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. 2018 Jun 1;13(6):e0198317.
doi: 10.1371/journal.pone.0198317. eCollection 2018.

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

Masatoshi Matsumoto  1 , Kazuki Kimura  1 , Kazuo Inoue  2 , Saori Kashima  3 , Soichi Koike  4 , Susumu Tazuma  5
Affiliations

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

Masatoshi Matsumoto et al. PLoS One. .

Abstract

Background: The disparity in the number of urban and rural physicians is a social problem in Japan. There may also be a disparity in the age of physicians. This study longitudinally examines both geographic and age distributions of physicians.

Methods: Individual data from the Survey of Physicians, Dentists and Pharmacists in 1994, 2004 and 2014 and municipality data from the National Population Census were used. The 2015 municipality border was applied to all years, and all municipalities were classified into equal-size quintiles based on population density. Both municipalities and physicians were longitudinally observed.

Results: Between 1994 and 2014, the number of physicians per 100,000 population increased by 31.8% in the most urban group of municipalities and 17.4% in the most rural group. The average age of physicians was highest in the most rural and lowest in the most urban group. The difference in average age between the urban and rural physicians widened from 2.1 years in 1994 to 6.0 years in 2014. This disparity is particularly pronounced among hospital physicians (from 1.5 years in 1994 to 7.6 years in 2014). In the most rural group, the number of hospital physicians younger than 40 years old has decreased by 59.4%, while the number of those 55-70 has grown by 153% and the number older than 70 years old by 41.0%. Between 1994 and 2004, only 23.0% of hospital physicians younger than 40 years old were retained in the most rural group; the retention rate fell to 19.3% between 2004 and 2014, while the rates increased in older physicians.

Conclusions: The uneven distribution of physicians is increasing in Japan, as is the aging of rural hospital physicians. Shortage of physicians in rural areas may be more serious than that shown as their headcount.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Age composition of physicians (A: Number; B: Proportion).
Fig 2
Fig 2. Population, population density and average age of physicians in each municipality in 2014.
Fig 3
Fig 3. Number of physicians per 100,000 population in each quintile of municipalities (A: Total; B: Hospital; C: Clinic physicians).
Fig 4
Fig 4. Average age of physicians in each quintile of municipalities (A: Total; B: Hospital; C: Clinic physicians).
Fig 5
Fig 5. Age-specific number of hospital physicians (A) and clinic physicians (B).
Fig 6
Fig 6. Age-specific number of hospital physicians in each quintile of municipalities.
See this image and copyright information in PMC

References

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    1. Matsumoto M, Inoue K, Takeuchi K. Quality of care in Japan: an additional strategy. Lancet. 2011;378(9807):e17 doi: 10.1016/S0140-6736(11)61841-2 - DOI - PubMed
    1. Kobayashi Y, Takaki H. Geographic distribution of physicians in Japan. Lancet 340: 1391–1393. - PubMed
    1. Matsumoto M, Inoue K, Bowman R, Noguchi S, Toyokawa S, Kajii E. Geographical distributions of physicians in Japan and US: Impact of healthcare system on physician dispersal pattern. Health Policy 2010;96(3):255–261. doi: 10.1016/j.healthpol.2010.02.012 - DOI - PubMed
    1. Inoue K, Matsumoto M. Japan’s new postgraduate medical training system. Clinical Teacher. 2004;1(1):39–41.

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