Workstyle Reform for Japanese Doctors Did Not Improve Surgical Productivity in the Long Term.

Introduction: This study aimed to determine the long-term effects of workstyle reform for doctors in Japan on surgical productivity changes using the Malmquist index (MI) model. We hypothesized that this reform would significantly increase surgical total factor productivity in the long term. Methods: We conducted a retrospective observational study at a university hospital covering the period from June 1 to September 30 during the years 2022 to 2025. A nonradial, nonoriented MI model with variable returns to scale was applied. The decision-making unit (DMU) was defined as the senior surgeon responsible for each procedure. Inputs included (1) the number of assisting surgeons and (2) operative duration from skin incision to closure. The output was defined as the surgical fee per procedure. Changes observed between 2022 and 2023 were categorized as "prereform," whereas those between 2024 and 2025 were categorized as "postreform." All inputs and outputs were aggregated for each DMU. The primary outcomes were productivity changes, and the secondary outcomes were efficiency and technical changes between the pre- and postreform periods. Results: A total of 5,415 surgical procedures performed by 62 surgeons were analyzed. There was no statistically significant difference in overall productivity change between the pre- and postreform periods. However, there was a significant increase in efficiency change and a significant decrease in technical change between the pre- and postreform periods. Conclusions: No evidence was found to suggest that the workstyle reform for doctors in Japan increased their surgical total factor productivity in the long term. The counterbalancing effects of efficiency and technical changes resulted in no change in overall productivity.