title: Effects of the 2004 postgraduate training program on the interprefectural distribution of psychiatrists in Japan.
abstract: OBJECTIVE
  After a new postgraduate training program was launched by the Ministry of Health, Labour, and Welfare in 2004, concern regarding the maldistribution of physicians has increased in Japan. This study aimed to assess the interprefectural distribution of psychiatrists in Japan before and after the start of the new postgraduate training program.
  
  
  METHODS
  Our data included nine time points: 1996, 1998, 2000, 2002, 2004, 2006, 2008, 2010 and 2012. The Gini coefficient (GC) was calculated using prefectures as the study unit to assess whether the interprefectural distribution of psychiatrists significantly changed in relation to the population and area of prefectures. The effect of the new postgraduate training program on the GC of psychiatrist distribution was assessed by estimating the interaction between year and period (before or after the postgraduate training program) using a general linear model analysis.
  
  
  RESULTS
  The total number of psychiatrists increased from 10,093 to 14,733 over the observed period. The general linear model showed a significant interaction between the year and the period for the GC based on the number of psychiatrists per 100 km(2) , whereas no interaction was found for the GC based on the number of psychiatrists per 100,000 population.
  
  
  CONCLUSIONS
  The interprefectural distribution of psychiatrists per 100 km(2) worsened after the launch of the new training program; this result may reflect the adverse impact of the training program. Further observation is needed to explore how this difference in the interprefectural distribution of psychiatrists affects the mental health status of the population.
authors.affiliation: Aomori Prefectural Center for Mental Health and Welfare, Aomori, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Sugawara
authors.forename: Osamu
authors.initials: O
authors.lastname: Tanaka
authors.forename: Norio
authors.initials: N
authors.lastname: Yasui-Furukori
mesh_terms: D004503:Education, Medical, Graduate / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan; D010820:Physicians / Q000706:statistics & numerical data*; D011570:Psychiatry / Q000706:statistics & numerical data*; D040841:Resource Allocation / Q000706:statistics & numerical data*
keywords: Gini coefficient; Japan; geographical distribution; inequality; psychiatrist