Gruelling work hours are discouraging people from entering the medical profession in a country where the population is rapidly aging, foreign doctors are barred and a swelling public debt caps doctors’ salaries.

The strains are even being felt here at the Hyogo Brain and Heart Center’s in the western city of Himeji, one of Japan’s best-known neurology and cardiology hospitals.

“We toil like workhorses,” said Teishi Kajiya, the hospital’s vice director and a cardiologist, taking some time for an interview before heading to the operation room.

“It’s become the norm for doctors to work 36 hours straight, which is emotionally and physically exhausting. We never know when one of us might collapse,” he said, looking weary despite his tidy coat.

“If this routine continues, doctors’ abilities during surgery will drop and could increase the likelihood of medical errors.”

At the root of the problem is the steady decline in the number of so-called “level-two” hospitals which treat common injuries that require immediate hospitalization, particularly in rural areas with falling populations.

The burden has shifted to “level-three” hospitals, which offer emergency services for patients with life-threatening injuries, such as that in Himeji.

“Since the number of level-two hospitals here fell by half in the past 10 years, our hospital is overwhelmed by patients,” Kajiya said.

“Now that we are forced to accept patients with lesser injuries, there’s a great risk that we’re unable to treat patients whose lives are truly in danger,” he added.

He said the hospital has turned down at least 100 patients in each of the past two years, adding that he was unaware of what happened to those who were rejected.

“The reality is that we’ve been forced to reduce emergency treatment to a portion of our patients since there are too few doctors. It simply can’t be helped,” Kajiya said.

The hospital, which has a total of 60 medical staff including doctors and resident students, is able to ensure only a bare minimum of three doctors on duty at all times for emergency patients, he said.

The situation is more dire for level-two hospitals. A recent poll by the Mainichi Shimbun showed that nearly 60 percent of such non-emergency hospitals had only one doctor on duty after hours.

By medical standards, at least three doctors are required to attend to a single emergency patient at any one time.

The human toll is already being seen across Japan.

In January, an injured motorcyclist died from his wounds after being forced to wait one hour before being hospitalized.

Osaka, Japan’s second city, last year reported 3,800 cases in which ambulances had to call multiple hospitals to ensure treatment.

In one case, an 89-year-old women stricken with vomiting and diarrhea died of a heart attack after her local fire department spent two hours contacting 30 medical facilities — all of which refused to accept her, citing insufficient beds, shortage of on-duty doctors or because she had not sought previous medical treatment.

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