Aging of hospital physicians in rural Japan: A longitudinal study based on national census data

Geographical Disparities in the Distribution of Community Pharmacies Providing Aseptic Preparation Services in Japan

Purpose

Providing medical, nursing, and welfare services in each community is becoming increasingly important as population ages in Japan, and the demand for aseptic preparation in community pharmacies is expected to increase. In this study, the disparity in the distribution of community pharmacies providing aseptic preparation services were examined to explore how the unequal distribution of the pharmacies can be improved in the future.

Methods

The regional inequality of community pharmacies providing aseptic preparation services was evaluated using Gini coefficients. The regional distribution was evaluated using a geographic information system application.

Results

Only 8.0% of all insurance community pharmacies in Japan provided aseptic preparation services. The Gini coefficient of pharmacies providing aseptic preparation services for the total population of each municipality was 0.410. The population coverage, within 16 km of pharmacies providing aseptic preparation services, was 96.5% of the total population. The residential grid coverage, within 16 km of the pharmacies, was 75.2% of the total network, approximately one quarter not covered. It is estimated that the coverage ratios will improve by some percentage by 2050, although the projected population in 2050 is expected to decrease by approximately 20%.

Conclusion

The current number and distribution of pharmacies providing aseptic preparation services are inadequate, and measures need to be taken to avoid future problems.

Primary care physicians working in rural areas provide a broader scope of practice: a cross-sectional study

BACKGROUND

Scope of practice (SoP) is an important factor for primary care physicians (PCPs). One of the strong determinants of SoP is rurality. Although Japan has several rural areas, the SoP in rural areas and the effect of rurality on SoP have not been investigated. This study aimed to describe SoP in Japanese primary care settings and examine the association between rurality and SoP.

METHODS

This cross-sectional study included PCPs in Japan. The participants were randomly sampled from the mailing list of the Japan Primary Care Association. The Scope of Practice Inventory (SPI) and Scope of Practice for Primary Care (SP4PC) were used as indicators of SoP. The Rurality Index for Japan (RIJ) was used for rurality. This study compared the number of items of SPI (total score, inpatient care, urgent care and ambulatory care) and SP4PC experienced by > 80% of all PCPs in the most urban (RIJ:1-10) and rural areas (RIJ: 91-100). A multivariable linear regression analysis was also performed to examine the relationship between the RIJ and SPI/SP4PC.

RESULTS

Of 1,000 potential participants, 299 physicians responded to the survey (response rate: 29.9%). PCPs in the most rural areas experienced a greater number of items in the inpatientl/urgent care domains of the SPI and SP4PC than those in the most urban areas. The RIJ was the only common factor for a broader SoP in both the SPI and SP4C models. The coefficients of SoP were 0.09 (95% confidence interval: 0.03-0.16) in the SPI model and 0.017 (0.005-0.03) in the SP4PC model.

CONCLUSION

Rurality was considerably associated with SoP. The findings of this study will be helpful in understanding the SoP on rural and urban areas.

Using national census data to facilitate healthcare research

National censuses are conducted at varying intervals across both the developed and developing world and collect detailed data on a wide range of societal, economic and health questions. This immense volume of data has many potential uses in the field of healthcare research and can be utilised either in isolation or in conjunction with other information sources such as hospital records. At a governmental level census data can be used for healthcare service planning by providing accurate population density information but also, through the use of more detailed data collection, by helping to identify high-risk populations that may require increased resource allocation. It can also be a key tool in addressing and improving healthcare inequality and deprivation by both identifying those populations with poorer healthcare outcomes and through helping researchers to better understand the causes of this inequality. Similarly, it has utility when studying the complex causes of disease and assessing the success of strategies designed to tackle these aetiologies. However, the maximum benefit from these various uses can only be realised if the data collection and analysis processes utilised are robust and this requires that census bureaus regularly review and modify their methods in a transparent and thorough way.

Gender difference of geographic distribution of physicians in Japan: three-point analysis of 1994, 2004 and 2014

BACKGROUND

Japan's medical education system produces 9,000 graduates annually. Despite the government's implementation of several strategies, including increasing the number of doctors trained, the country still struggles with a shortage of physicians in rural areas. This study examined this issue, focusing on gender and considering years of physician experience, demographic and geographic factors.

METHODS

We analyzed the Physician Census from 1994, 2004, and 2014, examining data on physicians' gender and the number of years since licensure. To correct the impact of municipal mergers, the analysis was aligned with the number of municipalities in 2014 (1741). We examined data from each physician (gender and years of medical experience) and analyzed the demographic and geographic distribution trend using Spearman correlation coefficients. We then used the Gini coefficient to evaluate the distribution change of physicians based on gender and years of experience.

RESULTS

The number of physicians increased 1.29-fold over the 20-year observation period (1.23-fold for male physicians and 2.17-fold for female physicians), and the percentage of female physicians increased from 13.4% to 20.4%. We found that 87.7% of physicians were concentrated in the top 1/3 municipalities in terms of population. The number of female physicians was higher at 91.8% compared to 86.8% for male physicians. The Gini coefficients were lower for veteran physicians of both sexes than for younger physicians. The Gini coefficient for all physicians was 0.315-0.298-0.298 (male physicians: 0.311-0.289-0.283, female physicians: 0.394-0.385-0.395) The Gini coefficients for female compared to male physicians were higher in all age groups, showing that The distribution of female physicians is skewed toward urban areas.

CONCLUSION

Female physicians are less distributed in rural areas than male physicians. In addition, despite the fact that the number of female physicians has increased more than male physicians over the past 20 years, the geographic ubiquity of female physicians has not improved. Since the trend of increasing the number of female physicians is expected to continue in the future, it is necessary to take some measures, such as providing a work-life balance suitable for female physicians.

The Effectiveness of the Multiple-Attending-Physicians System Compared With the Single Attending-Physician System in Inpatient Setting: A Mixed-Method Study

OBJECTIVES

Medical facilities have been required to effectively utilize insufficient human resources in many countries. Therefore, we qualitatively and quantitively compared physicians' working burden, and assessed advantages and disadvantages of the single- and the multiple-attending physicians systems in inpatient care.

METHODS

In this cross-sectional study, we extracted electronic health record of patients from a hospital in Japan from April 2017 to October 2018 to compare anonymous statistical data between the single-attending and multiple-attending-physicians system. Then, we conducted a questionnaire survey for all physicians of single and multiple-attending systems, asking about their physical and psychiatric workload, and their reasons and comments on their working styles.

RESULTS

The average length of hospital stay was significantly shorter in the multiple-attending system than in the single-attending system, while patients' age, gender, and diagnoses were similar. From the questionnaire survey, no significant difference was found in all categories although physical burden in multiple-attending system tended to be lower than that in single-attending system. Advantages of multiple-attending system extracted from qualitative analysis are (1) improvement of physicians' quality of life (QOL), (2) lifelong-learning effect, and (3) improving the quality of medical care, while disadvantages were (1) risk of miscommunications, (2) conflicting treatment policies among physicians, and (3) patients' concern.

CONCLUSIONS

The multiple-attending physician system in the inpatient setting can reduce the average length of stay for patients and also reduce the physical burden on physicians without compromising their clinical performance.

Improvement in Quality of Life through Self-Management of Mild Symptoms during the COVID-19 Pandemic: A Prospective Cohort Study

The COVID-19 pandemic has inhibited people's help-seeking behaviors (HSBs). In particular, older people in rural communities experienced limited access to medical care, which negatively affected their quality of life (QOL). Within HSB, self-management of mild symptoms may mitigate the difficulties experienced by older people in rural communities. However, few studies have examined the relationship between self-management and QOL. Therefore, we conducted a prospective cohort study to clarify this relationship. Our participants were over 65 years of age and lived in rural communities. QOL was measured with the EuroQol 5-Dimension 5-Level (EQ-5D-5L). Demographic data and QOL were collected from participants via questionnaires in 2021 and 2022. The exposure group showed a significantly greater change in EQ-5D-5L health status index scores than the control group (p = 0.002). In addition, the exposure group scored significantly lower than the control group on the EQ-5D-5L dimension "usual activities" in 2021 and on all dimensions in 2022. Thus, self-management of mild symptoms may improve QOL among older people in rural communities during the COVID-19 pandemic. Educational interventions for this population regarding self-management could improve QOL for entire communities.

Spinal Cord Injury in Middle-aged and Older Adults Who Had Undergone Active Rehabilitation Treatment at a Remote Hospital: A Case Series

Background:

Middle-aged and older individuals with spinal cord injury (SCI) often require long-term care even after receiving rehabilitation treatment, making it difficult for them to return home. We retrospectively investigated our active rehabilitation treatment for patients with SCI.

Case:

Included in this case series were ten patients with SCI who were admitted to our general hospital (located in the southern part of Wakayama Prefecture) and who underwent active rehabilitation treatment. The participants were investigated retrospectively by access to electronic medical records. The Barthel index scores for discharged patients were determined at an outpatient clinic, and the community phase of rehabilitation management was recorded. The average age of the 10 patients was 67.4 ± 13.4 years, and the average period from onset to transfer to our hospital was 102.6 ± 69.9 days. The Barthel index scores significantly improved from 39.0 ± 30.9 at admission to 65.0 ± 28.2 at discharge (P<0.05). Among the seven patients who were discharged to their homes, six had cervical SCI. Some patients with American Spinal Injury Association impairment scale grades A and B at admission could be discharged home, and their Barthel index scores were maintained after discharge.

Discussion

: Even in a remote rural hospital, the activities of daily living of patients with SCI improved, and seven of the ten patients were discharged home. The activities of daily living of the discharged patients were maintained. To achieve these results, active rehabilitation treatment conducted by rehabilitation specialists is important.

Effect of Residents-as-Teachers in Rural Community-Based Medical Education on the Learning of Medical Students and Residents: A Thematic Analysis

Residents-as-teachers (RaT) is a theoretical framework emphasizing the significance of the similar learning background of teachers and learners. In Japan, community-based medical education (CBME) is a practical approach to teaching family medicine. This study aimed to investigate the impact and challenges of RaT on the learning of medical students and residents in CBME at a rural community hospital in Japan. Over the course of a year, the researchers conducted one-on-one interviews with three residents and ten medical students participating in family medicine training at the hospital. The interviews were recorded and transcribed verbatim. Grounded theory was used in the data analysis to clarify the findings. Three key themes emerged from the research: lack of educational experience with RaT, effectiveness of RaT, and challenges of RaT. Although participants were prejudiced against RaT, they felt its implementation could facilitate the establishment of beneficial relationships between learners and teachers. They were also able to participate in medical teams effectively. The findings suggest that the increased participation of senior doctors in RaT could strengthen its learning effects. RaT in rural CBME should be applied in various contexts, and its effectiveness should be further investigated both qualitatively and quantitatively.

The use of information and communication technology in Japanese rural clinics

High-speed information and communication technology (ICT) networks stretch all over Japan. However, their utility in facilitating rural healthcare remains uncharacterized. A nationwide questionnaire survey was sent by mail to 1,018 rural clinics constructed in a public manner in municipalities throughout Japan. ICT use was classified by type, including a doctor-to-doctor manner. Only 19% of the 303 clinics surveyed (with a response rate of 30%) used ICT. Specifically, 50% used it in a doctor-to-doctor manner, while 35% used it to obtain electronic medical records. Differences in proficiency levels among ICT users were cited by 21% of the respondents as a major problem associated with ICT use. In Japan, the prevalence of ICT use for rural healthcare appeared low. We suggest a policy reform to facilitate ICT use in rural healthcare.

The Association between the Self-Management of Mild Symptoms and Quality of Life of Elderly Populations in Rural Communities: A Cross-Sectional Study

Maintaining people’s health based on their help-seeking behavior (HSB) regarding mild symptoms is essential. An effective HSB, especially self-management, can facilitate the attainment of appropriate healthcare resources and affect health outcomes such as quality of life (QOL). However, clear evidence regarding the relationship between self-management, mild symptoms, and QOL is unavailable. Therefore, this cross-sectional study investigated this association in a rural elderly population. The participants, aged over 65 years, were living in rural communities. The primary outcome of QOL was examined using the EuroQol 5-Dimension 5-Level (EQ-5D-5L). After adjusting for propensity score matching, 298 participants in the self-management usage group were matched with 298 in the group not using self-management. The most frequent HSB trend was consulting with primary care physicians, followed by self-care, consulting with families, utilizing home medicines, and buying medicines. The EQ-5D-5L scores were statistically higher in the self-management usage group than in the other group. The HSBs with a trend of using self-management were related to a high QOL. Self-management of symptoms along with other HSBs can improve elderly HSBs in rural contexts. Educational interventions and system development for HSBs in rural contexts could be effective in enhancing the QOL of rural elderly populations.

Distribution and Retention Trends of Obstetricians and Gynecologists in Japan: A Longitudinal Study

Introduction:

This longitudinal study aimed to investigate the distribution and retention of obstetricians and gynecologists in Japan.

Methods:

I used descriptive statistics and multivariate logistic regression to analyze data from National Census surveys administered during 1996-2016.

Results:

Between 1996 and 2016, the number of obstetricians and gynecologists increased by 6% and urban physicians by 15%, whereas the number of rural physicians decreased by 25%. The annual retention rate, which was calculated using the square root of the biannual rates [the number of physicians still working as obstetricians and gynecologists at the time of the subsequent survey (e.g., in 1998) divided by the number of obstetricians and gynecologists in the original survey (e.g., in 1996)], was >90%. Obstetricians and gynecologists were less likely to continue to work as obstetricians and gynecologists after 30-44 years of experience (1996-2006 cohort: OR = 0.20, 95% CI = 0.17-0.25; 2006-2016 cohort: OR = 0.32, 95% CI = 0.25-0.41) and >45 years of experience (1996-2006 cohort: OR = 0.14, 95% CI = 0.11-0.17; 2006-2016 cohort: OR = 0.11, 95% CI = 0.08-0.15). The odds were lower for rural obstetricians and gynecologists (1996-2006 cohort: OR = 0.65, 95% CI = 0.51-0.82; 2006-2016 cohort: OR = 0.59, 95% CI = 0.43-0.80). As the number of female physicians increased, the number of practicing obstetricians and gynecologists also increased. In 2004, the mandatory postgraduate clinical training that was newly implemented caused a drop in the number of young doctors; however, this reversed in 2006. Rural to urban migration was steady, and the working hours were consistently long. To stabilize high retention rates, the working environments need to be improved.

Conclusions:

The present study clearly indicated the trend of the distribution of obstetricians and gynecologists in Japan. The result may be especially important for the health policy making in Japan.

A Longitudinal Survey of Postgraduate Residency Hospital Type and Career Paths in Japan (1996-2016)

Objective

To analyze the relationship between postgraduate residency hospital type and career paths in Japan.

Methodology

A longitudinal study based on secondary data collected from the national physician census was conducted in Japan. The sample comprised 3,991 residents for the 1996-2006 cohort and 6,153 residents for the 2004-2014 cohort.

Results

The percentage of residents who trained at university hospitals in their first year of registration decreased dramatically from 70% to 40% due to the 2004 mandatory clinical training reform. In contrast, the percentage of physicians working at university hospitals in their third year of registration increased from 20% to around 40%. Further, the number of physicians who had not worked at university hospitals during their first 10 years increased from 12% in 2004 to 18% in 2014.

Conclusions

Since the introduction of the mandatory postgraduate clinical training, residents’ career paths have changed based on the residency hospital type that they attended. The resident shortage at university hospitals remains a longstanding issue in Japan.

Comprehensive Care through Family Medicine: Improving the Sustainability of Aging Societies

Comprehensive care through family medicine can enhance the approach to multimorbidity, interprofessional collaboration, and community care, and make medical care more sustainable for older people. This study investigated the effect of implementing family medicine and the comprehensiveness of medical care in one of the most rural communities. This implementation research used medical care data from April 2015 to March 2020. Patients' diagnoses were categorized according to the 10th revision of the International Statistical Classification of Disease and Related Health Problems (ICD-10). In 2016, family medicine was implemented in only one general hospital in Unnan. The comprehensiveness rate improved in all ICD-10 disease categories during the study period, especially in the following categories-infections; neoplasms; endocrine, nutritional, and metabolic diseases; mental disorders; nervous system; circulatory system; respiratory system; digestive system; skin and subcutaneous tissue; musculoskeletal system and connective tissue; and the genitourinary system. Implementing family medicine in rural Japanese communities can improve the comprehensiveness of medical care and resolve the issue of fragmentation of care by improving interprofessional collaboration and community care. It can be a solution for the aging of both patient and healthcare professionals. Future research can investigate the relationship between family medicine and patient health outcomes for improved healthcare sustainability.

Nursing activities at clinics in rural areas in Japan: gaps between recognition of importance and implementation

This study determined the level of implementation and the importance placed on various nursing activities at clinics in rural areas of Japan in order to explore the achievement and perceived importance of implementing certain nursing roles and activities at such clinics. To identify these items, a questionnaire was administered to 40 nurses working in rural clinics. The results showed that activities related to “Basic Nursing Practice” and “Community Understanding” were recognized as important and were performed by almost all nurses. Some activities related to “Administration and Operation” and “Cooperation with Local Government” were recognized as important, but were not implemented, thereby hampering the continuum of care across the health system. These activities, which are related to collaboration with hospitals and local governments that support the clinics, included adjustment of staff inside and outside the facilities to guarantee the use of paid holidays, as well as collaboration with acute care, remote medical systems, and local governments during emergencies and for disaster preparation. Additional support for nurses in collaboration between clinics in rural areas, hospitals, and regional administrations that support the clinics remains a challenge to be addressed.

The Contribution of Citizens to Community-Based Medical Education in Japan: A Systematic Review

Community-based medical education (CBME) offers vital support to healthcare professionals in aging societies, which need medical trainees who understand comprehensive care. In teaching comprehensive care practices, CBME can involve citizens from the relevant community. This research synthesizes the impact of the involvement of communities on the learning of medical trainees in CBME. We conducted a systematic review, in which we searched ten databases from April 1990 to August 2020 for original articles in Japan regarding CBME involving citizens and descriptively analyzed them. The Kirkpatrick model was used to categorize the outcomes. Our search for studies following the protocol returned 1240 results; 21 articles were included in this systematic review. Medical trainees reported satisfaction with the content, teaching processes, and teachers' qualities. Medical trainees' attitudes toward community and rural medicine improved; they were motivated to become family physicians and work in communities and remote areas. This review clarified that citizen involvement in CBME had an effective impact on medical trainees, positively affecting perceptions of this type of education, as well as improving trainees' knowledge about and attitude toward community and rural medicine.

Temporal trends of physician geographical distribution and high and intermediate physician density areas and factors related to physicians' movement to low physician density areas in Japan: a longitudinal study (1996-2016)

OBJECTIVES

A major issue in Japan's health policy is the geographical maldistribution of physicians. This study aimed to analyse temporal trends in the geographical distribution of physicians and analyse physicians in high and intermediate physician density areas and factors related to their movement to low physician density areas in Japan.

DESIGN

A longitudinal study.

SETTING

All physicians in 344 secondary medical districts.

PARTICIPANTS

I analysed data from the biennial national census, conducted by the Ministry of Health, Labour and Welfare between 1996 and 2016 and and divided it into two cohorts of 10 years each: 1996-2006 and 2006-2016.

PRIMARY AND SECONDARY OUTCOME MEASURES

I estimated the temporal trends in the number and percentages of physicians, and used logistic regression to analyse physicians in high and intermediate physician density areas and the factors related to their movement to low physician density areas.

RESULTS

The overall number of Japanese doctors increased by 31% between 1996 and 2016. The number of physicians per population in the physician high-density areas increased by 29%, while those in low-density areas increased by 32%, suggesting that the gap between areas marginally decreased. The multivariable logistic regression analyses revealed that academic hospital experience had the highest OR for predicting physician movement to low physician density areas after 10 years, both in the 1996 and 2006 cohorts. Other factors that positively correlated with physician movement were being male, being younger than 40 years, being qualified after the age of 30, urban area, intermediate physician density area and practice in a non-academic hospital.

CONCLUSIONS

As less-experienced physicians demonstrate high mobility among geographic categories, and retention rates are low in low physician density areas, especially for less-experienced physicians, a new system that considers these factors would create opportunities for younger physicians to work in low-density areas.

Perceptions of Residents among Rural Communities with Medical Group Practice in Japan

Elucidating the perceptions of residents regarding medical group practice (GP) among rural communities (GP-R) in Japan will be useful for establishing this system in such communities. A survey by questionnaire, as made by experts in rural health, was conducted in 2017. The self-administered questionnaire inquired about the perceptions of residents for accepting the GP-R into the community’s healthcare using seven major elements of GP-R. The questionnaire was randomly distributed to 400 adult residents who lived in rural communities with a recently launched GP and had access to clinics within the communities. Among the 321 respondents, comparisons were made between younger (≤sixties) and older (≥seventies) residents, and a stepwise multiple regression analysis was performed to extract the factors influencing acceptance of the GP-R system. The results showed that older residents had a greater disapprove of being treated by different physicians daily or weekly in clinics (p < 0.001) and the use of telemedicine (p < 0.001) compared with younger residents. Younger residents showed a greater disapproval of clinics closing on weekdays than older residents (p = 0.007). Among all respondents, regardless of age groups, over half of residents approved of the involvement of nurse practitioners in the GP-R. Living with family and children was also extracted as an independent factor influencing a positive perception of the GP-R. These data suggest that the promotion of GP-R should consider generation gaps in the approach to medical practice as well as the family structures of residents. The involvement of nurse practitioners can also encourage the acceptance of GP-R in Japan.

Time changes in the geographical distribution of physicians and factors associated with starting rural practice in Japan

PURPOSE

The geographical maldistribution of physicians is an important issue for health policy. This study aimed to evaluate recent trends in Japan and identify the factors associated with starting a rural practice.

METHODS

A longitudinal study was conducted using secondary analysis of national census data. The number of physicians in each region was described in 1996, 2006, and 2016 and, for two cohorts, 1996 to 2006 and 2006 to 2016; a logistic regression analysis was used to identify factors related to starting a rural practice after 10 years.

FINDINGS

Between 1996 and 2016, the number of physicians in rural areas increased by 4%. Results of the logistic regression analysis showed that, in both cohorts, the factor with the highest odds ratio for starting a rural practice after 10 years was initial academic hospital experience. Other factors showing positive correlations were additional hospital practice and being qualified and over 30 years old, whereas female sex and aged at least 40 years had negative correlations.

CONCLUSIONS

From 1996 to 2016, despite the increase in the total number of physicians, geographical maldistribution increased. Some findings support the policy that some physicians should work in rural areas in return for scholarships.

Geographic Distribution of Regional Quota Program Graduates of Japanese Medical Schools: A Nationwide Cohort Study

PURPOSE

To show the practice location of graduates from two Japanese programs recruiting physicians to rural areas: a regional quota program of medical schools and a prefecture scholarship program (a prefecture is an administrative geographic division). Graduates of each program must work in a designated rural prefecture for a fixed period.

METHOD

A nationwide cohort study was conducted for three groups of participants graduating between 2014 and 2016: quota graduates without scholarship (quota alone), nonquota graduates with scholarship (scholarship alone), and quota graduates with scholarship. A questionnaire was sent via medical school or prefecture office to each potential subject to collect baseline individual data, including home prefecture and graduation year. Data were connected through physician identification number to the Physician Census 2016 of the Ministry of Health, Labour and Welfare to identify the subjects' practice location and compared with data for other physicians in the census. Comparisons were conducted with Mann-Whitney and chi-square tests.

RESULTS

The proportion of physicians working in nonmetropolitan municipalities for quota alone (185/244; 75.8%), scholarship alone (305/363; 84.0%), and quota with scholarship (341/384; 88.8%) was significantly higher than for other physicians (13,299/22,906; 58.1%). Median population density of the municipalities where subjects worked for quota alone (1,042.4 persons per square kilometer), scholarship alone (613.5), and quota with scholarship (547.4) was significantly lower than that for other physicians (3,214.0). These disparities increased with number of years since graduation.

CONCLUSIONS

The regional quota and prefecture scholarship programs succeeded in producing physicians who practiced in rural areas of Japan.

Scholarly Activity Support Systems in Internal Medicine Residency Programs: A National Representative Survey in Japan

Objective To describe the clinical research support systems in Japanese board certification programs of internal medicine and to assess the relationship between these support systems and the scholarly activities of residents. Methods In 2018, a 26-item web questionnaire was mailed to 542 points of contact of hospitals listed as certified residency programs of internal medicine in order to obtain information about the presence of a research support system and scholarly activity from 2016. We used hospital characteristic data from the Japanese Diagnostic Procedure Combination database, a national inpatient database, and the annual report of the Japanese Society of Internal Medicine. Results A total of 228 hospitals (42%) responded to the survey. There were regular research lectures in 129 hospitals (57%), protected time (time to perform research during working hours) in 53 hospitals (23%), research consultations in 175 hospitals (77%), regular journal clubs in 213 hospitals (77%), regular research conferences in 151 hospitals (66%), data warehouses in 139 hospitals (61%), and financial research support from the hospital budget in 140 hospitals (61%). A multivariate analysis showed that none of the research support systems were related to the number of conference presentations. In contrast, protected time [odds ratio (OR) 3.66, 95% confidence interval (CI) 1.43-9.39] and regular research conferences (OR 2.20, 95% CI 1.14-4.23) were related to the presence of clinical research presentations in scientific conferences hosted by residents. Conclusion Protected time and regular research conferences were related to the scholarly activity of residents in Japanese teaching hospitals.

Future projection of the physician workforce and its geographical equity in Japan: a cohort-component model

INTRODUCTION

The geographical inequity of physicians is a serious problem in Japan. However, there is little evidence of inequity in the future geographical distribution of physicians, even though the future physician supply at the national level has been estimated. In addition, possible changes in the age and sex distribution of future physicians are unclear. Thus, the purpose of this study is to project the future geographical distribution of physicians and their demographics.

METHODS

We used a cohort-component model with the following assumptions: basic population, future mortality rate, future new registration rate, and future in-migration and out-migration rates. We examined changes in the number of physicians from 2005 to 2035 in secondary medical areas (SMAs) in Japan. To clarify the trends by regional characteristics, SMAs were divided into four groups based on urban or rural status and initial physician supply (lower/higher). The number of physicians was calculated separately by sex and age strata.

RESULTS

From 2005 to 2035, the absolute number of physicians aged 25-64 will decline by 6.1% in rural areas with an initially lower physician supply, but it will increase by 37.0% in urban areas with an initially lower supply. The proportion of aged physicians will increase in all areas, especially in rural ones with an initially lower supply, where it will change from 14.4% to 31.3%. The inequity in the geographical distribution of physicians will expand despite an increase in the number of physicians in rural areas.

CONCLUSIONS

We found that the geographical disparity of physicians will worsen from 2005 to 2035. Furthermore, physicians aged 25-64 will be more concentrated in urban areas, and physicians will age more rapidly in rural places than urban ones. The regional disparity in the physician supply will worsen in the future if new and drastic measures are not taken.