Nationwide trend analysis of burnout among resident physicians in Japan before and after the national workstyle reform: a repeated cross-sectional survey of 25 368 participants.

OBJECTIVES

This study examined temporal changes in burnout and working environments among Japanese resident physicians across the COVID-19 period and the preparation and implementation phases of the national workstyle reform. Furthermore, it assesses associated changes in their working environments.

DESIGN

This study was conducted as a multicentre repeated cross-sectional study.

SETTING

Data were used from the General Medicine In-Training Examination surveys conducted in 2020, 2022, 2023 and 2024.

PARTICIPANTS

Participants included postgraduate year 1 (PGY-1) and PGY-2 residents across Japan.

PRIMARY AND SECONDARY OUTCOME MEASURES: Data on working hours, emergency duties, inpatient load, self-study time and burnout were collected through standardised questionnaires. Multivariable logistic regression was performed to assess associations between workstyle reform phases and burnout, adjusting for demographic and institutional characteristics.

RESULTS

Altogether, 25 368 residents participated (6816 in 2020; 6063 in 2022; 6584 in 2023; 5905 in 2024). Burnout prevalence was the highest during the COVID-19 pandemic in 2020 (21.7%), which decreased to 13.3% in 2024. Weekly working hours of ≥80 hours declined from 19.9% to 2.3%, and those working <45 hours increased from 2.5% to 24.7%. Compared with the pre-reform period (2020-2022), odds of burnout were significantly lower during the preparation (2023; adjusted OR (aOR) 0.60, 95% CI 0.55 to 0.66) and implementation (2024; aOR: 0.67, 95% CI 0.61 to 0.74) phases.

CONCLUSIONS

Residents' burnout was the highest in 2020 and subsequently declined in parallel with improvements in job satisfaction, working hours and clinical workload. These findings suggest that system-level efforts to improve workload balance may be associated with better resident well-being, while causal attribution to the reform should be interpreted cautiously.