[Factors related to municipality expectations of retaining physicians in public medical facilties].
OBJECTIVE
This study was conducted to investigate the association between municipality expectations of retaining physicians in public medical facilities and their evaluation of the physicians from key aspects considered important for practicing community medicine.


METHODS
A cross-sectional study using a self-reported postal questionnaire survey was conducted with all 3,152 local governments in Japan from July to September, 2000. Three thousand and fifty-nine (94%) local governments responded. Of the responders, 1,315 (42%) operated public medical facilities. These local governments evaluated their expectations of retaining physicians in medical facilities and the physicians themselves focusing on the following aspects considered important for practicing community medicine: degree of government satisfaction with the physician's involvement in public health and welfare services; primary care for emergency patients; human relationships between the physician and the population, staff of the facility or the municipal officials; public estimation of the facility; income and expenditure of the facility; understanding of the local government's system.


RESULTS
The subjects were 1,092 local governments (83.0%) that responded to all of the questions. The proportion of municipalities expecting to retain physicians was 56% overall, 61% in rural areas and 44% in urban areas (P<0.001). The proportion of governments satisfied with the physicians' human relationships was higher than the other factors and the proportion satisfied about income and expenditure of facilities was the lowest. Multiple logistic regression analysis revealed that the degree of local government expectation of retaining physicians was significantly associated with the physicians' involvement in public health and welfare services (Odds ratio (OR) 1.8; 95% confidential interval (95%CI) 1.3-2.5), their human relationship with the population and public estimation of facilities (OR 1.6; 95%CI 1.1-2.2), and income and expenditure (OR 1.3; 95%CI 1.01-1.8 in all, OR 1.7; 95%CI 1.7-2.4 in rural areas). Primary care for emergency patients demonstrated a significant association in rural areas (OR 1.6; 95%CI 1.1-2.3).


CONCLUSIONS
Municipal expectation of retaining physicians in public medical facilities was significantly associated with factors related to the integration of medical, public health and welfare systems, human relationship with the population, public estimation and income and expenditure of the facilities overall. In rural areas, there was a closer association with income and expenditure and a significant association with emergency care. These findings suggest that the local governments' thought related with the expectation of retaining physicians are influenced by their different needs for medical services in community healthcare.
Fujiwara
Shinji
S
Jichi Medical School, Center for Community Medicine, Division of Community and Family Medicine.
Okayama
Masanobu
M
Takayashiki
Ayumi
A
Kajii
Eiji
E
D003153:Community Health Services; D003430:Cross-Sectional Studies; D007182:Income; D007564:Japan; D009111:Local Government; D010563:Personnel Turnover; D010820:Physicians / Q000600:supply & distribution* / Q000639:trends; D011635:Public Health Administration / Q000639:trends; D011795:Surveys and Questionnaires; D000078329:Workforce