Current state and future direction of task shifting in obstetric and gynecological care: A survey of obstetrician-gynecologists across Japan

Abstract

To conduct a survey about task shifting in obstetric and gynecological care. A multivariate logistic regression analysis was conducted in Japanese hospitals using obstetrician-gynecologists (OB/GYNs) who answered that task shifting was rarely used at their working environment as the outcome variable and using their personal attributes (sex, age, type of medical institution employed at, and regional characteristics) as predictor variables. Opinions were gathered regarding promoting task shifting impact on individual work duties. Responses were collected from 919OB/GYNs (49.9% women, 50.8% <40years). Characteristics' analysis of 34.6% of OB/GYNs who thought that task shifting was hardly used indicated that it was used significantly more at private university hospitals (odds ratio 5.33, 95% confidence interval: 2.33-12.18) than at national university hospitals (odds ratio 3.54, 95% confidence interval: 1.67- 7.51). "Transfer of patients (from operating rooms to the ward)" and "securing the contrast agent line" were the only items related to the task shifting status for individual work duties that were identified by most respondents, revealing that task shifting is not progressing. More than half and 9% of the OB/GYNs said that task shifting progression would improve and decline medical care quality, respectively. Overall, 46% and 24% of the respondents thought that task shifting could reduce working hours by ">1 hour, but <2hours"/day and "<1hour"/day, respectively. The current study confirmed that OB/GYNs working at university hospitals believe that task shifting is not progressing in university hospitals and that the working environment is poor. Even if task shifting reduces the number of working hours per day by 2hours, the working hours of these physicians still exceed the criteria for death by overwork. Thus, further working hour reduction measures are needed in addition to task shifting, such as consolidation of medical institutions dealing with deliveries. To promote task shifting in obstetrical and gynecological care in Japan, it is necessary to continue promoting policy-based, institutional, and educational guidance.