Division of Public Health and Epidemiology, Department of Social Medicine, Asahikawa Medical University.
Environ Health Prev Med. 2023;28:14. doi: 10.1265/ehpm.22-00169.
Internal medicine (IM) doctors in Japan play the role of primary care physicians; however, the shortage of rural physicians continues. This study aims to elucidate the association of age, sex, board certification, type of work, and main clinical work with the retention or migration of IM doctors to rural areas.
This retrospective cohort study included 82,363 IM doctors in 2010, extracted from the national census data of medical doctors. The explanatory variables were age, sex, type of work, primary clinical work, and changes in board certification status. The outcome was retention or migration to rural areas. The first tertile of population density (PD) of municipalities defined as rural area. After stratifying the baseline ruralities as rural or non-rural areas, the odds ratios (ORs) of the explanatory variables were calculated using generalized estimation equations. The analyses were also performed after age stratification (<39, 40-59, ≥60 years old).
Among the rural areas, women had a significantly higher OR for retention, but obtaining board certification of IM subspecialties had a significantly lower OR. Among the non-rural areas, physicians who answered that their main work was IM without specific subspecialty and general had a significantly higher OR, but obtaining and maintaining board certification for IM subspecialties had a significantly lower OR for migration to rural areas. After age stratification, the higher OR of women for rural retention was significant only among those aged 40-59 years. Those aged under 40 and 40-59 years in the non-rural areas, who answered that their main work was IM without specific subspecialty had a significantly higher OR for migration to rural areas, and those aged 40-59 years in the rural areas who answered the same had a higher OR for rural retention.
Obtaining and maintaining board certification of IM subspecialties are possible inhibiting factors for rural work, and IM doctors whose main work involves subspecialties tend to work in non-rural areas. Once rural work begins, more middle-aged female IM doctors continued rural work compared to male doctors.
日本的内科医生扮演着初级保健医生的角色；然而，农村医生的短缺仍在继续。本研究旨在阐明年龄、性别、专科认证、工作类型和主要临床工作与内科医生留任或迁移到农村地区之间的关系。
本回顾性队列研究纳入了 2010 年全国医生普查数据中 82363 名内科医生，解释变量为年龄、性别、工作类型、主要临床工作以及专科认证状态的变化。结果是留任或迁移到农村地区。将市的人口密度（PD）的第一个三分位数定义为农村地区。在将基线农村地区分为农村和非农村地区后，使用广义估计方程计算解释变量的比值比（OR）。还在年龄分层（<39、40-59、≥60 岁）后进行了分析。
在农村地区，女性留任的 OR 显著较高，但获得内科亚专科认证的 OR 显著较低。在非农村地区，回答主要工作是内科但没有特定亚专科和全科的医生迁移到农村地区的 OR 显著较高，但获得和维持内科亚专科认证的 OR 显著较低。在年龄分层后，只有 40-59 岁的女性留任农村地区的 OR 较高具有统计学意义。非农村地区年龄在 40 岁以下和 40-59 岁之间、回答主要工作是内科但没有特定亚专科的医生迁移到农村地区的 OR 显著较高，而农村地区年龄在 40-59 岁之间、回答同样问题的医生留任农村地区的 OR 较高。
获得和维持内科亚专科认证可能是农村工作的抑制因素，主要工作涉及亚专科的内科医生倾向于在非农村地区工作。一旦开始农村工作，与男性医生相比，更多中年女性内科医生继续从事农村工作。
