dimensional assessment of prolonged fatigue syndrome. J Psychosom Res 38:383–392

    Article  PubMed  CAS  Google Scholar 

  • 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 37:98–101

    Google Scholar 

  • 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 81:331–336

    Article  Google Scholar 

Download references


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.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Koji Wada.

Additional information

Koji Wada has no commercial interest related to this article.



Personal time

  1. 1.

    Work often encroaches on my personal time.

  2. 2.

    Even on holidays, it is necessary to take calls from the hospital.

  3. 3.

    It is necessary to go to the hospital in case patients whom you are responsible for have any trouble even on off-duty nights.

Relationship with patients

  1. 4.

    I feel a good personal connection with my patients.

  2. 5.

    The gratitude displayed by my patients keeps me working.

Patient care issues

  1. 6.

    I worry about being sued because of medical malpractice.

  2. 7.

    My relationship with patients is more adversarial than it used to be.

  3. 8.

    I am overwhelmed by the needs of my patients.

  4. 9.

    Time pressures keep me from developing good patient relationships.

Relationships with other physicians

  1. 10.

    My physician colleagues are a good source of professional stimulation.

  2. 11.

    I get along with my physician colleagues.

  3. 12.

    My physician colleagues value my unique perspectives in practice.

  4. 13.

    My physician colleagues are an important source of personal support.

Relationships with staff

  1. 14.

    I feel a good personal connection with my nonphysician colleagues.

  2. 15.

    My nonphysician colleagues in my practice are a major source of personal support.

  3. 16.

    Nonphysician colleagues in my practice support my professional judgment.

  4. 17.

    Nonphysicians in my practice reliably carry out clinical instructions.


  1. 18.

    My total salary is fair.

  2. 19.

    I am well compensated compared to physicians in other specialties taking our workloads into account.

Administrative work

  1. 20.

    My role in managing the business aspects of my practice is a burden to me.

  2. 21.

    Paperwork is a burden to me.


  1. 22.

    Medical suppliers are available when I need them.

  2. 23.

    I have sufficient examination room space to see my patients.

  3. 24.

    There are enough support staff in my practice.

Career satisfaction

  1. 25.

    All things considered, I am satisfied with my career as a physician.

  2. 26.

    I would recommend medicine to others as a career.


  1. 27.

    Workload is always too much for me.

  2. 28.

    Time pressure is strong.

  3. 29.

    My work is often interrupted by other tasks.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wada, K., Arimatsu, M., Yoshikawa, T. et al. Factors on working conditions and prolonged fatigue among physicians in Japan. Int Arch Occup Environ Health 82, 59–66 (2008).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: