The dynamics of obstetricians and gynecologists in Japan: A retrospective cohort model using the nationwide survey of physicians data

Ide, Hiroo; Yasunaga, Hideo; Kodama, Tomoko; Koike, Soichi; Taketani, Yuji; Imamura, Tomoaki

doi:10.1111/j.1447-0756.2009.01039.x

Cited by 26 publications

(30 citation statements)

References 4 publications

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“…As a result, the number of medical facilities for child delivery is decreasing in Japan. The OB/GY specialty has largely been left to internists [25]. Pediatricians are also in a difficult situation.…”

Section: Future Increases Of Clinic Based Physicians Its Impact and mentioning

confidence: 99%

A future estimate of physician distribution in hospitals and clinics in Japan

et al. 2009

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Section: Future Increases Of Clinic Based Physicians Its Impact and mentioning

confidence: 99%

A future estimate of physician distribution in hospitals and clinics in Japan

et al. 2009

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“…This may be especially critical for Japan, which has experienced substantial shortages of pediatric and OB-GYN physicians over the last two decades [17,18]. This dearth has disproportionately affected rural and underserved areas, with international and domestic media reporting on several high-profile cases of catastrophic OB-GYN-related outcomes due to provider shortages [19,20]. …”

Section: Discussionmentioning

confidence: 99%

Differences in residents’ self-reported confidence and case experience between two post-graduate rotation curricula: results of a nationwide survey in Japan

et al. 2014

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BackgroundIn Japan, all trainee physicians must begin clinical practice in a standardized, mandatory junior residency program, which encompasses the first two years of post-graduate medical training (PGY1 – PGY2). Implemented in 2004 to foster primary care skills, the comprehensive rotation program (CRP) requires junior residents to spend 14 months rotating through a comprehensive array of clinical departments including internal medicine, surgery, anesthesiology, obstetrics-gynecology (OBGYN), pediatrics, psychiatry, and rural medicine. In 2010, Japan’s health ministry relaxed this curricular requirement, allowing training programs to offer a limited rotation program (LRP), in which core departments constitute 10 months of training, with electives geared towards residents’ choice of career specialty comprising the remaining 14 months. The effectiveness of primary care skill acquisition during early training warrants evaluation. This study assesses self-reported confidence with clinical competencies, as well as case experience, between residents in CRP versus LRP curricula.MethodsA nation-wide cross-sectional study of all PGY2 physicians in Japan was conducted in March 2011. Primary outcomes were self-report confidence for 98 clinical competency items, and number of cases experienced for 85 common diseases. We compared confidence scores and case experience between residents in CRP and LRP programs, adjusting for parameters relevant to training.ResultsAmong 7506 PGY2 residents, 5052 replied to the survey (67.3%). Of 98 clinical competency items, CRP residents reported higher confidence in 12 items compared to those in an LRP curriculum, 10 of which remained significantly higher after adjustment. CRP trainees reported lower confidence scores in none of the items. Out of 85 diseases, LRP residents reported less experience with 11 diseases. CRP trainees reported lower case experience with one disease, though this did not remain significant on adjusted analysis. Confidence and case experience with OBGYN- and pediatrics-related items were particularly low among LRP trainees.ConclusionsResidents in the specialty-oriented LRP curriculum showed less confidence and less case experience compared to peers training in the broader CRP residency curriculum. In order to foster competence in independent primary care practice, junior residency programs requiring experience in a breadth of core departments should continue to be mandated to ensure adequate primary care skills.

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“…However, physicians do change their posts after only relatively short time spans; this tendency is more prominent among younger physicians. Some experts in Japan have pointed out that there is a particular shortage of physicians in obstetrics/gynecology [13] and pediatrics [14] and this fact, combined with the general shortage of physicians overall, has drawn considerable public attention. Moreover, the proportion of physicians who leave their post within two years is much higher.…”

Section: Discussionmentioning

confidence: 99%

Retention rate of physicians in public health administration agencies and their career paths in Japan

Koike

Kodama

Matsumoto

et al. 2010

BMC Health Serv Res

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BackgroundPhysicians who serve as public health specialists at public health centers and health departments in local or central government have significant roles because of their public health expertise. The aim of this study is to analyze the retention and career paths of such specialists in Japan.MethodWe analyzed the data of seven consecutive surveys, spanning 1994 to 2006. We first analyzed the 2006 survey data by sex, age group, and facility type. We then examined the changes over time in the proportion of physicians working in public health administration agencies. We also examined the distribution of the facility types and specialties in which physicians worked both before beginning and after leaving their jobs. These analyses were performed by using physician registration numbers to cross-link data from two consecutive surveys.ResultsThe proportion of physicians working in public health administration agencies was 0.7% in 2006. The actual numbers for each survey ranged between 1,800 and 1,900. The overall rate remaining in public health administration agencies during the two-year survey interval was 72.8% for 1994-1996. The ratio declined to 67.2% for 2004-2006. Among younger physicians with 1-10 years of experience, the retention rate showed a sharp decline, dropping from 72.6% to 50.0%. Many of these physicians came from or left for a hospital position, with the proportion entering academic hospital institutions increasing in recent years. In many cases, physicians left or entered internal medicine clinical practices.ConclusionAt present in Japan, the number of physicians who leave and the number who begin a position are almost the same; thus, some of the problems associated with physicians leaving are yet to become apparent. However, the fact that the retention period is shortening for younger physicians may represent a future problem for ensuring the quality of physicians in public health administration agencies. Possible strategies include: increasing the number of physicians entering positions; reducing the number leaving positions; and creating a system where physicians can easily reenter positions after leaving while also establishing a revolving door type of career development system, involving both public health departments and hospital clinical departments.

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The dynamics of obstetricians and gynecologists in Japan: A retrospective cohort model using the nationwide survey of physicians data

Abstract: The gravest problem in the OB/GYNs workforce is the continued decline in newly graduated OB/GYNs. Improvements in working conditions and job satisfaction are considered vital.

Cited by 26 publications

References 4 publications

A future estimate of physician distribution in hospitals and clinics in Japan

A future estimate of physician distribution in hospitals and clinics in Japan

Differences in residents’ self-reported confidence and case experience between two post-graduate rotation curricula: results of a nationwide survey in Japan

Retention rate of physicians in public health administration agencies and their career paths in Japan

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