Overtime restrictions and physician mental health

Author(s):

Austin Littrell

Key Takeaways

The study links both short and long sleep durations to slower PVT responses, increased burnout, and depression in physicians.
PVT performance is suggested as a potential objective indicator of psychological health, though further research is needed.
Japan's 2024 duty hour reform limits physician overtime to 960 hours annually, with exceptions for rural physicians and trainees.
Researchers advocate for uniform overtime caps across all physicians to improve mental health and safety.

A study of Japanese physicians assessed the link between sleep duration, objective alertness and psychological health.

Researchers from Juntendo University Graduate School of Medicine in Japan, and the University of Pennsylvania Perelman School of Psychiatry in the U.S., conducted a study to assess the relationship between sleep duration, objective alertness and psychological health in 1,226 Japanese physicians. The study utilized standardized surveys to assess sleep duration in addition to symptoms of burnout and depression. A brief Psychomotor Vigilance Test (PVT-B) was used to assess the physician’s alertness, and results suggest that PVT performance could be a useful indicator for psychological wellbeing moving forward.

Their findings, published in the Journal of Sleep Research, showed that daily sleep duration was inversely related to weekly work hours. Slower responses on the PVT demonstrated significant association with both exceptionally short ( <6 hours) and long ( ≥8 hours) sleep durations. According to the study, a physician working 10 additional work hours per week resulted in a 0.40-point increase in burnout severity and a 1.7% increased chance of reporting a traffic accident.

Attentional lapses and generally poor objective alertness on the PVT were associated with increased rates of depression and intense feelings of burnout, suggesting that PVT performance could be a useful indicator of psychological health, although further research is required.

“We believe that the PVT is a key tool to objectively assess alertness levels of essential workers, since self-reported alertness is inaccurate at identifying those with sleep debt, as shown in one of our previous studies,” Hiroo Wada, M.D., Ph.D., a professor from Juntendo University Graduate School of Medicine, and co-author of the study, said in university release. “To establish an objective means of assessing alertness and its associations with mental and physical health of physicians who work for extended durations, we collaborated with the University of Pennsylvania, where the PVT was originally developed.”

In 2024, a duty hour reform went into effect in Japan, limiting overtime at 960 hours annually for Japanese physicians, with exceptions for physicians serving rural areas and medical trainees, who had their overtime capped at 1,860 hours annually. Roughly 40% of Japanese physicians had previously reported logging over 960 hours per year, with 10% of them reporting more than 1,860 hours.

“The stricter 960-hour annual overtime cap will likely benefit Japanese physician sleep and mental health,” Mathias Basner, M.D., Ph.D., M.S.C., a professor in the Department of Psychiatry at the University of Pennsylvania Perelman School of Medicine, developer of the PVT-B and co-author of the study, said. “Future studies will need to show whether the suggested cap will be able to relevantly reduce overtime and improve sleep, alertness and mental health in physicians, or whether an even stricter cap is necessary.”

The study emphasizes the importance of significant sleep in order to maintain alertness for Japanese physicians, supporting the hard cap of overtime hours to support mental wellbeing. That said, rural physicians and medical trainees are capped at nearly twice as many hours, which not all members of the research team agree is correct.

“Almost doubling the overtime cap for physicians and for medical trainees who serve rural areas may make sense from an administrative perspective, but it makes little sense from a public health and safety perspective. The same cap should apply to all physicians regardless of the sector they work in or their career progression,” expressed Takeshi Tanigawa, M.D., Ph.D., a professor from Juntendo University Graduate School of Medicine, and co-author of the study.