Tomoko Kodama

The dynamics of obstetricians and gynecologists in Japan: a retrospective cohort model using the nationwide survey of physicians data.

Aim:  A shortage of obstetricians and gynecologists (OB/GYNs) in Japan has been highlighted. We conducted a descriptive and retrospective cohort study using data from the Survey of Physicians in Japan, and analyzed the dynamics of OB/GYNs.

Postgraduate training and career choices: an analysis of the National Physicians Survey in Japan.

Medical Education 2010: 44 : 289–297

Shortage of pediatricians in Japan: a longitudinal analysis using physicians' survey data.

Background:  Currently, there is a shortage of hospital pediatricians in Japan. In the present study, using data from the Survey of Physicians, Dentists, and Pharmacists in Japan, we analyzed the dynamics and distribution of pediatricians, using a time series approach.

A future estimate of physician distribution in hospitals and clinics in Japan

OBJECTIVES To make future estimates of physician distributions in hospitals and clinics to better understand the impact of recent health policy changes in post graduate clinical education, and to discuss possible policy implications. METHODS Analyze National Surveys Data conducted from 1972 to 2004. Multistate Life Table was used to make future estimations of numbers of physicians in hospitals and clinics. RESULTS A typical Japanese physicians career would start from academic hospitals, and move through non-academic hospitals to clinics. After the introduction of the new post-graduate clinical training system in 2004, more medical school graduates started their careers at non-academic hospitals. Recently, the flow of physicians from academic hospitals to non-academic hospitals has been declining while the flow from academic hospitals to clinics has slightly increased. We also observed a shift of physicians from hospitals to clinics. From the data we estimated that the number of physicians working at clinics will be almost equal to those at non-academic hospitals in 2016, for the first time in 30 years. CONCLUSIONS It is important to discuss the appropriate sharing of roles, responsibilities, and cooperation among medical facilities in line with the observed changes of career paths and physician distributions.

Residency hospital type and career paths in Japan: An analysis of physician registration cohorts

Background: In 2004, a new postgraduate medical training system was introduced in Japan and a shift of new graduates from university hospitals to other postgraduate education hospitals happened. Aim: The aim of this study is to analyse the past trends on postgraduate medical education choices and subsequent career options to discuss possible outcomes of the current shift and policy implications. Methods: Data from the national physician survey from 1976 to 2006 were analysed. The proportion change of physicians started their career in university hospitals was calculated. The career paths for physicians by different residency type were presented. Results: More than 90% of physicians experienced university hospital work at least once in their 20-year careers. In their first 10 years of their career, physicians who started their residency in a university hospital tended to spend more years working in university hospitals, and those who started in other post-graduate training hospitals tended to spend less in university hospitals. Then, these groups presented quite similar patterns in their career choices. Conclusions: University hospitals need to strengthen their function as continuing education and career development centres and to adopt a less paternalistic approach, as fewer residents start their career in university hospitals.

Physician-scientists in Japan: attrition, retention, and implications for the future.

Purpose To investigate career trends for physician–scientists in Japan. Method The authors analyzed 1996–2008 biennial census survey data from Japan’s national physician registry to examine trends over time in the numbers and proportion of physician–scientists by sex and years since registration. They also analyzed the transition of registered physicians into and out of the physician–scientist field across two sets of two consecutive surveys (1996–1998 and 2006–2008). Results The number of physician–scientists between 1996 and 2008 was stable, with a low of 4,893 and a high of 5,325. The number of younger physician–scientists (those registered 0–4 years at the time of the surveys) declined sharply, however, from 828 in 1996 to 253 in 2008. The number of female physician–scientists increased from 528 in 1996 to 746 in 2008. Across the two survey periods, about 30% of physician–scientists left the career path, but this attrition was offset by about the same number of new individuals entering the field. Conclusions Although the total number of physician–scientists was relatively unchanged during the period studied, it is essential that educators and policy makers develop approaches to address underlying demographic changes to ensure an adequate age- and gender-balanced supply of physician–scientists in the future.

Retention rate of physicians in public health administration agencies and their career paths in Japan.

BackgroundPhysicians who serve as public health specialists at public health centers and health departments in local or central government have significant roles because of their public health expertise. The aim of this study is to analyze the retention and career paths of such specialists in Japan.MethodWe analyzed the data of seven consecutive surveys, spanning 1994 to 2006. We first analyzed the 2006 survey data by sex, age group, and facility type. We then examined the changes over time in the proportion of physicians working in public health administration agencies. We also examined the distribution of the facility types and specialties in which physicians worked both before beginning and after leaving their jobs. These analyses were performed by using physician registration numbers to cross-link data from two consecutive surveys.ResultsThe proportion of physicians working in public health administration agencies was 0.7% in 2006. The actual numbers for each survey ranged between 1,800 and 1,900. The overall rate remaining in public health administration agencies during the two-year survey interval was 72.8% for 1994-1996. The ratio declined to 67.2% for 2004-2006. Among younger physicians with 1-10 years of experience, the retention rate showed a sharp decline, dropping from 72.6% to 50.0%. Many of these physicians came from or left for a hospital position, with the proportion entering academic hospital institutions increasing in recent years. In many cases, physicians left or entered internal medicine clinical practices.ConclusionAt present in Japan, the number of physicians who leave and the number who begin a position are almost the same; thus, some of the problems associated with physicians leaving are yet to become apparent. However, the fact that the retention period is shortening for younger physicians may represent a future problem for ensuring the quality of physicians in public health administration agencies. Possible strategies include: increasing the number of physicians entering positions; reducing the number leaving positions; and creating a system where physicians can easily reenter positions after leaving while also establishing a revolving door type of career development system, involving both public health departments and hospital clinical departments.

Long-term Career Transition in the Surgical Workforce of Japan: A Retrospective Cohort Study Using the Nationwide Survey of Physicians Data from 1972 to 2006

BackgroundA surgical workforce is essential for providing surgical services to the community. However, little is known about surgeons’ career changes in circumstances where physicians can freely choose their specialty. Differing career transitions among surgical specialties were hypothesized.MethodsLongitudinal data were obtained for all physicians in Japan, giving a total of 4,302,844 items of data (for 390,368 physicians) from 1972 to 2006. Descriptive statistics for all physicians and surgeons were calculated in 1976, 1986, 1996, and 2006. “Active surgeons” (working at hospitals), “primary care surgeons” (working at clinics), and “retired surgeons” were analyzed among physicians licensed in 1972, 1982, and 1992 for the subspecialties of general surgery, orthopedic surgery, neurosurgery, urology, and “other” surgeries. Survival analysis and Cox’s proportional hazard analysis were conducted to examine factors affecting career changes.ResultsDuring the study period, the greatest change was observed in the increased number of surgeons per 100,000 physicians. The percentage of female surgeons and surgeons registered in a surgical subspecialty also increased greatly. Significant differences, by sex, age, and subspecialty, were shown in survival analyses for surgeons’ career changes in the transition from active surgeons to primary care surgeons or retired surgeons. Surgical specialty was still a significant factor for predicting career transition, even after adjustment for the surgeons’ characteristics.ConclusionsThe current study elucidated the differences in career transitions among surgical specialties. Given the observed findings, policy makers should consider more detailed and effective measures for retaining surgeons in active practice.