Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-City, Tochigi, 329-0498, Japan.
Division of Health Policy and Management, Center for Community Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-City, Tochigi, 329-0498, Japan.
BMC Health Serv Res. 2024 Sep 11;24(1):1049. doi: 10.1186/s12913-024-11446-6.
In Japan, local governments have rural clinics designated for areas without physicians (RCDA) to secure physicians for rural medical care. Moreover, a medical policy of dispatching physicians between the RCDA and core hospitals for rural areas (CHRA) exists. This study aimed to assess the actual situation of physician migration from RCDAs and those who migrated, and examine the factors associated with their migration.
This retrospective cohort study used biennial national physicians' survey data from 2012 to 2018. It targeted physicians who worked at RCDAs in 2012 and participated in all four surveys (n = 510). The physicians were divided into two groups. One group consisted of physicians who worked continuously at the RCDA over the four study periods (retained physicians, n = 278), and the other included physicians who migrated to other institutions midway through the study period (migrated physicians, n = 232). We tracked the types of facilities where RCDA physicians worked from 2012 to 2018, also examined the factors associated with their migration.
Among physicians from RCDAs who migrated to other institutions (n = 151) between 2012 and 2014, many migrated to hospitals (n = 87/151, 57.6%), and some migrated to CHRA (n = 35/87, 40.2%). Physicians in their 40s (Hazard ratio 0.32 [95% CI 0.19-0.55]), 50s (0.20 [0.11-0.35]), and over 60 years (0.33 [0.20-0.56]) were more likely to remain at RCDAs. Changes in their area of practice (1.82 [1.34-2.45]) and an increase in the number of board certifications held by physicians between 2012 and 2018 (1.50 [1.09-2.06]) were associated with migration.
Many migrating physicians choose to work at hospitals after migrating from RCDAs. It was seemed that the physician dispatch system between RCDA and CHRA has been a measure to secure physicians in rural areas. Young age, obtaining board certification, and changes in areas of practice were associated with physician migration from RCDAs.
在日本，地方政府设立了乡村诊所指定医师（RCDA），以确保农村地区的医疗服务有医师。此外，还存在一项将医师从 RCDA 派遣到农村核心医院（CHRA）的医疗政策。本研究旨在评估从 RCDA 迁移的医师和已迁移医师的实际情况，并考察与迁移相关的因素。
本回顾性队列研究使用了 2012 年至 2018 年的两年一次全国医师调查数据。研究对象为 2012 年在 RCDA 工作并参加了全部四次调查的医师（n=510）。将这些医师分为两组。一组为连续四年在 RCDA 工作的医师（保留医师，n=278），另一组为在研究期间中途迁移到其他机构的医师（迁移医师，n=232）。我们追踪了 2012 年至 2018 年期间 RCDA 医师工作的机构类型，并考察了与他们迁移相关的因素。
在 2012 年至 2014 年间从 RCDA 迁移到其他机构的（n=151）医师中，许多人迁移到了医院（n=87/151，57.6%），有些人迁移到了 CHRA（n=35/87，40.2%）。40 多岁（风险比 0.32 [95%置信区间 0.19-0.55]）、50 多岁（0.20 [0.11-0.35]）和 60 岁以上（0.33 [0.20-0.56]）的医师更有可能留在 RCDA。其执业领域的变化（1.82 [1.34-2.45]）和 2012 年至 2018 年间医师获得的专业认证数量的增加（1.50 [1.09-2.06]）与迁移有关。
许多迁移的医师选择在从 RCDA 迁移后在医院工作。RCDA 与 CHRA 之间的医师派遣制度似乎是确保农村地区有医师的一项措施。年轻、获得专业认证和执业领域的变化与从 RCDA 迁移的医师有关。
