Numata Yoshiki, Matsumoto Masatoshi
School of Medicine, Hiroshima University, Japan.
Department of Community-based Medical System, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan.
J Rural Med. 2024 Jul;19(3):166-173. doi: 10.2185/jrm.2023-047. Epub 2024 Jul 1.
The Japanese government's physician workforce reform, which commenced in April 2024, introduced regulations on physicians' working hours. However, in areas facing physician shortages such as rural regions and surgical medical specialties, healthcare provision relies heavily on the extended working hours of each physician. The anticipated impact of this reform, when implemented, was significant. Using publicly available government data, we estimated the current working hours of physicians in various medical specialties in each prefecture across Japan. Subsequently, we calculated the ratio of surplus or deficit physicians when hypothetically assuming that all physicians adhered to the regulatory upper limit of 58.4 working hours per week nationwide. Assuming that all physicians work to the regulated maximum, there would be a shortage of doctors in various medical specialties across Japan, such as surgery, neurosurgery, orthopedic surgery, obstetrics and gynecology, and emergency medicine. Geographically, shortages of doctors are observed in rural prefectures such as those in the Tohoku region, particularly in emergency- and surgery-related specialties, indicating a critical shortage of physicians in rural areas. Additionally, it has become evident that even in medical specialties with a calculated surplus of physicians nationwide, the margin of surplus is generally only a few percentage points. Currently, rural areas and surgical medical specialties in Japan have limited leeway in the physician workforce, and the strict application of workforce reform may lead to a severe shortage of physicians in these areas. It is noteworthy that as similar reforms may subsequently be implemented in other countries, analogous challenges would arise. Thus, the implementation of workforce reform requires a flexible approach to minimize its negative effects, which widen the existing disparity in the workforce.
日本政府于2024年4月开始的医生劳动力改革引入了医生工作时间的规定。然而，在农村地区和外科医学专科等面临医生短缺的领域，医疗服务严重依赖每位医生的延长工作时间。这项改革实施后的预期影响重大。我们利用公开的政府数据，估算了日本各都道府县不同医学专科医生的当前工作时间。随后，我们假设全国所有医生都遵守每周58.4小时的监管上限，计算了过剩或短缺医生的比例。假设所有医生都按规定的上限工作，日本全国各医学专科，如外科、神经外科、骨科、妇产科和急诊医学，都将出现医生短缺。从地域上看，在东北地区等农村都道府县存在医生短缺现象，特别是在与急诊和外科相关的专科领域，这表明农村地区医生严重短缺。此外，很明显，即使在全国范围内计算出医生过剩的医学专科中，过剩幅度通常也只有几个百分点。目前，日本农村地区和外科医学专科在医生劳动力方面的回旋余地有限，严格实施劳动力改革可能导致这些地区医生严重短缺。值得注意的是，由于其他国家随后可能实施类似改革，也会出现类似挑战。因此，劳动力改革的实施需要采取灵活的方法，以尽量减少其负面影响，因为这些负面影响会扩大现有的劳动力差距。
