Board certification and urban–rural migration of physicians in Japan

Abstract

BackgroundThe board certification system serves as a quality assurance system for physicians, and its design and operation are important health policy issues. In Japan, board certification was established and operated independently by academic societies and has not been directly linked to reimbursement systems. The phenomenon of younger physicians seeking specialist careers has raised concerns about acceleration of the tendency of fewer physicians working in rural areas and the maldistribution of physicians. Little is known about the associations between physicians’ geographical migration patterns and board certification status changes or between the continuation of urban/rural practice and the maintenance of board certification. This study aimed to identify these associations and to discuss their policy implications.MethodsWe analyzed 2012 and 2014 data from the Survey of Physicians, Dentists, and Pharmacists, a national census survey. To analyze geographical migration patterns, transitions in practice location (rural, intermediate, and urban) were analyzed by board certification status change (new, lost, consistently certified, and consistently uncertified). Logistic regression analysis was conducted to assess whether the odds of migrating to more urban/rural municipalities were associated with board certification status changes, adjusting for covariates, and whether practicing in a rural area was associated with maintaining board certification.ResultsAmong 18,726 newly board-certified physicians, 94.9% (13,435/14,150) of those working in urban areas before certification remained in urban areas, whereas 64.6% (393/608) of those working in rural areas stayed in rural areas. Those who were newly certified had higher odds of moving to more urban areas, adjusting for covariates. Those who stayed in rural areas showed lower odds of maintaining board certification, adjusting for covariates.ConclusionsNewly board-certified physicians are more likely to migrate to other types of areas, particularly more urban areas, than other physicians. Allocating more training quotas to rural areas could be one option for leveling the distribution of specialists. It also appeared that those practicing in rural areas have difficulty maintaining their certification, so the need to establish a support system for already-certified physicians in rural areas should be emphasized.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3441-y) contains supplementary material, which is available to authorized users.

Burnout Syndrome Among Primary Care Physicians in Oman

“…Previous studies have indicated that the urban-rural dichotomy tends to play a part in the development of occupational burnout. 37,38…”

Factors related to Japanese internal medicine doctors’ retention or migration to rural areas: a nationwide retrospective cohort study

“…Many Japanese physicians have attempted to obtain board certification, although this does not increase medical fees in Japan’s health insurance system. Newly board-certified physicians in rural and intermediate municipalities are likely to migrate to urban municipalities [ 8 ]; however, the participants in this study were all physicians, including those with specialties unsuitable for rural areas, and the follow-up period was only two years. To increase the number of rural physicians, the regional quota program at medical schools began in 2008, and medical students who take exams through the regional quota program and receive student loans, are obliged to work for the prefecture for nine years instead of exempting repayment [ 9 ].…”

The “Healthy Akame!” community – government – university collaboration for health: a community-based participatory mixed-method approach to address health issue in rural Japan

“…Through the process of urbanization, people in Japan-especially the younger generation-have moved to the large cities, leaving rural areas with smaller populations and a higher proportion of residents who are older adults [11]. This situation has driven an unequal distribution of physicians, as well as other health care service providers [12,13]. Fewer facilities, less human resources, and greater di culty in accessing health care services have compromised people's health in rural areas of Japan.…”