Widening disparity in the geographic distribution of pediatricians in Japan

Abstract

BackgroundThe shortage of physicians in Japan is a serious concern, particularly in specialties like pediatrics. The purpose of this study was to investigate recent changes in the geographic distribution of pediatricians and the factors underlying this change.MethodsWe investigated the numerical changes in the pediatrician workforce (2002 to 2007) per 100,000 of the population under the age of 15 years in 369 secondary medical areas throughout Japan, using attributive variables such as population size, social and economic status, and pediatric service delivery. We performed principal component analysis and multiple regression analysis.ResultsWe obtained two principal components: one that reflected the degree of urbanization and another that reflected the volume of pediatric service delivery. Only the first component score was positively correlated with an increased pediatrician workforce per 100,000 of the population under the age of 15 years. We classified the secondary medical areas into four groups using component scores. The increase in pediatrician workforce during this period was primarily absorbed into the two groups with higher levels of urbanization, whereas the two rural groups exhibited little increase. Pediatricians aged 50 to 59 years increased in all four groups, whereas pediatricians aged 30 to 39 years decreased in the two rural groups and increased in the two urban groups.ConclusionsThe trends of the pediatrician workforce increase generally kept pace with urbanization, but were not associated with the original pediatrician workforce supply. The geographic distribution of pediatricians showed rapid concentration in urban areas. This trend was particularly pronounced among female pediatricians and those aged 30 to 39 years. Given that aging pediatricians in rural areas are not being replaced by younger doctors, these areas will likely face new crises when senior physicians retire.

Examining changes in the equity of physician distribution in Japan: a specialty-specific longitudinal study

“…Finally, there may be other ways to divide the SMAs for the subgroup analysis. However, our subgroup analysis was based on the categorization used in a previous study, 19 and provided an intuitive understanding of the differences in group characteristics.…”

“…Finally, a subgroup analysis was conducted by dividing SMAs into groups according to two regional characteristics. Using the method described in Sasaki et al , 19 we classified each SMA into one of four groups based on whether the SMA was an urban or rural area, and whether the SMA had a higher or lower initial physician supply in 2000. An SMA was designated an urban area (or a rural area) if its population density was higher (or lower) than the median value in all SMAs.…”

Designing a pediatric emergency triage and action program

“…This is partly because of the uneven distribution of pediatricians among urban and rural areas. 4 Formal training programs for general practitioners (GPs) working in pediatric primary care settings were not available before the Japanese Primary Care Association began to establish pediatric training sites in 2009. 5 Currently, a relatively large number of physicians-especially physicians in rural areashave no choice but to see children despite having no pediatric training after completing their initial postgraduate training program.…”

Board certification and urban–rural migration of physicians in Japan

“…Uneven geographical distribution, particularly that related to clinical training and specialty choice is an issue in many countries [ 7 – 15 ]. In Japan as well, younger physicians seeking specialist careers has raised concern that fewer physicians will work in rural areas and that the concentration of physicians in urban areas will increase [ 16 , 17 ] and this concern has drawn public attention as relative shortages of physicians in rural areas have accelerated [ 18 – 20 ].…”