title: Widening disparity in the geographic distribution of pediatricians in Japan.
abstract: BACKGROUND
  The 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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  We 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.
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan. imanaka-y@umin.net.
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Sasaki
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Otsubo
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Imanaka
mesh_terms: D000328:Adult; D005260:Female; D054625:Healthcare Disparities / Q000639:trends*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D010372:Pediatrics / Q000639:trends; D025341:Principal Component Analysis; D012044:Regression Analysis; D019035:Rural Health Services / Q000639:trends; D019037:Urban Health Services / Q000639:trends; D000078329:Workforce