J.Jpn. Surg. Soc.
ISSN 1880-1129

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J.Jpn. Surg. Soc.. 127(5): 516-522, 2026

Feature topic

WORKPLACE ENVIRONMENT IN PEDIATRIC SURGERY: CURRENT STATUS, CHALLENGES, AND FUTURE DIRECTIONS

1) President, Japanese Society of Pediatric Surgeons (JSPS)
2) Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan

Satoshi Ieiri1)2), Keisuke Yano2), Makoto Matsukubo2), Koji Yamada2)

In April 2024, Japan implemented a nationwide work-style reform for physicians, introducing legal limits on overtime work. While this initiative aims to reduce excessive workloads and improve physician well-being, its implementation remains particularly challenging in pediatric surgery. Pediatric surgeons are responsible for a wide range of conditions affecting patients from the neonatal period through adolescence, including congenital anomalies, acute abdominal emergencies, trauma, and other urgent surgical conditions. Consequently, emergency consultations and operations constitute a substantial proportion of daily clinical practice. In addition, pediatric surgical care in Japan faces several structural challenges, including a declining birth rate, regional maldistribution of pediatric surgeons, workforce shortages, and an aging surgical population. In many regional hospitals, a small number of pediatric surgeons are required to maintain continuous 24-hour, 365-day coverage, making compliance with regulations regarding work-hour limits and mandatory rest intervals difficult.
This article reviews the current working environment of pediatric surgeons in Japan and highlights the challenges associated with implementing physician work-style reform. The authors also describe institutional efforts to improve working conditions, including the introduction of team-based care, an on-call system, flexible work arrangements, and digital communication tools. Furthermore, future strategies are discussed, including regionalization of specialized pediatric surgical services, strengthening interinstitutional collaboration, task shifting, and the utilization of telemedicine. Sustainable pediatric surgical care will require a transition from reliance on individual dedication toward a healthcare system supported by appropriate workforce allocation, regional cooperation, and organizational reform.

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