Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Miyagi, Japan.
Department of Internal Medicine, Navitas Clinic, Tachikawa, Tokyo, Japan.
Public Health. 2020 May;182:143-150. doi: 10.1016/j.puhe.2020.02.008. Epub 2020 Apr 16.
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.
医疗服务分布不均和医生分配不公是全世界关注的问题。揭示日本专科培训体系的变化如何影响医生的分布，可以帮助我们理解这个问题。2018 年，日本医疗专科委员会实施了一项新的、标准化的专科培训体系，该体系得到了厚生劳动省的认可。本研究旨在调查新体系如何影响在日本开始专科培训的医生（学员）的地理分布和专业选择。
回顾性观察研究。
考虑到所选的县和专业，调查了 2018 年与对照期（2012-2014 年）相比学员数量的变化。各县的背景特征包括人口、65 岁及以上居民的比例（老龄化率）和每县的总医生人数。我们绘制了洛伦兹曲线，并计算了学员分布的基尼系数。
2018 年，全国每 10 万人中的学员人数从对照期的 5.5 人增加到 6.6 人。2018 年，每 10 万人中有学员的人数在人口≧200 万的县、老龄化率低（<27%）和医生密度高（每 10 万人中≧250 名医生）的县有所增加。2018 年的基尼系数从对照期的 0.160 增加到 0.226。
新培训体系实施后，参加专科培训的医生人数有所增加，内科和外科以外的专业吸引了更多的学员。城乡各县之间医生分布的不平等程度加剧。这表明需要在保持专科培训最佳机会的同时，探索新的平衡分配的方法。
