New physician specialty training system impact on distribution of trainees in Japan.
Gini coefficient
Postgraduate training
Specialty training system
Uneven distribution of doctors
Journal
Public health
ISSN: 1476-5616
Titre abrégé: Public Health
Pays: Netherlands
ID NLM: 0376507
Informations de publication
Date de publication:
May 2020
May 2020
Historique:
received:
07
01
2019
revised:
13
01
2020
accepted:
07
02
2020
pubmed:
20
4
2020
medline:
20
9
2020
entrez:
20
4
2020
Statut:
ppublish
Résumé
The problem of uneven distribution of medical services and inequitable distribution of physicians is drawing much attention worldwide. Revealing how changes in the specialty training system in Japan have affected the distribution of doctors could help us understand this problem. In 2018, a new and standardized specialty training system was implemented by the Japanese Medical Specialty Board, which is recognized by the Ministry of Health, Labor and Welfare. The purpose of this study was to investigate how this new system has affected the geographical distribution of doctors commencing specialty training (trainees) and choice of specialty in Japan. Retrospective observational study. The change in the number of trainees between the control period (2012-2014) and 2018 was investigated, taking into account the prefecture and specialty selected. Population, the proportion of residents aged 65 years or older (aging rate), and the total number of overall doctors in each prefecture were considered as the background characteristics of each prefecture. We created a Lorenz curve and calculated the Gini coefficient for the distribution of trainees. In 2018, the number of trainees per 100,000 population increased to 6.6 nationwide compared with 5.5 during the control period. The number of trainees per 100,000 population in 2018 increased in prefectures with a large population of ≧ 2,000,000, a low aging rate (<27%), and a high doctor density (≧ 250 doctors per 100,000 population). The Gini coefficient showed an increase to 0.226 in 2018 compared with only 0.160 during the control period. After the implementation of the new training system, there was an increase in the number of doctors enrolling in specialty programs, and the specialties other than internal medicine and surgery have attracted more trainees. Inequality in the distribution of doctors between urban and rural prefectures worsened. This indicates the need to explore new ways of balancing distribution while maintaining optimal opportunities for specialist training.
Identifiants
pubmed: 32305513
pii: S0033-3506(20)30045-7
doi: 10.1016/j.puhe.2020.02.008
pii:
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
143-150Informations de copyright
Copyright © 2020 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.