title: Career pathways of board-certified surgeons in Japan.
abstract: OBJECTIVE
  To investigate the career pathways of board-certified surgeons' and the factors associated with them maintaining their certification in Japan.
  
  
  METHODS
  We analyzed data from the surveys of physicians, dentists and pharmacists. A multivariate logistic regression model was used to investigate whether factors such as gender, year of registration, place of work, and subspecialty board certification were associated with maintaining board certification.
  
  
  RESULTS
  Most Japanese surgeons attain board certification within 5-10 years of initial medical registration. After adjusting for possible confounding factors, the odds of maintaining board certification were significantly lower for women, those who were beyond 20 years post-registration, those who worked in hospitals other than academic hospitals or clinics, and those who had board certification in surgery only. Of the total board-certified surgeons analyzed, 93.2 % continued to work in hospitals and 2.8 % moved to clinics within 2 years. Of those who moved from hospitals to clinics, half continued to practice surgery, while nearly 40 % changed their specialty to internal medicine.
  
  
  CONCLUSIONS
  It is necessary to establish a special training system for mature surgeons who move from surgery to general practice later in their careers. As the number of female surgeon increases, a support system is also required to secure the future supply of surgeons.
authors.affiliation: Center for Community Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan. koikes@jichi.ac.jp.|Department of Health Management and Policy, Graduate School of Medicine, University of Tokyo Hospital, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-0033, Japan. koikes@jichi.ac.jp.
authors.forename: Soichi
authors.initials: S
authors.lastname: Koike
authors.affiliation: Center for Community Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.|Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shimizu
authors.affiliation: Department of Community Based Medical System, Faculty of Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Matsumoto
authors.affiliation: Department of Medical Community Network and Discharge, Chiba University Hospital, 1-8-1 Inohana, Chuo, Chiba, Chiba, 260-8677, Japan.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Ide
authors.affiliation: Department of Planning, Information and Management, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo, 113-0033, Japan.
authors.forename: Hidenao
authors.initials: H
authors.lastname: Atarashi
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-0033, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
mesh_terms: D002321:Career Choice; D002322:Career Mobility; D002568:Certification / Q000706:statistics & numerical data; D005260:Female; D058006:General Practice; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D010822:Physicians, Women / Q000706:statistics & numerical data / Q000639:trends; D012737:Sex Factors; D012944:Social Support; D013044:Specialty Boards; D066231:Surgeons / Q000193:education / Q000600:supply & distribution / Q000639:trends; D013997:Time Factors; D017132:Workplace
keywords: Board certification; Japan; Surgeon career pathway