Abstract
BackgroundThe board certification system serves as a quality assurance system for physicians, and its design and operation are important health policy issues. In Japan, board certification was established and operated independently by academic societies and has not been directly linked to reimbursement systems. The phenomenon of younger physicians seeking specialist careers has raised concerns about acceleration of the tendency of fewer physicians working in rural areas and the maldistribution of physicians. Little is known about the associations between physicians’ geographical migration patterns and board certification status changes or between the continuation of urban/rural practice and the maintenance of board certification. This study aimed to identify these associations and to discuss their policy implications.MethodsWe analyzed 2012 and 2014 data from the Survey of Physicians, Dentists, and Pharmacists, a national census survey. To analyze geographical migration patterns, transitions in practice location (rural, intermediate, and urban) were analyzed by board certification status change (new, lost, consistently certified, and consistently uncertified). Logistic regression analysis was conducted to assess whether the odds of migrating to more urban/rural municipalities were associated with board certification status changes, adjusting for covariates, and whether practicing in a rural area was associated with maintaining board certification.ResultsAmong 18,726 newly board-certified physicians, 94.9% (13,435/14,150) of those working in urban areas before certification remained in urban areas, whereas 64.6% (393/608) of those working in rural areas stayed in rural areas. Those who were newly certified had higher odds of moving to more urban areas, adjusting for covariates. Those who stayed in rural areas showed lower odds of maintaining board certification, adjusting for covariates.ConclusionsNewly board-certified physicians are more likely to migrate to other types of areas, particularly more urban areas, than other physicians. Allocating more training quotas to rural areas could be one option for leveling the distribution of specialists. It also appeared that those practicing in rural areas have difficulty maintaining their certification, so the need to establish a support system for already-certified physicians in rural areas should be emphasized.
Highlights
The board certification system serves as a quality assurance system for physicians, and its design and operation are important health policy issues
The number of physicians who lost their general area certification gradually increased, reaching approximately 300 in the 27th year but showed a gentler slope than that for new certification (Fig. 1). Of those who worked in rural municipalities, 16.9% moved to more urban municipalities—7.5% to intermediate areas and 9.3% to urban areas—in 2014
Of those who worked in intermediate areas in 2012, 11.2% moved to more urban areas and 1.4% to less urban area in 2014
Summary
The board certification system serves as a quality assurance system for physicians, and its design and operation are important health policy issues. This study aimed to identify these associations and to discuss their policy implications Both securing health care quality and achieving a fair distribution of medical resources are important health care policy issues. In Japan, board certification systems were established and operated independently by academic societies These systems have not been directly linked to reimbursement through the health insurance system. The establishment of the Panel on Board Certification within the Ministry of Health, Labour and Welfare (MHLW) was intended to review a wide range of issues around the board certification system, such as how to improve the quality of board-certified specialists and provide better care for patients as well as how to design a new board certification system that does not accelerate the maldistribution of physicians.
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