Geographical distribution of family physicians in Japan: a nationwide cross-sectional study

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...

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Autores principales: Yoshida, Shuhei, Matsumoto, Masatoshi, Kashima, Saori, Koike, Soichi, Tazuma, Susumu, Maeda, Takahiro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6819408/
https://www.ncbi.nlm.nih.gov/pubmed/31664903
http://dx.doi.org/10.1186/s12875-019-1040-6
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author Yoshida, Shuhei
Matsumoto, Masatoshi
Kashima, Saori
Koike, Soichi
Tazuma, Susumu
Maeda, Takahiro
author_facet Yoshida, Shuhei
Matsumoto, Masatoshi
Kashima, Saori
Koike, Soichi
Tazuma, Susumu
Maeda, Takahiro
author_sort Yoshida, Shuhei
collection PubMed
description 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.
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spelling pubmed-68194082019-10-31 Geographical distribution of family physicians in Japan: a nationwide cross-sectional study Yoshida, Shuhei Matsumoto, Masatoshi Kashima, Saori Koike, Soichi Tazuma, Susumu Maeda, Takahiro BMC Fam Pract Research Article 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. BioMed Central 2019-10-29 /pmc/articles/PMC6819408/ /pubmed/31664903 http://dx.doi.org/10.1186/s12875-019-1040-6 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Yoshida, Shuhei
Matsumoto, Masatoshi
Kashima, Saori
Koike, Soichi
Tazuma, Susumu
Maeda, Takahiro
Geographical distribution of family physicians in Japan: a nationwide cross-sectional study
title 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_short 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
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6819408/
https://www.ncbi.nlm.nih.gov/pubmed/31664903
http://dx.doi.org/10.1186/s12875-019-1040-6
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