title: National medical care system may impede fostering of true specialization of radiation oncologists: study based on structure survey in Japan.
abstract: OBJECTIVE
  To evaluate the actual work environment of radiation oncologists (ROs) in Japan in terms of working pattern, patient load, and quality of cancer care based on the relative time spent on patient care.
  
  
  METHODS
  In 2008, the Japanese Society of Therapeutic Radiology and Oncology produced a questionnaire for a national structure survey of radiation oncology in 2007. Data for full-time ROs were crosschecked with data for part-time ROs by using their identification data. Data of 954 ROs were analyzed. The relative practice index for patients was calculated as the relative value of care time per patient on the basis of Japanese Blue Book guidelines (200 patients per RO).
  
  
  RESULTS
  The working patterns of RO varied widely among facility categories. ROs working mainly at university hospitals treated 189.2 patients per year on average, with those working in university hospitals and their affiliated facilities treating 249.1 and those working in university hospitals only treating 144.0 patients per year on average. The corresponding data were 256.6 for cancer centers and 176.6 for other facilities. Geographically, the mean annual number of patients per RO per quarter was significantly associated with population size, varying from 143.1 to 203.4 (p < 0.0001). There were also significant differences in the average practice index for patients by ROs working mainly in university hospitals between those in main and affiliated facilities (1.07 vs 0.71: p < 0.0001).
  
  
  CONCLUSIONS
  ROs working in university hospitals and their affiliated facilities treated more patients than the other ROs. In terms of patient care time only, the quality of cancer care in affiliated facilities might be worse than that in university hospitals. Under the current national medical system, working patterns of ROs of academic facilities in Japan appear to be problematic for fostering true specialization of radiation oncologists.
authors.affiliation: Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
authors.forename: Hodaka
authors.initials: H
authors.lastname: Numasaki
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Shibuya
authors.forename: Masamichi
authors.initials: M
authors.lastname: Nishio
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ikeda
authors.forename: Kenji
authors.initials: K
authors.lastname: Sekiguchi
authors.forename: Norihiko
authors.initials: N
authors.lastname: Kamikonya
authors.forename: Masahiko
authors.initials: M
authors.lastname: Koizumi
authors.forename: Masao
authors.initials: M
authors.lastname: Tago
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Ando
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Tsukamoto
authors.forename: Atsuro
authors.initials: A
authors.lastname: Terahara
authors.forename: Katsumasa
authors.initials: K
authors.lastname: Nakamura
authors.forename: Michihide
authors.initials: M
authors.lastname: Mitsumori
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Nishimura
authors.forename: Masato
authors.initials: M
authors.lastname: Hareyama
authors.forename: Teruki
authors.initials: T
authors.lastname: Teshima
mesh_terms: D002173:Cancer Care Facilities / Q000458:organization & administration / Q000592:standards; D006785:Hospitals, University / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D007564:Japan; D009313:National Health Programs; D009369:Neoplasms / Q000532:radiotherapy; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000592:standards*; D018787:Radiation Oncology / Q000458:organization & administration / Q000706:statistics & numerical data*; D013038:Specialization; D013997:Time Factors; D000078329:Workforce; D016526:Workload / Q000706:statistics & numerical data*; D017132:Workplace