The distribution and transitions of physicians in Japan: a 1974-2004 retrospective cohort study.
BACKGROUND
In Japan, physicians freely choose their specialty and workplace, because to date there is no management system to ensure a balanced distribution of physicians. Physicians in Japan start their careers in hospitals, then become specialists, and then gradually leave hospitals to work in private clinics and take on primary care roles in their specialty fields. The present study aimed to analyse national trends in the distribution and career transitions of physicians among types of facilities and specialties over a 30-year period.


METHODS
We obtained an electronic file containing physician registration data from the Survey of Physicians, Dentists and Pharmacists. Descriptive statistics and data on movement between facilities (hospitals and clinics) for all physicians from 1974, 1984, 1994 and 2004 were analysed. Descriptive statistics for the groups of physicians who graduated in 1970, 1980 and 1990 were also analysed, and we examined these groups over time to evaluate their changes of occupation and specialty.


RESULTS
The number of physicians per 100,000 population was 113 in 1974, and rose to 212 by 2004. The number of physicians working in hospitals increased more than threefold. In Japan, while almost all physicians choose hospital-based positions at the beginning of their career, around 20% of physicians withdrew from hospitals within 10 years, and this trend of leaving hospitals was similar among generations. Physicians who graduated in 1980 and registered in general surgery, cardiovascular surgery or paediatric surgery were 10 times more likely to change their specialty, compared with those who registered in internal medicine. More than half of the physicians who registered in 1970 had changed their specialties within a period of 30 years.


CONCLUSIONS
The government should focus primarily on changing the physician fee schedule, with careful consideration of the balance between office-based physicians and hospital-based physicians and among specialties. To implement effective policies in managing health care human resources, policy-makers should also pay attention to continuously monitoring physicians' practising status and career motivations; and national consensus is needed regarding the number of physicians required in each type of facility and specialty as well as region.
Ide
Hiroo
H
Department of Planning, Information and Management, The University of Tokyo Hospital, and Department of Health Management and Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. idea-tky@umin.ac.jp
Koike
Soichi
S
Kodama
Tomoko
T
Yasunaga
Hideo
H
Imamura
Tomoaki
T
BMJ. 2005 Jan 8;330(7482):55-6
15637352
Health Serv Res. 2005 Dec;40(6 Pt 1):1931-52
16336557
Arch Intern Med. 2002 Jul 22;162(14):1577-84
12123400
Health Policy. 2009 Oct;92(2-3):244-9
19481286
CMAJ. 1998 Mar 24;158(6):723-8
9538850
BMJ. 2003 Jul 19;327(7407):139-42
12869457
Acad Med. 2005 Aug;80(8):728-32
16043525
JAMA. 2003 Sep 3;290(9):1173-8
12952999
Acad Med. 1997 Dec;72(12):1088-96
9435716
Nihon Koshu Eisei Zasshi. 2004 Feb;51(2):117-32
15058102
J Obstet Gynaecol Res. 2009 Aug;35(4):761-6
19751339
Acad Med. 2006 Dec;81(12):1069-75
17122471
Med Care. 2006 Mar;44(3):234-42
16501394
Acad Med. 1996 Feb;71(2):198-209
8615940
Acad Med. 2005 Sep;80(9):791-6
16123455
Am J Public Health. 2000 Aug;90(8):1225-8
10937001
Acad Med. 2005 Sep;80(9):815-9
16123459
Health Serv Res. 2007 Dec;42(6 Pt 1):2252-6; discussion 2294-323
17995564
Lancet. 1992 Dec 5;340(8832):1391-3
1360099
Lancet. 2008 Feb 23;371(9613):668-674
18295024
Med Educ. 2001 May;35(5):488-94
11328520
CMAJ. 1999 Apr 20;160(8):1159-63
10234346
Pediatr Int. 2009 Oct;51(5):645-9
19419521
Health Policy. 2008 Aug;87(2):194-202
18243398
Med Educ. 2007 Mar;41(3):302-8
17316216
JAMA. 2001 Sep 5;286(9):1041-8
11559288
Am J Obstet Gynecol. 2004 Mar;190(3):851-7
15042024