Geographic Maldistribution Of Physicians Research Articles

Increase in the number of female physicians and the geographical maldistribution of physicians in Japan

BACKGROUND: In recent years, the geographical maldistribution of physicians has become a major problem in Japan, and prefectures are formulating plans to secure additional physicians. During the same period, the percentage of female physicians in Japan has been continuously increasing, and they now account for 40% of the total enrollment in medical schools. The purpose of this study is to clarify the impact of the increasing proportion of female physicians on the maldistribution of physicians. METHODS: We used individual data from the surveys of physicians, dentists, and pharmacists from 1996 to 2018 and government-aggregated data with the same statistics from 1996 to 2020. The Gini coefficient was used to measure geographic maldistribution. Physicians were divided into four groups according to age and gender: men under 40, females under 40, men over 40, and females over 40, and the temporal trends in the maldistribution and contribution ratio of each group were calculated. RESULTS: Physician geographical maldistribution worsened after 2006 and continued to worsen until 2016. The contribution ratio of female physicians to the worsening geographical maldistribution exceeded 100% for both under 40 and over 40 age groups. However, geographical maldistribution within female physicians has become more stable in recent years. Conclusion: The large contribution of the female physician group to the deterioration of the Gini coefficient for all physicians may be due to the greater weight of these groups. However, the Gini coefficient for the female group tended to be stable.

Primary Care Physicians in Nova Scotia: Are They Where They Need To Be?

Purpose: Accessible primary health care (PHC) is a key area of interest for policy and research as accessible PHC is associated with better health outcomes and lower health system costs. A critical dimension of accessible PHC is an adequate supply of family physicians (FPs) or general practitioners (GPs). Our study sought to analyze the geographic distribution of FP/GPs practicing in Nova Scotia (NS) and to provide an in-depth analysis of the distribution of FP/GPs in relation to population PHC needs. Methods: Using data from the College of Physicians & Surgeons of Nova Scotia’s registry and 2019 annual license renewal survey, we provide a descriptive analysis of physician distribution, demographics and practice structure characteristics across the four Nova Scotia Health management zones (Central, Eastern, Northern, Western) for the population of FP/GPs practicing in NS in 2019. Additionally, we provided a descriptive analysis of PHC demand indicators and population demographics derived from the Canadian Institute for Health Information, the Canadian Community Health Survey, and the Canadian Census. These population PHC need indicators include hospitalization rates for ambulatory care sensitive conditions (ACSC), perceived health, the Canadian Index of Multiple Deprivation (CIMD), and the percentage of the population aged 65 and over across Nova Scotia Health management zones. Results: FP/GPs practising outside the Central zone are less numerous, older, and more likely to be male and international medical graduates. FP/GPs practicing outside the Central zone are more likely to have solo practices, practice in rural areas and not provide care through technology. Additionally, there is a greater potential demand for PHC outside of the Central zone, indicated by lower physician-to-100,000 population ratios, higher rates of hospitalizations for ACSC, a larger percentage of individuals living in rural areas, aged 65 and over, rating their health as fair or poor, and in the most deprived quintile of the situational vulnerability and economic dependency dimensions of the CIMD. Conclusions: These findings indicate a geographic maldistribution of physicians across NS and potential gaps in access to FP/GPs compared to population health needs across Nova Scotia Health management zones. The findings have implications for targeted physician resources planning and policy.

Feelings toward medicine in remote areas among medical students aiming to become generalists : A comparison with other specialists

Geographic maldistribution of physicians is a serious problem in Japan, resulting in a few physicians in remote areas. We distributed questionnaires to 396 medical students at Tokushima University from 2013 to 2016. We examined the intensity of medical students toward medicine in remote areas by using a visual analog scale and investigated what medical specialty they chose after two years of clinical training. The intensity of interest in medicine and the intensity of willingness to contribute to it in remote areas were statistically higher among medical students who intended to choose general medicine. After graduation, only five participants chose to specialize in general medicine. Of the 14 medical students who originally chose general medicine, six chose internal medicine, three chose general medicine, and the others chose surgery, neurosurgery, anesthesiology, orthopedics, or emergency medicine. This study demonstrated that medical students who intend to choose general medicine have a higher intensity of willingness to contribute to medicine in remote areas, indicating that the support program for these students to become general practitioners after graduation increases the number of physicians in remote areas. J. Med. Invest. 70 : 129-134, February, 2023.

Rural Residency Training as a Strategy to Address Rural Health Disparities: Barriers to Expansion and Possible Solutions.

Rural Residency Training as a Strategy to Address Rural Health Disparities: Barriers to Expansion and Possible Solutions.

Temporal trends of physician geographical distribution and high and intermediate physician density areas and factors related to physicians' movement to low physician density areas in Japan: a longitudinal study (1996-2016).

ObjectivesA major issue in Japan’s health policy is the geographical maldistribution of physicians. This study aimed to analyse temporal trends in the geographical distribution of physicians and analyse physicians in high and intermediate physician density areas and factors related to their movement to low physician density areas in Japan.DesignA longitudinal study.SettingAll physicians in 344 secondary medical districts.ParticipantsI analysed data from the biennial national census, conducted by the Ministry of Health, Labour and Welfare between 1996 and 2016 and and divided it into two cohorts of 10 years each: 1996–2006 and 2006–2016.Primary and secondary outcome measuresI estimated the temporal trends in the number and percentages of physicians, and used logistic regression to analyse physicians in high and intermediate physician density areas and the factors related to their movement to low physician density areas.ResultsThe overall number of Japanese doctors increased by 31% between 1996 and 2016. The number of physicians per population in the physician high-density areas increased by 29%, while those in low-density areas increased by 32%, suggesting that the gap between areas marginally decreased. The multivariable logistic regression analyses revealed that academic hospital experience had the highest OR for predicting physician movement to low physician density areas after 10 years, both in the 1996 and 2006 cohorts. Other factors that positively correlated with physician movement were being male, being younger than 40 years, being qualified after the age of 30, urban area, intermediate physician density area and practice in a non-academic hospital.ConclusionsAs less-experienced physicians demonstrate high mobility among geographic categories, and retention rates are low in low physician density areas, especially for less-experienced physicians, a new system that considers these factors would create opportunities for younger physicians to work in low-density areas.

Developing Programs That Will Change Health Professions Education and Practice: Principles of Program Evaluation Scholarship

Developing Programs That Will Change Health Professions Education and Practice: Principles of Program Evaluation Scholarship

Geographic Maldistribution of Physicians in Japan : Increasing the Number of Generalists is One Solution

Despite massive intervention from Japan's national and local governments, the skewed distribution of physicians remains a serious social problem. This review paper summarizes past literature and proposes a future strategy to deal with this sophisticated issue based on scientific evidence. There are several ways to achieve a more balanced distribution, the most feasible of which is to increase the number of generalists. This increase might be imminent with the establishment of a formal board certification for general practitioners (sougou‐shinryou‐i) and raising the number of rural subquota (chiikiwaku) entrants to medical school. All the stakeholders should co‐operate to take advantage of this great opportunity to increase the number of generalist physicians and solve Japan's distribution problem.

What factors influence the choice of urban or rural location for future practice of Nepalese medical students? A cross-sectional descriptive study.

BackgroundNepal is experiencing a public health issue similar to the rest of the world, i.e., the geographical maldistribution of physicians. Although there is some documentation about the reasons physicians elect to leave Nepal to work abroad, very little is known about the salient factors that influence the choice of an urban versus rural practice setting for those physicians who do not migrate. In recent years, around 1000 medical students became doctors within Nepal, but their distribution in rural locations is not adequate. The purpose of this study was to explore what factors influence the choice of urban or rural location for the future clinical practice of Nepalese medical students in the final year of their programMethodsA cross-sectional descriptive study design was used for this study involving Nepalese medical students in their final year of study and currently doing an internship in a medical college. The sample consisted of 393 medical students from four medical colleges in Nepal that were selected randomly. An anonymous self-administered questionnaire was used for data collection. To determine the association with rural location choice for their future practice setting, a comparison was done that involved demographic, socio-economic, and educational factors. Data were entered in EpiData and analyzed by using SPSS version 16.ResultsAmong the 393 respondents, two thirds were male (66.9%) and more than half were below 25 years of age. Almost all (93%) respondents were single and about two thirds (63.4%) were of Brahmin and Chhetri ethnic origin. About two thirds (64.1%) of the respondents were born in a rural setting, and 58.8% and 53.3% had a place of rearing and permanent address in a rural location, respectively. The predictors of future rural location choice for their clinical practice (based on the bivariate analysis) included:Rural (versus urban) place of birth, place of rearing, and permanent addressSource of family income (service, business, and agriculture)Occupation of father (service, business and agriculture)Wealth ranking (higher, middle, and lower wealth rank)Educational factors: location, type of secondary education, and type of higher secondary educationConclusionFor medical students who were soon to complete their studies, demographic and educational factors were found to be significant predictors for a rural location choice, as opposed to socio-economic factors. Our findings indicate that to ensure the rural retention of physicians, the government of Nepal should attract potential medical students from those who were reared and educated in a rural setting.

Population aging and physician maldistribution: A longitudinal study in Japan

Background: Over the past two decades, population aging and the introduction of the new postgraduate medical education program in 2004 have impacted on the geographic maldistribution of physicians in Japan. The purpose of this study was to evaluate recent changes in physician distribution across municipalities from 1996 to 2012 using Gini coefficients and to clarify the impact of the new medical education program on physician distribution.Methods: We extracted the number of physicians classified by type of medical institution and municipal bodies. Gini coefficients were calculated using both population and demand for medical services. We calculated the contribution ratio (CR) of maldistribution within each type of medical institution to the whole maldistribution using Rao’s method. In addition, we calculated the incremental difference in Gini coefficients between 2002 and 2010, and calculated the CR of the incremental Gini coefficient difference for each medical institution type using Seki’s method.Results: Both Gini coefficients decreased from 1996 to 2002, and increased after 2006. The CR of other hospitals increased from 2004. The incremental difference in the Gini coefficient using demand between 2002 and 2010 was 0.012, and the CR of each type of medical institution was -25.1% (university hospitals), 131.0% (other hospitals) and -5.9% (clinics).Conclusions: Our analysis showed that the geographic maldistribution of physicians has worsened since the introduction of the new postgraduate medical education program, and the CR of maldistribution in other hospitals was high. Our study suggested that new medical resource distribution policies should be discussed to improve maldistribution.

Transition of physician distribution (1980-2002) in Japan and factors predicting future rural practice

The geographic maldistribution of physicians (their concentration in urban areas and shortage in rural areas) has long been an important political issue in post-war Japan. The aim of this study was to evaluate long-term transition in the geographic distribution of physicians, and to reveal which rural physician characteristics predict their retention in rural areas after 22 years. A record-linkage study was conducted to extract a physician cohort by merging the 1980 and 2002 Physician Census in which all licensed physicians are legally required to register. Physician characteristics in 1980 that predicted rural practice in 2002 were identified. Data were used from the 93 077 physicians who were recorded in both 1980 and 2002 Physician Censuses. The number of physicians increased by 52% between 1980 and 2002. In both 1980 and 2002, the physician-to-population ratios in rural areas were approximately half that in urban areas, indicating that the physician maldistribution had not improved. In 1980, 82 414 (88.5%) physicians worked in urban areas and 10 663 (11.5%) worked in rural areas. In 2002, 76 435 (92.7%) of the 1980 urban physicians were still practicing in cities, but only 5958 (55.9%) of the 1980 rural physicians had stayed in their rural area. Logistic regression analysis showed that primary-care discipline and rural practice in 1980 positively predicted rural practice in 2002 (OR [95% CI]: 1.28 [1.23-1.35] and 16.18 [15.43-16.95], respectively). However, female sex and age in 1980 were negative predictors for rural practice in 2002 (OR [95% CI]: 0.80 [0.74-0.86] and 0.91 [0.90-0.94], respectively). The rapid increase of physicians between 1980 and 2002 has not substantially affected their geographic distribution. Baseline rural practice, primary care discipline and male sex of physicians were found to be predictors of rural practice after 22 years.

Continuing professional development for rural physicians: an oxymoron or just non‐existent?

There is geographic maldistribution of physicians across Australia and their professional isolation, particularly in relation to continuing professional development, is a definite problem. It tends to be worse in smaller centres where there is no critical mass that allows for peer support. Although some academic research has been carried out concerning the needs of rural GP, none has targetted rural specialists. Several activities, including the Commonwealth-funded Support Scheme for Rural Specialists, have been well received and other initiatives, including the rural clinical schools and university departments of rural health, are beginning to provide an infrastructure that will help overcome the professional isolation through the use of innovative technologies such as interactive videoconferencing. This is being used to deliver RACP initiatives such as the basic physician trainee lecture series and the potential for vertical integration of training in rural settings which offer some promise to address the rural workforce shortage in the years to come.

Physician recruitment and retention: shortage and utilization

Rural, northern and small/medium sized communities are experiencing shortages of primary health care physicians. Despite incentives, recruitment and retention programmes, the geographic maldistribution of physicians is increasing. Communities have no or limited primary, obstetrical and emergency care and patients must travel long distances to access care. This Canada‐wide trend is of particular concern in the province of Ontario. Discusses the challenges facing health care planners as they search for causes and solutions. Is there a true physician shortage or only a maldistribution issue? The problems of shortages, utilization, supply and demand are discussed from a monopolistic medical model and a competitive, market model perspective. Different physician payment methods and their effect on utilization/distribution, supply/demand are also examined. Ultimately, the Ontario government must show leadership and provide direction in solving these problems if all Ontarians are to receive accessible, affordable, quality health care.

Rural practice. Preference, perception, and reality.

Numerous studies have approached the geographic maldistribution of physicians in the United States by evaluating factors associated with rural placement and retention, with "rural" being variably defined. To our knowledge, no one has qualitatively investigated physicians' perceptions of rurality or how closely those perceptions fit commonly used definitions of rurality. In addition, no one has evaluated physicians' preference for rural practice or the association between this preference and the rurality of their practice as they perceive it. This descriptive study uses a questionnaire mailed to graduates of a community hospital, university-affiliated Family Medicine residency program to evaluate physician perception and preference regarding rural practice. The participation rate was 83.1%. Agreement between the rurality of practice sites, as perceived, and definitions of rural was greatest when defined as a "nonurban population center of less than 25,000." Twenty-one (44.7%) of 47 respondents who preferred rural practice sites perceived themselves to be in urban practice sites. Respondents identified a nonurban population center of less than 25,000 as their perceived threshold between rural and urban practice settings. This threshold should be further evaluated as a potential operational standard. Nearly one half of the respondents who preferred rural practice perceived themselves to be in urban practice, indicating significant barriers to rural practice in this population. Potentially many more physicians may settle in rural practices if barriers for those who prefer rural practice can be identified and eliminated.

International medical education. Common elements in divergent systems

An assortment of medical education systems currently operate throughout the world, reflecting variations in populations, histories, societal and cultural traditions, political systems, and stages of economic development. Despite their many differences, common elements can be identified in many of these systems. A geographic maldistribution of physicians, insufficient funding for education, an imbalance between specialization and general practice, and inadequate mechanisms to evaluate medical competence are serious concerns in many countries today. On the positive side, there is a shared focus on community-based educational initiatives, provision of education through ambulatory care settings, and a trend toward integrated, problem-based educational strategies. To gain more comprehensive information about current approaches to medical education, the American Medical Association conducted the 1990 International Survey of Medical Education. SURVEY METHOD AND PURPOSE The survey, which consisted of 31 multiple-part questions, was designed to identify similarities and differences among the numerous medical education systems. It was mailed

International Medical Education

An assortment of medical education systems currently operate throughout the world, reflecting variations in populations, histories, societal and cultural traditions, political systems, and stages of economic development. Despite their many differences, common elements can be identified in many of these systems. A geographic maldistribution of physicians, insufficient funding for education, an imbalance between specialization and general practice, and inadequate mechanisms to evaluate medical competence are serious concerns in many countries today. On the positive side, there is a shared focus on community-based educational initiatives, provision of education through ambulatory care settings, and a trend toward integrated, problem-based educational strategies. To gain more comprehensive information about current approaches to medical education, the American Medical Association conducted the 1990 International Survey of Medical Education. SURVEY METHOD AND PURPOSE The survey, which consisted of 31 multiple-part questions, was designed to identify similarities and differences among the numerous medical education systems. It was mailed

Strategies for developing innovative programs in international medical education. A viewpoint from Latin America.

Problems affecting the quality of medical education and health services in Latin America include variable standards of medical education, geographic maldistribution of physicians, a shortage of nurses and allied health workers, overtraining of physicians in high technology, government control of health and education systems, and economic problems. The Panamerican Federation of Associations of Medical Schools (PAFAMS) was founded for the purpose of addressing such problems in Latin American medical education. PAFAMS has promoted the exchange of ideas and experience among its member associations and schools by establishing a data base of information on medical education and developing mechanisms to disseminate such information. Other PAFAMS initiatives include a program to integrate professional health education and health care services within individual communities, and the linkage of medical education programs with health care institutions as a means of improving the quality of health care. A crucial next step in Latin America is the development of a leadership program to identify and nurture leaders in individual countries who will be instrumental in developing community-based health services by means of medical education oriented to such purpose. Thus, the key issue is to develop healthcare-oriented medical education.

Part three: Wives’ Influence on Male Physicians’ Locations of Medical Practice

Abstract A major deficiency of the American health care system is the geographical maldistribution of physicians. Small towns and rural areas of large metropolitan areas have less than their share of physicians. This research is concerned with isolating a key factor associated with where, geographically, physicians are likely to locate their medical practices. Questionnaire data derived from the first six classes of a new medical school indicate that the influence of significant others, especially spouses, is a crucial factor in the location decision. Interviews with medical students and spouses amplify the nature of the interaction process through which the influence on decisions takes place. A major finding is the way in which the female spouse's desire for a career of her own and a good educational system for children limits the new male physician from choosing a small town or a large intercity area for his practice. Implications of this finding for the maldistribution of physicians, the dynamics of me...