Geographical distribution of family physicians in Japan: a nationwide cross-sectional study
Abstract Background Geographical maldistribution of physicians, and their subsequent shortage in rural areas, has been a serious problem in Japan and in other countries. Family Medicine, a new board-certified specialty started 10 years ago in Japan by Japan Primary Care Association (JPCA), may be a...
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doaj-7c0e9852eba940f6a87ceafdd3002e1a2020-11-25T03:41:23ZengBMCBMC Family Practice1471-22962019-10-012011710.1186/s12875-019-1040-6Geographical distribution of family physicians in Japan: a nationwide cross-sectional studyShuhei Yoshida0Masatoshi Matsumoto1Saori Kashima2Soichi Koike3Susumu Tazuma4Takahiro Maeda5Department of Community-Based Medical Systems, Graduate School of Biomedical and Health Sciences, Hiroshima UniversityDepartment of Community-Based Medical Systems, Graduate School of Biomedical and Health Sciences, Hiroshima UniversityEnvironmental Health Sciences Laboratory, Department of Development Technology, Graduate School for International Development and Cooperation, Hiroshima UniversityDivision of Health Policy and Management, Center for Community Medicine, Jichi Medical UniversityDepartment of General Internal Medicine, Hiroshima University Hospital and Graduate School of Biomedical and Health SciencesDepartment of Community Medicine, Nagasaki University Graduate School of Biomedical ScienceAbstract Background Geographical maldistribution of physicians, and their subsequent shortage in rural areas, has been a serious problem in Japan and in other countries. Family Medicine, a new board-certified specialty started 10 years ago in Japan by Japan Primary Care Association (JPCA), may be a solution to this problem. Methods We obtained the workplace information of 527 (78.4%) of the 672 JPCA-certified family physicians from an online database. From the national census data, we also obtained the workplace information of board-certified general internists, surgeons, obstetricians/gynaecologists and paediatricians and of all physicians as the same-generation comparison group (ages 30 to 49). Chi-squared test and residual analysis were conducted to compare the distribution between family physicians and other specialists. Results Five hundred nineteen JPCA-certified family physicians and 137,587 same-generation physicians were analysed. The distribution of family physicians was skewed to municipalities with a lower population density, which shows a sharp contrast to the urban-biased distribution of other specialists. The proportion of family physicians in non-metropolitan municipalities was significantly higher than that expected based on the distribution of all same-generation physicians (p < 0.001). Conclusions Family physicians distributed in favour of rural areas much more than any other specialists in Japan. The better balance of family physician distribution reported from countries with a strong primary care orientation seems to hold even in a country where primary care orientation is weak, physician distribution is not regulated, and patients have free access to healthcare. Family physicians comprise only 0.2% of all Japanese physicians. However, if their population grows, they can potentially rectify the imbalance of physician distribution. Government support is mandatory to promote family medicine in Japan.http://link.springer.com/article/10.1186/s12875-019-1040-6GeographyHealth policyJapanFamily physician |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Shuhei Yoshida Masatoshi Matsumoto Saori Kashima Soichi Koike Susumu Tazuma Takahiro Maeda |
spellingShingle |
Shuhei Yoshida Masatoshi Matsumoto Saori Kashima Soichi Koike Susumu Tazuma Takahiro Maeda Geographical distribution of family physicians in Japan: a nationwide cross-sectional study BMC Family Practice Geography Health policy Japan Family physician |
author_facet |
Shuhei Yoshida Masatoshi Matsumoto Saori Kashima Soichi Koike Susumu Tazuma Takahiro Maeda |
author_sort |
Shuhei Yoshida |
title |
Geographical distribution of family physicians in Japan: a nationwide cross-sectional study |
title_short |
Geographical distribution of family physicians in Japan: a nationwide cross-sectional study |
title_full |
Geographical distribution of family physicians in Japan: a nationwide cross-sectional study |
title_fullStr |
Geographical distribution of family physicians in Japan: a nationwide cross-sectional study |
title_full_unstemmed |
Geographical distribution of family physicians in Japan: a nationwide cross-sectional study |
title_sort |
geographical distribution of family physicians in japan: a nationwide cross-sectional study |
publisher |
BMC |
series |
BMC Family Practice |
issn |
1471-2296 |
publishDate |
2019-10-01 |
description |
Abstract Background Geographical maldistribution of physicians, and their subsequent shortage in rural areas, has been a serious problem in Japan and in other countries. Family Medicine, a new board-certified specialty started 10 years ago in Japan by Japan Primary Care Association (JPCA), may be a solution to this problem. Methods We obtained the workplace information of 527 (78.4%) of the 672 JPCA-certified family physicians from an online database. From the national census data, we also obtained the workplace information of board-certified general internists, surgeons, obstetricians/gynaecologists and paediatricians and of all physicians as the same-generation comparison group (ages 30 to 49). Chi-squared test and residual analysis were conducted to compare the distribution between family physicians and other specialists. Results Five hundred nineteen JPCA-certified family physicians and 137,587 same-generation physicians were analysed. The distribution of family physicians was skewed to municipalities with a lower population density, which shows a sharp contrast to the urban-biased distribution of other specialists. The proportion of family physicians in non-metropolitan municipalities was significantly higher than that expected based on the distribution of all same-generation physicians (p < 0.001). Conclusions Family physicians distributed in favour of rural areas much more than any other specialists in Japan. The better balance of family physician distribution reported from countries with a strong primary care orientation seems to hold even in a country where primary care orientation is weak, physician distribution is not regulated, and patients have free access to healthcare. Family physicians comprise only 0.2% of all Japanese physicians. However, if their population grows, they can potentially rectify the imbalance of physician distribution. Government support is mandatory to promote family medicine in Japan. |
topic |
Geography Health policy Japan Family physician |
url |
http://link.springer.com/article/10.1186/s12875-019-1040-6 |
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