The Future of Hospital Medicine in Japan: Lessons From the United States Hospital Medicine System

Tomoharu Suzuki,1,* Kohta Katayama,2,* Nathan Houchens,3,4 Sarah Hartley,3,4 Yasuharu Tokuda,5,6 Takashi Watari7,8 1Department of Hospital Medicine, Urasoe General Hospital, Urasoe, Okinawa, Japan; 2Department of General Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan; 3Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA; 4Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA; 5Muribushi Okinawa Center for Teaching Hospitals, Urasoe, Okinawa, Japan; 6Tokyo Foundation for Policy Research, Tokyo, Japan; 7Kyoto University Hospital, Integrated Clinical Education Center, Kyoto, Japan; 8General Medicine Center, Shimane University Hospital, Shimane, Japan*These authors contributed equally to this workCorrespondence: Takashi Watari, Shimane University Hospital, General Medicine Center, 89-1 Enya, Izumo city, Shimane prefecture, Shimane, Japan, Email [email protected]: To compare hospitalist roles and training systems between the United States (US) and Japan, identifying strengths and challenges to guide development of Japan’s emerging hospital medicine program.Methods: A qualitative, descriptive narrative study was conducted during a 10-day observational site visit to the Veterans Affairs Ann Arbor Healthcare System and University of Michigan Hospital in October 2022. Two experienced Japanese hospitalist authors independently observed clinical rounds, interprofessional meetings, and educational sessions. Data were collected through direct observation and structured discussions focusing on care-team structures, workflows, multidisciplinary collaboration, educational approaches, and quality improvement activities. The authors subsequently developed a comparative analysis report of Japan-US differences. Guided discussions based on this report were conducted with experienced US hospitalists and a pioneer physician of General Medicine in Japan to obtain expert commentary on the analyses. No quantitative data analysis or specific analytical software was utilized for this narrative comparison.Results: The US hospitalist model demonstrated group practice approaches with shift-based schedules supporting work-life balance. Multidisciplinary teams actively incorporated residents and students in patient care, quality improvement, and teaching. Japan’s traditional attending physician model emphasized continuity of care but showed high workloads and limited multidisciplinary integration. Japanese hospitalists faced challenges including extensive work hours, fewer specialized training opportunities in quality improvement and patient safety, and less robust team-based learning environments.Conclusion: Incorporating elements from the US model—such as group practice with shift-based systems, enhanced multidisciplinary collaboration, and structured educational and quality improvement initiatives—could address workload issues and foster professional development in Japan’s hospital medicine system while preserving valued aspects of continuity of care. These findings provide specific actionable guidance for healthcare administrators, medical education directors, and policymakers involved in developing Japan’s hospitalist system, as well as to practicing Japanese hospitalists seeking to enhance their professional practice environments and educational frameworks.Keywords: health systems comparison, quality improvement, medical education, multidisciplinary care