Time use, unpaid care work, and income: a nationwide cross-sectional web survey of gender gaps among hospital physicians in Japan

BACKGROUND: Time is the most limited resource in medicine. When unpaid care and domestic work are distributed unevenly by gender, this can alter how physicians work, train, and earn-an international pattern with implications for equity and workforce sustainability. Here, we investigated gender differences in income and daily time allocation for paid work, unpaid care work (housework and child care), and other essential activities. METHODS: We conducted a cross-sectional web survey of physicians registered with a large Japanese medical portal (m3.com) from January 9 to 31, 2024. Participants were full-time hospital physicians who met the inclusion criteria (n = 2,540; 2,224 men and 316 women). The exposure was physician gender (women vs. men). Outcomes were self-reported daily hours across seven time-use domains-unpaid care work on weekdays and on weekends/holidays (primary), paid work, academic and professional development, commuting, meals and personal care, leisure, and sleep-and personal annual income (≥ ¥15 million vs. < ¥15 million). We estimated adjusted gender differences in time use and the adjusted prevalence ratio for earning ≥ ¥15 million, controlling for key demographic and occupational factors. RESULTS: Response and participation rates could not be calculated because the survey vendor did not disclose the sampling denominator. After multivariable adjustment, women spent more hours on unpaid care work than men on both weekdays (1.51 h/day; 95% confidence interval [CI] 1.31 to 1.70) and weekends/holidays (2.35 h/day; 95% CI 1.98 to 2.72). Women also reported fewer hours in paid work, academic and professional development, and leisure. Women were less likely than men to earn ≥ ¥15 million annually (adjusted prevalence ratio 0.65; 95% CI 0.56 to 0.76). CONCLUSIONS: In this cross-sectional sample of full-time hospital physicians in Japan, substantial gender disparities in income and time use remained after adjustment for major demographic and occupational factors. Universal caregiver supports should be designed to encourage and facilitate men's participation, to avoid reinforcing gendered divisions of labor.