J.Jpn. Surg. Soc.. 127(4): 405-408, 2026

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Feature topic

THE ROLE OF EMERGENCY GENERAL SURGERY IN THE ERA OF WORK-STYLE REFORM: PERSPECTIVES FROM ACUTE CARE SURGERY AND DIVERSITY, EQUITY, AND INCLUSION

Recent work-style reforms and regulations on physicians’ working hours have necessitated a fundamental reorganization of emergency general surgery (EGS) systems to ensure sustainability of surgical care. In North America, acute care surgery (ACS) has been established as a surgical subspecialty encompassing trauma, EGS, surgical critical care, and surgical rescue. By adopting a shift-based, team-oriented model, ACS has enabled effective working-hour management while maintaining quality of care. Previous studies demonstrated that the introduction of ACS reduces on-call burdens for non-ACS surgeons and improves quality of life among surgeons. Notably, ACS has a higher proportion of female surgeons and greater representation of women in leadership roles compared with other surgical subspecialties, suggesting that this model facilitates career continuity across diverse life stages. In contrast, traditional EGS systems in Japan often rely on long working hours and individual commitment, which may hinder the participation and retention of diverse human resources. Incorporating the principles of ACS together with a diversity, equity, and inclusion (DEI) framework may provide a viable strategy to redesign EGS systems under work-style reform. Such an approach has the potential to promote equitable workforce participation, enhance surgeon well-being, and ensure the long-term sustainability of emergency surgical care.

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