The shortage of surgeons in Japan: Results of an online survey of qualified teaching hospitals that take part in the surgical training programs for board certification by the Japan Surgical Society

Abstract

Purpose: A collapse in regional healthcare through the maldistribution of physicians has been a long-debated issue in Japan and amidst this situation, a new system of board certification was initiated. The Japan Surgical Society (JSS) conducted a nation-wide survey to grasp the current distribution of surgeons in Japan, and their roles.

Methods: All 1976 JSS-certified teaching hospitals were invited to respond to a web-based questionnaire. The responses were analyzed to seek a solution to the current issues.

Results: Responses to the questionnaire were received from 1335 hospitals. The surgical departments of medical universities serve as an internal labor market and were the source of surgeons for most hospitals. More than 50% of teaching hospitals throughout the country claimed a shortage of surgeons even in well-populated prefectures such as Tokyo and Osaka. Hospitals rely on surgeons to cover the deficits in medical oncology, anesthesiology, and emergency medicine. These additional responsibilities were identified as significant predictors of a shortage of surgeons.

Conclusions: Surgeon shortage is a serious issue throughout Japan. Given the limited number of surgeons and surgical trainees, hospitals should make every effort to recruit specialists in the additional fields where surgeons are filling the gaps and allow surgeons to engage more in surgery.

Keywords: Board certification; Regional healthcare; Surgical training.

Fig. 1

Shortage of surgeons. The figures on the left show responses to question 15 “Do you feel there is a shortage of surgeons at your hospital?” The figures on the right show responses to question 16 “How many additional surgeons do you think your hospital needs?” a, d depict responses from all teaching hospitals that responded,b, e depict responses from all 237 main training facilities, andc, f depict responses from 1098 of 1739 partner training facilities

Fig. 2

a The proportion of hospitals in each prefecture that answered “yes, definitely” to question 15 “Do you feel there is a shortage of surgeons at your hospital?” Only data from Tokyo and Osaka are labelled.b. Response to question 19 “How do you recruit surgeons?” stratified by the prefecture. Dispatch from university was the most frequent answer in all prefectures, with one exception

Fig. 3

Duties in anesthesia. The figures on the left show responses to question 9 “What is the percentage of anesthesia conducted by a surgeon for their own surgery?” The figures on the right show responses to question 10 “What is the percentage of anesthesia conducted by a surgeon for surgery performed by other departments?”a, d depict responses from all teaching hospitals that responded,b, e depict responses from all 237 main training facilities andc, f depict responses from 1098 of 1739 partner training facilities. “Always”, “sometimes”, and “rarely” stand for > 90%, 10–90% and < 10%, respectively

Fig. 4

Duties in medical oncology. The figures show response to question 11 “What is the percentage of chemotherapy administered to their own patients by the surgeons?” a depicts responses from all teaching hospitals that responded, b depicts responses from all 237 main training facilities, and c depicts responses from 1098 of 1739 partner training facilities. “Always”, “sometimes”, and “rarely” stand for > 90%, 10–90% and < 10%, respectively

Fig. 5

Duties in the emergency room. The figures on the left show responses to question 12 “How many days a week does a surgeon receive first calls from the emergency room during the day?” The figures on the right show response to question 13 “How many days a week does a surgeon receive first calls from the emergency room at night?” a, d depict responses from all teaching hospitals that responded,b, e depict responses from all 237 main training facilities, and c, f depict responses from 1098 of 1739 partner training facilities. “Always”, “sometimes”, and “rarely” stand for “almost every day”, “a few days a week” and “rarely”, respectively

Fig. 6

Responses to question 16 “How could the shortage of surgeons at your hospital be resolved?” are shown. The responders were allowed to choose more than one from the list of alternatives