The distance and chance of lifetime geographical movement of physicians in Japan: an analysis using the age-period-cohort model

BACKGROUND: The uneven geographical distribution of physicians in Japan is a result of those physicians electing to work in certain locations. In order to understand this phenomenon, it is necessary to analyze the geographic movement of physicians across the Japanese landscape. METHODS: We obtained individual data on physicians from 1978 to 2012 detailing their attributes, work institutions, and locations. The data are from Japanese governmental sources (the Survey of Physicians, Dentists, and Pharmacists). The total sample size was 122 150 physicians, with 77.5% being male and 22.5% female. After obtaining the data, we calculated the geographical distance of each physician’s movement by using geographic information systems software (GIS; ArcGIS, ESRI, Inc., CA, USA). Geographical distance was then converted into time distance. We compared the resulting median values through nonparametric testing and then conducted a multivariate analysis. Our next step involved the use of an age-period-cohort (APC) model to measure the degree of impact three points of data, experience (experience years), the historical and environmental context of the data (survey year), and physician cohort (registration year) had on the movement of each physician. RESULTS: The ratio of female physicians who selected an urban area as their first working location was higher than that of male physicians. However, the selection of an urban area was becoming more popular as a first working location for both males and females as the year of data increased. The overall distance of geographical movement for female physicians was less than it was for male physicians. Physicians moved the greatest distance between their second and fourth years following license acquisition, at which point the time distance became shorter. The median time distance was 46 min in 2000 and 22 min in 2008. The physicians in our study did not move far from their first working location, and the overall distance of movement lessened in the more recent years of study. The median distance of movement after 20 years was 25.9 km for male physicians, and 19.1 km for female physicians. The results of the APC model indicated that the effects of experience years (age) gradually declined, that the survey year (period) effects increased, and that the registration year (cohort) effects increased initially before leveling off. CONCLUSIONS: The trends following the introduction of the new mandatory training system in 2004 may imply that the concentration of physicians in Japan’s urban areas is expected to increase. After 2000, the effect of that period on physicians explains their geographical movements more so than the factor of their age.