Aging of hospital physicians in rural Japan: A longitudinal study based on national census data

Kimura, Kazuki; Inoue, Kazuo; Kashima, Saori; Koike, Soichi; Tazuma, Susumu

doi:10.1371/journal.pone.0198317

Cited by 25 publications

(33 citation statements)

References 30 publications

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“…4 Since the introduction of mandatory clinical training in 2004, the system of posting physicians by medical specialty in university medical departments has weakened, resulting in a worsening of the geographical maldistribution of physicians. [5][6][7][8] However, the number of physicians in university hospital practice has tended to increase in recent years; thus, further verification is needed with respect to any effects on future posting of physicians.…”

Section: Discussionmentioning

confidence: 99%

“…In 2004, a new residency training system for physicians within the first 2 years after graduation was introduced nationwide; this system allowed young physicians to choose non‐university hospitals for their clinical training . As a result, university hospitals' system of posting physicians on the basis of specialty weakened, and geographical maldistribution worsened …”

Section: Introductionmentioning

confidence: 99%

“…4 As a result, university hospitals' system of posting physicians on the basis of specialty weakened, and geographical maldistribution worsened. [5][6][7][8] Several workforce policies have been established to deal with this problem. 9 First, the number of medical students was increased from 7625 in 2007 to 9420 in 2017 by increasing quotas in existing medical schools.…”

Section: Introductionmentioning

confidence: 99%

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Time changes in the geographical distribution of physicians and factors associated with starting rural practice in Japan

Ishikawa

2019

Health Planning & Management

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Summary Purpose The geographical maldistribution of physicians is an important issue for health policy. This study aimed to evaluate recent trends in Japan and identify the factors associated with starting a rural practice. Methods A longitudinal study was conducted using secondary analysis of national census data. The number of physicians in each region was described in 1996, 2006, and 2016 and, for two cohorts, 1996 to 2006 and 2006 to 2016; a logistic regression analysis was used to identify factors related to starting a rural practice after 10 years. Findings Between 1996 and 2016, the number of physicians in rural areas increased by 4%. Results of the logistic regression analysis showed that, in both cohorts, the factor with the highest odds ratio for starting a rural practice after 10 years was initial academic hospital experience. Other factors showing positive correlations were additional hospital practice and being qualified and over 30 years old, whereas female sex and aged at least 40 years had negative correlations. Conclusions From 1996 to 2016, despite the increase in the total number of physicians, geographical maldistribution increased. Some findings support the policy that some physicians should work in rural areas in return for scholarships.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Time changes in the geographical distribution of physicians and factors associated with starting rural practice in Japan

Ishikawa

2019

Health Planning & Management

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“…7 Several reports claim that the 2004 reform has worsened the already uneven regional distribution of doctors. [7][8][9][10] However, the impact of the increasing residency rates at non-university hospitals on doctors' subsequent career paths, and speci cally on the type of institution they decide to work at after concluding their training, have not been examined.…”

Section: Introductionmentioning

confidence: 99%

A Longitudinal Survey of Postgraduate Residency Hospital Type and Career Paths in Japan (1996–2016)

Ishikawa

2020

Preprint

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Background: Postgraduate clinical training—a two-year residency program after graduation—became compulsory in Japan in 2004, prompting a shift in residency site preference for new graduates from university to non-university hospitals. Methods: Starting from the hypothesis that shortages of residents at university hospitals continue to be a problem in Japan, a longitudinal study was conducted based on secondary data collected from a biannual national physician survey. The career paths for physicians by residency hospital type were analyzed. The attributes of two physician cohorts were examined a decade after their registration, in 1996 and 2004 respectively, to understand how having carried out their residency at university or non-university hospitals affected their careers.Results: Around 40% of residents were training at university hospitals in their first year of registration at the time of the 2004 reform. In contrast, physicians working at university hospitals in their third year of registration rose to around 40%. Physicians who had not worked at university hospitals during their first ten years increased from 12% in 2004 to 18% in 2014.Conclusions: Since the introduction of mandatory postgraduate clinical training, residents’ career paths have changed based on the type of hospital where they attended residency. Resident shortages at university hospitals remain a challenge in Japan.

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“…However, the aging of the population has caused problems in rural and/or remote mountains, islands, and peninsulas, where approximately 10% of the Japanese population reside [4]. Such communities have long had various issues associated the medical/health care systems, including relocation of physicians' practices, aging physicians, a lack of 24-h availability of medical care, little nursing and home care [5], few public services [6], and little social and family support [7]. In addition, physicians working in rural communities have been reported to be dissatisfied with their work and lifestyle [8].…”

Section: Introductionmentioning

confidence: 99%

Perceptions of Residents among Rural Communities with Medical Group Practice in Japan

Manabe

Sawada²,

Kojo

et al. 2019

IJERPH

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Elucidating the perceptions of residents regarding medical group practice (GP) among rural communities (GP-R) in Japan will be useful for establishing this system in such communities. A survey by questionnaire, as made by experts in rural health, was conducted in 2017. The self-administered questionnaire inquired about the perceptions of residents for accepting the GP-R into the community’s healthcare using seven major elements of GP-R. The questionnaire was randomly distributed to 400 adult residents who lived in rural communities with a recently launched GP and had access to clinics within the communities. Among the 321 respondents, comparisons were made between younger (≤sixties) and older (≥seventies) residents, and a stepwise multiple regression analysis was performed to extract the factors influencing acceptance of the GP-R system. The results showed that older residents had a greater disapprove of being treated by different physicians daily or weekly in clinics (p < 0.001) and the use of telemedicine (p < 0.001) compared with younger residents. Younger residents showed a greater disapproval of clinics closing on weekdays than older residents (p = 0.007). Among all respondents, regardless of age groups, over half of residents approved of the involvement of nurse practitioners in the GP-R. Living with family and children was also extracted as an independent factor influencing a positive perception of the GP-R. These data suggest that the promotion of GP-R should consider generation gaps in the approach to medical practice as well as the family structures of residents. The involvement of nurse practitioners can also encourage the acceptance of GP-R in Japan.

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Aging of hospital physicians in rural Japan: A longitudinal study based on national census data

Cited by 25 publications

References 30 publications

Time changes in the geographical distribution of physicians and factors associated with starting rural practice in Japan

Time changes in the geographical distribution of physicians and factors associated with starting rural practice in Japan

A Longitudinal Survey of Postgraduate Residency Hospital Type and Career Paths in Japan (1996–2016)

Perceptions of Residents among Rural Communities with Medical Group Practice in Japan

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