His mother Junko, 61, found his lifeless body and a farewell note that read: “I’m all to be blamed. I’m so sorry to give you such pain... I’m at my limit and I have no choice.”
His suicide, which was judged by manpower authorities as karoshi (death by overwork), has become both a cautionary tale and a rallying call for change. Not only had he faced an uncompromising superior and worked 100 days straight without a single day off, but he was also found to have clocked 178, 169 and 207 overtime hours in the prior three months. To give some perspective: these figures are on top of the regular 40-hour work week – eight hours a day, five days a week works out to 160 hours a month.
The unrelenting work pressures, in particular the punishing overtime hours, that pushed Dr Takashima over the brink are a troubling feature of the Japanese healthcare system. A 2022 Japan Doctors’ Union survey found that one out of two respondents were concerned about the impact on their own health – an irony as their role is to restore the health of others; three in 10 doctors admitted to having entertained thoughts of death and suicide.
Doctors are joined by construction workers and truck drivers in clocking the longest working hours in Japan where, unsurprisingly, there has been a spate of tragedies across the three professions. The exceptionally smooth running of services for which Japan is renowned – and not just in these three sectors – is facing a reckoning as a result of rising demand and concurrent labour shortages. The practice of crushing overtime hours has kept the system going, but even that is hitting the buffers, and one is looming next month.
Overtime limits will kick in for the medical, construction and logistics industries from April, with errant employers facing fines of up to 300,000 yen (S$2,700) or jail of up to six months.
These are part of workplace reforms passed in 2018 following a spate of high-profile karoshi deaths.
The limits had first gone into effect in 2019 for large companies, and then in 2020 for small and medium-sized enterprises. The latest phase involving those in the medicine, construction and logistics sectors is happening only now, given their expected outsized impact on society.
The overtime cap is well-meaning, but questions remain on its effects. At heart, Japan has to ask itself: What price is it prepared to pay for its widely admired first-rate services?
Taken for granted
That the situation has come to be framed as a “2024 problem” speaks volumes of a country that has taken efficiency for granted: cheap round-the-clock medical care, same-day or next-day deliveries, and a breakneck pace of construction exemplified by how, in one remarkable case, a gaping sinkhole measuring 30m by 27m by 15m was filled in 48 hours.
Such supposed efficiencies have been built on back-breaking, unlimited overtime.
In medicine, there have long been far too few doctors to go around, and far too much bureaucracy. Japan’s 339,623 doctors mean there are 269 physicians per 100,000 people, which is lower than the OECD (Organisation for Economic Cooperation and Development) average of 350 doctors per 100,000 people.
In construction, given tight and rigid project timelines, Japan’s 4.79 million construction workers often clock overtime.
The entire logistics industry, meanwhile, is built on 870,000 truckers who ply long distances over long hours. Road transport accounts for 90 per cent of freight in Japan.
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While the overtime caps come April look good on paper, the government has written into law a series of exceptions that reduce the impact of the changes.
For instance, under the new rules, construction workers can work up to 45 monthly overtime hours, capped at 360 annual overtime hours. However, the limit may be raised or scrapped under “exceptional circumstances”, such as natural disasters.
One such exceptional case may be the 2025 Osaka World Expo, whose organisers have sought to be excluded from the law as it is drastically behind schedule despite the opening date of April 13, 2025.
For truck drivers and doctors, the ceiling will be capped at 960 annual overtime hours or an average of 80 monthly overtime hours. But an allowance for more hours is being made for physicians in rural areas, which are already under-served in terms of services.
Will the caps help the people for which it is intended? Some say while it will go some way towards reducing overtime work, it is cutting things fine. The 80-hour monthly limit – setting aside exceptions – is no different from the so-called “karoshi line” – the point which Japan has designated as the threshold for death by overwork.
Hardly a panacea
But there is more to the overtime culture. One reason is Japan’s stagnant wages.
A low base pay for truck drivers and construction workers incentivises them to work more overtime to earn more money. Said Moody’s Analytics senior economist Stefan Angrick: “Overwork creates problems for individuals and society at large, including issues related to health. It also reduces the incentive for companies to invest in technology and automation.”
Many workers have said that if companies fail to raise wages accordingly to make up for the reduction in overtime pay, they will seek side hustles to make up for their lost income – which will defeat the very purpose of the law.
A 28-year-old truck driver told public broadcaster NHK in Fukuoka en route to Ishikawa Prefecture – 900km and at least a 10-hour drive away – that his take-home pay was up to 400,000 yen (S$3,600) a month. “I want to earn more, but my working hours will become shorter,” he said. “I might use my extra rest time to get another job.”
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In construction, civil engineering lecturer Kazuyoshi Tateyama of Ritsumeikan University sees the need to change a mindset that has turned work systems into victims of their own success. “Design was systemised, standards were established, and manuals were completed. And this allowed Japan to build high-quality infrastructure in a short period of time,” he said. “But this success formula also makes it difficult to transition.”
In medicine, the Labour Ministry has highlighted activities that are time-consuming but are not regarded as overtime. These “voluntary self-improvement” practices include the practice of surgical procedures as well as preparation and participation in academic conferences that are necessary for resident doctors who hope to become specialists – like the late Dr Takashima.
Dr Kenji Shibuya of The Tokyo Foundation for Policy Research think-tank noted sardonically – and rightly – that the very future of Japan’s medical profession hinges on such critical activities that are diminished as “voluntary self-improvement”.
Yet even discounting such “voluntary” actions, a Health Ministry survey has shown that one in 10 doctors already works more than 1,860 overtime hours a year, while four in 10 put in more than 960 hours.
Finding solutions
Solving the “2024 problem” would, first and foremost, require consumers to manage expectations.
This means, notwithstanding the e-commerce boom, being prepared to pay a premium for urgent deliveries – or wait for their turn in line. They should also avoid late-night hospital visits for non-emergency cases that have come to be described as “konbini diagnoses”, so-named after convenience stores that provide round-the-clock services.
Meanwhile, given the crippling labour shortage, one fix would be to hire more women and foreign workers, especially in construction and logistics. While it has traditionally been difficult to attract women, the labour shortage means a fundamental rethink of gender stereotypes is required.
In construction, women already account for three in 10 workers. While the percentage is paltry in logistics – 2.5 per cent, or about 20,000 truckers are women – Transport Ministry data shows that 134,000 women have a heavy vehicle licence. There is already at least one logistics company with all-female drivers: the Fukui City-based Heartful, which operates 22 vehicles.
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Japan already allows foreign workers in construction under its blue-collar skilled worker visa, which it is looking to expand to cover the road transportation sector.
The medical profession faces other hurdles. Foreigners would require a higher level of language proficiency. As for women, who account for 17.4 per cent of doctors, sexism continues to be rife. Top medical schools have recently been found to have systematically rigged entrance exams to make it harder for women to qualify, given the historically high female attrition rate.
Yet another urgent step would be to drastically increase wages to make blue-collar jobs more appealing and ensure workers do not end up worse off than before.
A third critical element is innovation. In logistics, an NX Research Institute study has found that if nothing is done, capacity will decline by 400 million tonnes – or 14.2 per cent – in 2024 and 940 million tonnes – or 34.1 per cent – by 2030 from 2019 levels.
This would effectively upend life as Japanese residents know it, impacting everything from the delivery of fresh produce to markets and the stocking of shelves at convenience stores, to the supply of parts to factories and same- or next-day deliveries to homes.
Japan is looking at expanding freight delivery through ships and trains – including the shinkansen bullet train – as well as drones and robots.
To ensure truck drivers get to their destinations faster, the government is even mooting raising the highway speed limit for large trucks to 100kmh from 80kmh.
Rivals are even joining hands to reduce duplication of effort and improve efficiency, with home appliance makers Sony and Hitachi, as well as paper manufacturers Daio and Hokuetsu, working together on customer delivery.
Logistics facilities are also automating the loading and unloading process. Daiwa House Industry and NTT Communications have developed an unmanned logistics system to smooth operations and reduce hiccups that is said to reduce man-hours by 30 per cent.
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Elsewhere, drones, surveillance sensors, and remote-controlled equipment like excavators are being rolled out in construction, with the government looking into banning contracts with unrealistic timelines.
Hospitals are looking at “task-sharing” measures such as allowing doctors to delegate tasks such as the administration of intravenous fluids to trained nurses, and paperwork to medical clerks.
But Dr Shibuya, along with Dr Takashima’s bereaved family, is urging the Labour Ministry to implement stronger guidelines against excessive overtime in medicine, including a relook at what constitutes “voluntary self-improvement” given that unrested doctors are prone to diagnostic errors and other mistakes.
Criminal and civil lawsuits are pending against the 460-bed Konan Medical Centre, which has refused to acknowledge culpability by arguing that Dr Takashima had put in 30.5 hours of overtime – rather than 207 hours – in the month before his death.
“Doctors are neither Superman nor robots,” Mrs Takashima said, adding: “Would it be OK if a pilot flies a plane on 200 hours of overtime a month?”
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