| Hospitalist A | Hospitalist B | Hospitalist C | |
|---|---|---|---|
| Gender/marital status | Male/married | Male/married | Male/not married |
| Nationality | Japanese | Japanese | Chinese |
| Interview duration | 34 min, 54 sec | 29 min, 57 sec | 27 min, 54 sec |
| Clinical training and specialty in Japan | Institution-specific program at a private clinical training hospital in prefectural capital (pre-MHLW PGCT); general internal medicine | Institution-specific program at a university hospital in the national capital (pre-MHLW PGCT); general medicine rotation, respiratory medicine | Completed the mandatory two -year MHLW PGCT at a metropolitan clinical training hospital in the national capital |
| Prior clinical experiences in the U.S. | IM residency & fellowship; ABIM-certified; 4 years’ experience | IM residency & fellowship; ABIM-certified; 6 years’ experience | IM residency (U.S.) |
| Current position and years of hospitalist experience | Full-time hospitalist (attending), 1.5 years | Full-time hospitalist (attending), 3 years | Full-time hospitalist, 4 months |
| Motivation and opportunity to move to the U.S. and become a hospitalist | •Sought better work-life balance and family compatibility •Moved to the U.S. to pursue a hospitalist career |
•Initially planned overseas research training •Chose U.S. clinical fellowship to continue clinical practice, leading to hospitalist work |
•Learned about the hospitalist career during residency •Selected the role based on peer and senior influence |
| 1. Systemic and structural differences between Japan and the United States |
| 1.1 Healthcare delivery and health insurance systems |
| 1.2 Role differentiation between generalists and specialists |
| 1.3 Employment structure and working conditions |
| 2. Need to change traditional work culture |
| 2.1 Incentives to work-life balance |
| 2.2 Task shifting to other healthcare professionals |
| 2.3 Overcoming cultural barriers and misconceptions |
| 3. Practical strategies for implementation in Japan |
| 3.1 Integration and reorganization of healthcare resources |
| 3.2 Pilot program in large hospitals |
| 3.3 Establishing structured handoffs and equitable workload |
| 3.4 Remote access and digital flexibility |
| 3.5 Delegation of authority and proxy orders |
| 4. Public acceptance and readiness |
| The storyline |
| The hospitalists, who had worked and practiced in both countries, recognized the challenges posed by the systemic and structural differences between Japan and the United States in physicians’ workstyle reform in Japan. These challenges were attributed to differences in healthcare delivery and health insurance systems, employment structure and working conditions, and role differentiation between generalists and specialists. They identified the need to change thetraditional work culture as a prerequisite for adapting the hospitalist model to Japan. Key changes essential for this transition included creating incentives for work-life balance, advancing task shifting to other healthcare workers, and overcoming cultural barriers and misconceptions. Practical strategies for implementation in Japan require the integration and reorganization of healthcare resources, starting from pilot programs in large hospitals. To achieve immediate progress, they suggested specific measures such as establishing structured handoffs and equitable workloads, enabling remote access and digital flexibility, and delegating authority and proxy orders. However, they believed that public acceptance and readiness were essential for adopting the new service. |
| Theory description |
| •Physicians who choose to become hospitalists in the United States tend to have an affinity for and orientation toward general internal medicine. |
| •Hospitalists, in their workstyle, do not receive incentives such as procedural fees, but they are satisfied with maintaining a good work-life balance and having shift schedules with clearly defined on and off times. |
| •Regarding salaries, they consider their compensation reasonable in relation to labor and hourly workload compared with other subspecialty physicians, mainly due to the favorable work-life balance. |
| •The introduction of the hospitalist system in Japan depends on public demand and requires demonstrating evidence of its necessity in Japan, along with promoting understanding among users receiving care. |
| •The advantages of Japan’s national health insurance system include good accessibility and relatively low costs; however, from the perspective of healthcare efficiency, it is necessary to strengthen the gatekeeping function of family physicians and reconsider the balance between generalists and specialists. |
| •Recruitment of hospitalists can begin with the consolidation of medical institutions and the establishment of hospitalist departments within large-scale hospitals. |
| •To introduce the system, it is necessary to delegate tasks to multiple professionals, including nurses; abolish traditional workstyle practices through cultural change, such as eliminating overtime and holiday work; and transition from an attending physician system to a team-based system. |
| •Although there may be legal restrictions, it is highly feasible―depending on operational innovation―to authorize remote access to medical records from outside the hospital and to permit order entry following delegation and subsequent approval by other professionals. |
