Trend in geographic distribution of physicians in Japan

Abstract

Background: Since the late 1980s, the policy of the Japanese government regarding physician manpower has been to decrease the number of medical students. However, the shortage of doctors in Japan has become a social problem in recent years. The aim of this study was to compare the numbers of physicians in Japan between 1996 and 2006 and the trends in distribution of physicians.

Methods: The time trends in number and distribution of physicians between 1996 and 2006 were analyzed. Gini coefficient, Atkinson index and Theil index were used as measures for mal-distribution of physicians to population. The distribution of physicians was visualized on a map by using geographic information system (GIS) software.

Results: The total number of physicians increased every year in the period from 1996 to 2006 but has remained below the international standard. All three measures of mal-distribution of physicians worsened after 2004, and the worsening was remarkable in the distribution of physicians working at hospitals. The number of physicians working at hospitals has significantly increased in urban areas but not in areas with low population densities. When medical interns were excluded from calculation, the measures of mal-distribution improved.

Conclusion: The problem of a doctor shortage in Japan is linked to both the shortage of absolute number of physicians and the mal-distribution of hospital physicians. The new postgraduate internship system might worsen this situation.

Figure 1

Year-to-year trends in numbers of physicians in Japan. Numbers of physicians practicing at general hospitals (open circles), university hospitals (open triangles) and clinics (crosses) in six time periods are shown (A). Increment ratios in numbers of physicians compared with those in 1996 are also shown (B).

Figure 2

Year-to-year trends in Gini coefficient, Atkinson index and Theil index for distribution of physicians. Measures of mal-distribution for physicians practicing at hospitals, general hospitals and clinics and total number of physicians in six time periods between 1996 and 2006 are shown.

Figure 3

Changes in number of physicians from 2002 to 2006. Differences in numbers of physicians between 2002 and 2006 were plotted on 10-km mesh maps. Distribution of population (A) and increases in number of physicians working at general hospitals (B), number of physicians practicing at university hospitals (C), number of physicians practicing at their own clinics (D) and total number of physicians are shown.