title: Long-term career transition in the surgical workforce of Japan: a retrospective cohort study using the nationwide survey of physicians data from 1972 to 2006.
abstract: BACKGROUND
  A surgical workforce is essential for providing surgical services to the community. However, little is known about surgeons' career changes in circumstances where physicians can freely choose their specialty. Differing career transitions among surgical specialties were hypothesized.
  
  
  METHODS
  Longitudinal data were obtained for all physicians in Japan, giving a total of 4,302,844 items of data (for 390,368 physicians) from 1972 to 2006. Descriptive statistics for all physicians and surgeons were calculated in 1976, 1986, 1996, and 2006. "Active surgeons" (working at hospitals), "primary care surgeons" (working at clinics), and "retired surgeons" were analyzed among physicians licensed in 1972, 1982, and 1992 for the subspecialties of general surgery, orthopedic surgery, neurosurgery, urology, and "other" surgeries. Survival analysis and Cox's proportional hazard analysis were conducted to examine factors affecting career changes.
  
  
  RESULTS
  During the study period, the greatest change was observed in the increased number of surgeons per 100,000 physicians. The percentage of female surgeons and surgeons registered in a surgical subspecialty also increased greatly. Significant differences, by sex, age, and subspecialty, were shown in survival analyses for surgeons' career changes in the transition from active surgeons to primary care surgeons or retired surgeons. Surgical specialty was still a significant factor for predicting career transition, even after adjustment for the surgeons' characteristics.
  
  
  CONCLUSIONS
  The current study elucidated the differences in career transitions among surgical specialties. Given the observed findings, policy makers should consider more detailed and effective measures for retaining surgeons in active practice.
authors.affiliation: Department of Planning, Information and Management, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. idea-tky@umin.ac.jp
authors.forename: Hiroo
authors.initials: H
authors.lastname: Ide
authors.forename: Soichi
authors.initials: S
authors.lastname: Koike
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
authors.forename: Tomoko
authors.initials: T
authors.lastname: Kodama
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Ohe
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Imamura
mesh_terms: D002321:Career Choice; D002322:Career Mobility; D016009:Chi-Square Distribution; D005260:Female; D013502:General Surgery; D006302:Health Services Research; D006280:Health Workforce / Q000706:statistics & numerical data; D006801:Humans; D007564:Japan; D008137:Longitudinal Studies; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data; D010820:Physicians / Q000600:supply & distribution*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D011795:Surveys and Questionnaires