Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Sep 17;8(9):e023696.
doi: 10.1136/bmjopen-2018-023696.

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

Koji Hara  1   2 , Susumu Kunisawa  1 , Noriko Sasaki  1 , Yuichi Imanaka  1
Affiliations

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

Koji Hara et al. BMJ Open. .

Abstract

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.

Keywords: Japan; aged physician; female physician; future projection; geographic distribution.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
The concept of the two-region gross migration model for group 1.
Figure 2
Figure 2
Physician workforce pyramids for the four area groups in 2005, 2015, 2025 and 2035.
Figure 3
Figure 3
Estimated trends in the number of physicians from 2005 to 2035.
Figure 4
Figure 4
Estimated trends in the number of physicians per 100 000 population from 2005 to 2035.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Shinjo D, Aramaki T. Geographic distribution of healthcare resources, healthcare service provision, and patient flow in Japan: a cross sectional study. Soc Sci Med 2012;75:1954–63. 10.1016/j.socscimed.2012.07.032 - DOI - PubMed
    1. Toyabe S. Trend in geographic distribution of physicians in Japan. Int J Equity Health 2009;8:5 10.1186/1475-9276-8-5 - DOI - PMC - PubMed
    1. Anand S, Fan VY, Zhang J, et al. . China’s human resources for health: quantity, quality, and distribution. Lancet 2008;372:1774–81. 10.1016/S0140-6736(08)61363-X - DOI - PubMed
    1. Morris S, Sutton M, Gravelle H. Inequity and inequality in the use of health care in England: an empirical investigation. Soc Sci Med 2005;60:1251–66. 10.1016/j.socscimed.2004.07.016 - DOI - PubMed
    1. Isabel C, Paula V. Geographic distribution of physicians in Portugal. Eur J Health Econ 2010;11:383–93. 10.1007/s10198-009-0208-8 - DOI - PubMed

Publication types

LinkOut - more resources