The Transition to Independence: A Longitudinal Qualitative Study on Drivers of Burnout in Japanese Early-Career Physicians.

Background/Objective: The transition from postgraduate residency to independent practice is a critical period prone to burnout. This longitudinal qualitative study explores the underlying drivers of burnout and its protective factors among early-career physicians in Japan during this transitional phase. Methods: At an urban Japanese hospital, seven residents completed semi-structured interviews at the end of their protected two-year basic postgraduate clinical training (2020) and again after transitioning to specialty training (2022); one further resident provided only partial information. Twelve senior physicians responsible for resident education and support center staff were interviewed for triangulation. Data were analyzed using grounded theory techniques with NVivo 14. Results: No participant described experiences consistent with burnout during basic postgraduate clinical training, as residents perceived their environment as highly protected, often reporting a lack of primary responsibility and a passive "guest-like" behavior rooted in the Japanese cultural desire to remain "good students." However, follow-up interviews revealed that the abrupt transition to independent practice exposed them to heavy responsibilities and complex patient management; burnout-like episodes after the transition were described by some participants. Overcoming manageable challenges with adequate support was described as contributing to professional growth. Peer communication and continuous mentoring were vital mitigating factors. Conclusion: Burnout-like experiences among early-career physicians appear to be driven mainly by the abrupt shift in clinical responsibility during the transition to independent practice rather than the absolute workload during initial training. Medical education programs should consider structured "graduated autonomy" and continuous mentoring to support this vulnerable transition.