J.Jpn. Surg. Soc.. 126(6): 529-534, 2025

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Feature topic

INSPIRING NEXT GENERATIONS TO CHOOSE UPPER GASTROINTESTINAL SURGERY

In Japan, the number of gastrointestinal surgeons has been declining despite increasing demand driven by the aging population and the complexity of surgical care. Analyses from the National Clinical Database have shown that centralization of high-risk procedures, particularly esophagectomy, in high-volume, accredited centers significantly improves short-term outcomes. However, this trend has also led to a concentration of expertise in university hospitals and major urban centers, making it difficult to maintain local surgical services. Based on the author’s clinical experiences in Sweden and Norway, where strict working hour regulations, shift-based scheduling, and team-based practice are well established, this report describes specific reforms implemented in our department. These measures include standardizing intraoperative handovers to reduce fatigue, exempting surgeons from duties after overnight shifts, and introducing flexible scheduling of outpatient clinics and external duties. Additionally, we have strengthened support for research activities and promoted diverse career development to sustain motivation among young surgeons. Moving forward, balancing the centralization of advanced surgical care with work-style reforms will be essential to building a culture where future surgeons feel confident that they have chosen a fulfilling, sustainable career path.

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