Residency hospital type and career paths in Japan: An analysis of physician registration cohorts

Koike, Soichi; Kodama, Tomoko; Matsumoto, Shimpei; Ide, Hiroo; Yasunaga, Hideo; Imamura, Tomoaki

doi:10.3109/01421591003695311

Cited by 9 publications

(9 citation statements)

References 21 publications

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“…Before the introduction of this system, most residents were trained in hospitals affiliated with medical schools. However, a large proportion of residents are now trained in town hospitals that have no direct association with medical schools [14]. Because hospitals affiliated with medical schools faced a substantial loss of their physician workforce, these hospitals began to poach physicians from town hospitals.…”

Section: Introductionmentioning

confidence: 99%

Widening disparity in the geographic distribution of pediatricians in Japan

2013

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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.

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Section: Introductionmentioning

confidence: 99%

Widening disparity in the geographic distribution of pediatricians in Japan

2013

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“…In fact, according to Kawamura, the salary for 2 years in university hospitals was 6 478 000 yen ($80 975 at the exchange rate of 1 USD = 80 JPY) on average, compared with 9 115 000 yen ($113 938) in non-university hospitals [25]. Lower salaries in university hospitals were often attributed to authoritarian influence by clinical departments in medical schools on young trainees’ future career paths in affiliated hospitals [26]. Therefore, it is possible that a young graduate’s choice of non-university hospitals in his/her early career is already affected by incentives other than authoritative reasons, including economic incentives related to annual salary.…”

Section: Introductionmentioning

confidence: 99%

Does salary affect the choice of residency in non-university teaching hospitals? A panel analysis of Japan Residency Matching Programme data

Enari

Hashimoto

2013

Hum Resour Health

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BackgroundPrevious studies have investigated factors that are influential on the choice of training hospitals among residency physicians, but the effect of salary was not conclusive. In this study, we aimed to examine whether a higher salary attracted more residents to non-university hospitals participating in the Japanese Residency Matching Programme.MethodsData on 475 hospitals/programmes between 2006 and 2009 were available for analysis. We first conducted an ordinary least squares regression analysis on the ratio of the number of applicants to the residency programme quota as an index of resident’s choice, for comparison with previous studies. We further performed panel data analysis to better control for unobserved heterogeneity across hospitals, which could be confounded by the amount of salary. We also performed stratified analysis by the population size of the hospital location.ResultsIn ordinary least squares regression, salary showed a positive, but not significant association, with the ratio of the number of applicants to the programme quota, while the results of a fixed effect model exhibited a positive and significant effect of salary (ε= 0.4995, P = 0.015) on the ratio. Analysis stratified by city size showed that the elasticity of salary was comparable (ε= 1.9089, P = 0.016 in large cities versus ε= 1.9185, P = 0.008 in small cities), while that of the number of teaching physicians was larger in large cities (ε= 1.9857, P = 0.009) compared with that in small cities (ε= 1.6253, P = 0.033). The number of teaching physicians had a significant and negative effect modification on salary, implying an antagonistic effect between these two attributes (ε= −1.5223, P = 0.038).ConclusionsOur results indicate that the amount of salary influences the choice of training hospitals among medical graduates who choose non-university settings. Use of a monetary reward in a residency programme could be a feasible tactic for hospitals to attract residents.

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“…Analysis of data from the period prior to the introduction of the mandatory postgraduate clinical training show that doctors chose to work at different institution types at consistent rates, regardless of whether they spent their rst year as licensed physicians at a university or non-university hospital. 11 This study, in contrast, demonstrates that residents' subsequent career paths diverged depending on where they trained in their rst year of registration. For example, the percentage of doctors who had never worked at a university hospital in their rst ten years on the registry rose after the reform, from 12% in 2004 (1994 cohort) to 18% in 2014 (2004 cohort).…”

Section: Discussionmentioning

confidence: 64%

“…at consistent rates after completing residency. 11 However, no study has documented the hospital type distribution after the reform was enacted. Data from a MHLW survey of doctors following completion of their postgraduate clinical training indicate that about 50% wished to work at a university hospital after residency, with more female than male doctors preferring university hospital employment.…”

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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Residency hospital type and career paths in Japan: An analysis of physician registration cohorts

Abstract: University hospitals need to strengthen their function as continuing education and career development centres and to adopt a less paternalistic approach, as fewer residents start their career in university hospitals.

Cited by 9 publications

References 21 publications

Widening disparity in the geographic distribution of pediatricians in Japan

Widening disparity in the geographic distribution of pediatricians in Japan

Does salary affect the choice of residency in non-university teaching hospitals? A panel analysis of Japan Residency Matching Programme data

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

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