New Physician Specialty Training System Impact on Distribution of Trainees in Japan

Abstract

Background: The problem of the uneven distribution of medical services is drawing much attention worldwide. To reveal how the changes in the specialty training system affected the distribution of doctors in Japan can 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 has affected the geographical distribution of doctors commencing specialty training (trainees) and choice of specialty in Japan. Methods: Change in the number of trainees between the control period (2012 to 2014) and 2018 was investigated, taking into account prefecture and specialty selected. Population, aging rate, and total number of overall doctors in each prefecture were considered as the background characteristics of each prefecture. The Gini coefficient was used to determine evenness of trainees' distribution. Findings: In 2018, the number of trainees per 100,000 population showed an increase to 6.6 nationwide compared with 5.5 during the control period. The number of trainees per 100,000 population in 2018 showed an increase in prefectures with a large population of ≧ 2,000,000, a low aging rate (< 27%), and a high doctor density (≧ 250 doctors per 100000 population). The Gini coefficient showed an increase to 0.226 in 2018 compared with only 0.160 during the control period. The total number of trainees and that per 100,000 population showed an increase in all specialties. Interpretation: After the implementation of the new training system, the number of doctors enrolling in specialty programs showed an increase. Inequality of distribution urban and rural prefectures worsened, however, indicating the need to explore ways of balancing unevenness of distribution while maintaining optimal opportunities for specialist training. Funding Statement: The authors state: This research isn’t receiving any funding. Declaration of Interests: Dr. Saito reports honorarium from TAIHO Pharmaceutical Co., Ltd., outside the submitted work. Ethics Approval Statement: The authors state: Not applicable.