Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, USA.
Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, United States.
BMC Med Educ. 2018 Mar 27;18(1):49. doi: 10.1186/s12909-018-1147-9.
Highly-competent patient care is paramount to medicine. Quality training and patient accessibility to physicians with a wide range of specializations is essential. Yet, poor quality of life for physicians cannot be ignored, being detrimental to patient care and leading to personnel leaving the medical profession. In 2004, the Japanese government reformed postgraduate training for medical graduates, adding a 2-year, hands-on rotation through different specialties before the specialization residency was begun. Residents could now choose practice location, but it sparked concerns that physician distribution disparities had been created. Japanese media reported that residents were choosing specialties deemed to offer a higher quality of life, like Ophthalmology or Dermatology, over underserved areas like Obstetrics or Cardiology. To explore the consequences of Japan's policy efforts, through the residency reform in 2004, to improve physician training, analyzing ophthalmologist supply and distribution in the context of providing the best possible patient care and access while maintaining physician quality of life.
Using secondary data, we analyzed changes in ophthalmologist supply at the secondary tier of medical care (STM). We applied ordinary least-squares regression models to ophthalmologist density to reflect community factors such as residential quality and access to further professional development, to serve as predictors of ophthalmologist supply. Coefficient equality tests examined predictor differences before and after 2004. Similar analyses were conducted for all physicians excluding ophthalmologists (other physicians). Ophthalmologist coverage in top and bottom 10% of STMs revealed supply inequalities.
Change in ophthalmologist supply was inversely associated with baseline ophthalmologist density before (P < .01) and after (P = .01) 2004. Changes in other physician supply were not associated with baseline other physician density before 2004 (P = 0.5), but positively associated after 2004 (P < .01). Inequalities between top and bottom 10% of ophthalmologist supply in STMs were large, with best-served areas maintaining roughly five times greater coverage than least-served areas. However, inequalities gradually declined between 1998 and 2012.
Ophthalmologist supply increased both before and after the 2004 reform, yet contrary to media reports, proceeded at a lesser rate than supply increases for other physicians. After 2004, geographical disparities decreased for ophthalmologists, while increasing for other physicians.
为患者提供高质量的医疗服务是医学的首要任务。为医生提供广泛的专业培训，并确保患者能够接触到他们，这是至关重要的。然而，医生的生活质量不佳不容忽视，这会对患者护理产生不利影响，并导致人员离开医疗行业。2004 年，日本政府改革了医学生的研究生培训，在开始专业住院医师培训之前，增加了为期 2 年的、涉及不同专业的实践轮转。住院医师现在可以选择执业地点，但这引发了人们的担忧，即可能已经出现了医生分布不均的情况。日本媒体报道称，住院医师选择的专业是那些被认为生活质量更高的专业，如眼科或皮肤科，而不是妇产科或心脏病学等服务不足的领域。本研究旨在探讨 2004 年住院医师改革改善医生培训的政策努力的后果，通过分析眼科医生的供应和分布情况，在维持医生生活质量的同时，为患者提供最佳的医疗服务和就诊机会。
我们使用二次数据，分析了二级医疗保健（STM）层面眼科医生供应的变化。我们应用普通最小二乘法回归模型来分析眼科医生密度，以反映社区因素，如居住质量和进一步专业发展的机会，作为眼科医生供应的预测因素。系数相等检验用于检验 2004 年前后预测因素的差异。对所有非眼科医生（其他医生）进行了类似的分析。STM 中排名前 10%和后 10%的眼科医生覆盖范围揭示了供应的不平等。
2004 年前后，眼科医生供应的变化与基线眼科医生密度呈负相关（P<0.01 和 P=0.01）。2004 年前，其他医生供应的变化与基线其他医生密度无关（P=0.5），但 2004 年后，变化与基线其他医生密度呈正相关（P<0.01）。STM 中排名前 10%和后 10%的眼科医生供应之间的不平等很大，服务最好的地区的覆盖率大约是服务最差地区的五倍。然而，这种不平等在 1998 年至 2012 年间逐渐减少。
2004 年改革前后，眼科医生的供应都有所增加，但与媒体报道相反，增加的速度低于其他医生的供应增加速度。2004 年后，眼科医生的地域差异有所减少，而其他医生的差异则有所增加。
