title: Characteristics of Physician Outflow from Disaster Areas following the Great East Japan Earthquake.
abstract: OBJECTIVE
  The shortage of physicians after a major disaster is a crucial issue. We aimed to evaluate the characteristics of physicians who left affected areas following the accident at Fukushima Daiichi Nuclear Power Plant caused by the Great East Japan Earthquake on March 11, 2011.
  
  
  METHODS
  Using data from a physician census conducted in 2010 (pre-disaster) and 2012 (post-disaster), we evaluated changes in the number of physicians in affected areas. We then calculated the odds ratios and 95% confidence intervals using a logistic regression model to evaluate the association between physician characteristics and outflow. We also conducted stratified analyses based on physician characteristics.
  
  
  RESULTS
  The number of physicians decreased in Fukushima Prefecture (-5.3%) and increased in Miyagi Prefecture (2.8%). The decrease in Fukushima and increase in Miyagi were evident even after taking the prefecture's population change into account (change in physician to population ratios: -1.9% and 3.2%, respectively). Compared with physicians who lived in areas >100 km from the nuclear power plant, physicians living 20-50 km and 50-100 km were, respectively, 3.9 times (95% confidence interval, 2.6-5.7) and 2.6 times (95% confidence interval, 1.7-3.8) more likely to migrate to distant areas. In the stratified analysis, younger physicians and those earlier in their careers had higher odds ratios for outflow than other physicians (P for interaction = 0.02 and <0.01, respectively).
  
  
  CONCLUSIONS
  The risk of outflow was greater among younger and early-career physicians in areas around the power plant. Political support may be necessary to recruit and retain such physicians, who will be responsible for future community health in the disaster area.
authors.affiliation: Department of Public Health and Health Policy, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Saori
authors.identifier: http://orcid.org/0000-0002-3401-8191
authors.initials: S
authors.lastname: Kashima
authors.affiliation: Department of Community Medicine, Chiba Medical Center, Teikyo University School of Medicine, Chiba, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Inoue
authors.affiliation: Department of Community Based Medical System, Institute of Biomedical and Health Sciences, Hiroshima University, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Matsumoto
mesh_terms: D004190:Disasters; D055866:Earthquakes; D062406:Fukushima Nuclear Accident; D005843:Geography; D007564:Japan; D055848:Nuclear Power Plants; D010820:Physicians