The Doctor Shortage in Local Hospitals: Is It Really a “People” Problem?
Local hospitals are plagued by chronic doctor shortages. This issue isn’t simply a quantitative problem of “not enough doctors.” Rather, it’s fundamentally a qualitative challenge: doctors who are hired don’t stay, leaving after a short period.
A seminar hosted by Japan Management, as reported by Jiji Medical, showcased how one local hospital successfully attracted and retained doctors. The key wasn’t the conventional approach of “hiring top talent,” but rather a shift in perspective to “designing an environment where doctors can continue to work.”
This case study offers valuable insights for small and medium business owners. Many companies struggling with labor shortages focus on hiring strategies—”how to find good people”—while simultaneously grappling with the retention problem of those hires leaving.
This article analyzes this local hospital’s case through the lens of “returnable management.” We’ll explore how designing reversibility into hiring and retention allows for bold experimentation without the fear of failure.
From “Hiring People” to “Designing Environments”
Many companies tackle labor shortages by trying to “hire top talent.” However, this approach carries significant risk. If the hired person doesn’t perform as expected or quits quickly, the investment is wasted. Furthermore, the immense time and cost spent on recruitment create psychological pressure to “keep this person at all costs,” leading to organizational rigidity.
This is a classic “irreversible decision.” Once you’ve decided to hire someone, the organization is forced to adapt to them before you can accurately assess their abilities or fit. You fall into a low-reversibility structure where the organization bends to the individual.
In contrast, the local hospital featured in this case took a different approach. They prioritized designing an “environment where doctors can continue to work” first, and then hired doctors who fit that environment. Specifically, they implemented the following measures:
- Flexible working hours: Mandatory post-night-shift leave and introduction of part-time work.
- Task delegation: Transferring tasks that don’t require a doctor to nurses and administrative staff.
- Clear career paths: Support for obtaining specialist certifications and ensuring research time.
All these measures are based on the idea of “creating an environment where it’s easy for doctors to leave if they want to.” This may sound contradictory, but it’s the core of “returnable management.”
The Paradox: “Ease of Leaving” Creates “Difficulty of Leaving”
Creating an “easy-to-leave environment” might seem like it would encourage turnover. However, it has the opposite effect. The peace of mind that comes from knowing you can leave anytime reduces psychological burden, fostering a feeling of “let’s try a little harder.”
Most doctors leave local hospitals not because of salary or benefits, but due to harsh working conditions and career stagnation. Heavy on-call duties, no time off, and no opportunities to advance their specialization. No matter how talented, doctors won’t last in such an environment.
This hospital reframed the reason for doctors leaving not as a “people problem” but as a “work design problem.” They broke down work processes, clearly identifying tasks only doctors can do and those that can be handled by other roles. This allowed doctors to focus on their core professional duties, creating a sense of fulfillment and breathing room.
The biggest advantage of this approach is its high reversibility. If the strategy of “delegating doctor tasks to other roles” fails, it’s easy to revert to the original state. Conversely, a strategy like “poaching a top doctor with a high salary” creates a huge loss if that doctor leaves, leading to an irreversible situation.
Three Design Principles for “Returnable Hiring”
From this local hospital’s case, here are three design principles for “returnable hiring” that SME owners can apply to their own talent strategies.
1. Design the “Reasons for Leaving” Before Hiring
Before starting recruitment, anticipate the reasons someone in that position might leave. List potential causes—salary, hours, career, relationships—and prepare “returnable solutions” for each. For example, if “long working hours” is a likely reason, have part-time or flextime options ready from the start. This isn’t about fixing problems after they arise, but embedding “returnable mechanisms” beforehand.
2. Implement a “Trial Hiring” Period
Instead of hiring directly as a permanent employee, establish a 3-to-6-month “trial hiring” period. Frame this as an “experiment” for both sides to assess fit. During this period, limit the scope of work and set clear evaluation criteria. At the end of the trial, both parties can agree to move to permanent employment or end the contract. This transforms a major hiring decision into a “reversible experiment.”
3. Design Work That Doesn’t Depend on Individuals
Minimize tasks that only a specific person can do. Standardize work so anyone can achieve the same results. This not only prevents over-reliance on individuals but also enables new hires to become productive quickly. It also maintains a “returnable state” where work doesn’t stop if someone leaves.
“Returnable Management” Transforms Local Hospitals
What’s unique about this case is its approach to the difficult problem of doctor shortages: not the conventional “attract top talent” mindset, but a “design the environment” mindset. This is a true practice of “returnable management.”
The key isn’t making the right decision; it’s creating a state where you can recover from a decision. In hiring doctors, approaching it with the flexibility to start over, rather than the pressure of an irreversible choice, ultimately builds a sustainable organization.
Business owners struggling with labor shortages should consider adopting this “returnable hiring” perspective. An organization designed with failure in mind can, in fact, become the strongest one.
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