BackgroundIn Japan, a shortage of physicians, who serve a key role in healthcare provision, has been pointed out as a major medical issue. The healthcare workforce policy planner should consider future dynamic changes in physician numbers. The purpose of this study was to propose a physician supply forecasting methodology by applying system dynamics modeling to estimate future absolute and relative numbers of physicians.MethodWe constructed a forecasting model using a system dynamics approach. Forecasting the number of physician was performed for all clinical physician and OB/GYN specialists. Moreover, we conducted evaluation of sufficiency for the number of physicians and sensitivity analysis.Result & conclusionAs a result, it was forecast that the number of physicians would increase during 2008–2030 and the shortage would resolve at 2026 for all clinical physicians. However, the shortage would not resolve for the period covered. This suggests a need for measures for reconsidering the allocation system of new entry physicians to resolve maldistribution between medical departments, in addition, for increasing the overall number of clinical physicians.

Placental/umbilical cord blood (CB) contains nucleated cells and hematopoietic stem/ progenitor cells (CD34 + cells). However it is difficult to predict the number of nucleated/ CD34 + cells in each CB before cell processing. Despite many previous studies from institutes affiliated with CB banks in metropolitan areas, little information is available regarding the characteristics of CB units from other medical facilities. The purpose of the present study was to analyze the maternal/neonatal factors on the yield of cells in CB units. A total of 176 CB units were obtained from single-birth and normal vaginal deliveries. Mononuclear low-density (LD) cells were separated using Ficoll-Paque within 24 hrs after CB collection and then processed for the purification of CD34 + cells. A multiple linear regression analysis was performed to assess the correlations between the yield of cells and maternal/neonatal factors including maternal age, gravid status, duration of labor, gestational age, neonatal height and weight, cord length, and meconium in the amniotic fluid. The total LD cells per CB unit had a weak positive correlation with the maternal age of primigravidae. The total LD cells per CB unit from the primigravidae aged 25 were significantly higher than those from the primigravidae aged 24. The total CD34 + cells per CB unit from the 1-gravidae were significantly higher than those from the 2-gravidae and 3-gravidae, respectively among all donors. These results indicate that the CB units from the primigravidae aged 25 are more likely to contain higher yield of LD/CD34 + cells. cord blood; mononuclear cells; CD34 + cells; maternal/neonatal factors.Tohoku

BackgroundIn Japan, the shortage of physicians has been recognized as a major medical issue. In our previous study, we reported that the absolute shortage will be resolved in the long term, but maldistribution among specialties will persist. To address regional shortage, several Japanese medical schools increased existing quota and established “regional quotas.” This study aims to assist policy makers in designing effective policies; we built a model for forecasting physician numbers by region to evaluate future physician supply–demand balances.MethodsFor our case study, we selected Hokkaido Prefecture in Japan, a region displaying disparities in healthcare services availability between urban and rural areas. We combined a system dynamics (SD) model with geographic information system (GIS) technology to analyze the dynamic change in spatial distribution of indicators. For Hokkaido overall and for each secondary medical service area (SMSA) within the prefecture, we analyzed the total number of practicing physicians. For evaluating absolute shortage and maldistribution, we calculated sufficiency levels and Gini coefficient. Our study covered the period 2010–2030 in 5-year increments.ResultsAccording to our forecast, physician shortage in Hokkaido Prefecture will largely be resolved by 2020. Based on current policies, we forecast that four SMSAs in Hokkaido will continue to experience physician shortages past that date, but only one SMSA would still be understaffed in 2030.ConclusionThe results show the possibility that diminishing imbalances between SMSAs would not necessarily mean that regional maldistribution would be eliminated, as seen from the sufficiency levels of the various SMSAs. Urgent steps should be taken to place doctors in areas where our forecasting model predicts that physician shortages could occur in the future.

This article describes the ongoing structure of radiation oncology in Japan in terms of equipment, personnel, patient load and geographic distribution to identify and overcome any existing limitations. From May 2016 to August 2018, the Japanese Society for Radiation Oncology conducted a questionnaire based on the Japanese national structure survey of radiation oncology in 2015. Data were analyzed based on the institutional stratification by the annual number of new patients treated with radiotherapy per institution. The estimated annual numbers of new and total (new plus repeat) patients treated with radiation were 225 000 and 271 000, respectively. Additionally, the estimated cancer incidence was 891 445 cases with approximately 25.2% of all newly diagnosed patients being treated with radiation. The types and numbers of treatment devices actually used included linear accelerator (linac; n = 936), Gamma Knife (n = 43), 60Co remote afterloading system (RALS; n = 21), and 192Ir RALS (n = 129). The linac system used dual-energy functions in 754 units, 3D conformal radiotherapy functions in 867, and intensity-modulated radiotherapy (IMRT) functions in 628. There were 899 Japan Radiological Society/Japanese Society for Radiation Oncology-certified radiation oncologists (RO), 1213.9 full-time equivalent (FTE) ROs, 2394.2 FTE radiotherapy technologists (RTT), 295.7 FTE medical physicists, 210.2 FTE radiotherapy quality managers, and 906.1 FTE nurses. The frequency of IMRT use significantly increased during this time. In conclusion, the Japanese structure of radiation oncology has clearly improved in terms of equipment and utility although there was a shortage of personnel in 2015.

Geographical inequalities in radiotherapy health resources tended to be larger in the Tokyo district than in the Hokkaido-Tohoku district. It is expected that the radiotherapy system will be substantially improved by the Basic Plan to Promote Cancer Control Programs.