J.Jpn. Surg. Soc.. 127(5): 502-509, 2026

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Feature topic

STRATEGIES FOR IMPROVING THE WORK ENVIRONMENT IN HEPATO-BILIARY-PANCREATIC SURGERY: TOYAMA-STYLE WORK REFORM

In recent years, the number of young physicians aspiring to specialize in hepato-biliary-pancreatic (HBP) surgery has declined, largely due to its high level of technical complexity and demanding work environment. Establishing a sustainable workforce has therefore become an urgent issue. This article reviews the current challenges in HBP surgery, including long working hours associated with complex procedures, a traditional apprenticeship-based culture, workplace harassment, and insufficient support for diverse working styles. To address these issues, several strategies are proposed, such as implementing shift-based systems and team-based care to distribute workload, promoting task shifting and providing early surgical exposure and operative opportunities for young surgeons.
In addition, the importance of structured, society-led career development support is emphasized. Flexible working arrangements that accommodate life events such as childbirth, childcare, and caregiving are also essential. Balancing a supportive work environment with high-level surgical expertise is expected to enhance both recruitment of young surgeons and the overall quality of HBP surgical care.

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