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Prefectures to be tested on efforts to address regional imbalance of doctors

The Yomiuri Shimbun Doctor shortages in regional areas have become critical. To maintain local medical services, effective measures to remedy the situation are needed.

A study panel at the Health, Labor and Welfare Ministry is discussing ways to deal with the regional imbalance in the number of doctors. The panel will compile a report within this year.

The central pillar of the report will be strenghtening the role and authority of prefectures. As part of the medical care plan for prefectural governments, the formulation of prefectures’ “plans to secure sufficient doctors,” which incorporate their targets and concrete measures for securing a sufficient number of doctors, will be written into law.

To make their plans to secure doctors effective, prefectural governments will be newly authorized to ask local universities’ medical departments to establish or increase an “intake quota of home-grown enrollees.” The prefectural governments will also assume the tasks of designating hospitals where clinical training is to be conducted and establishing quotas for such trainees.

The prefectural governments will further be made to increase their involvement in the dispatch of doctors from local universities’ medical departments and their hospitals.

Presently, there is a provision in the medical care plan that prefectural governments must state their measures to secure enough doctors. But the content of these measures often lacks specifics. This may be partly due to the limits on what such measures can accomplish, as a result of such factors as prefectures’ limited say in matters related to doctor training courses, which are deemed important for securing and retaining doctors.

This issue had not been resolved when it was left up to medical experts to tackle this on their own initiative. It is appropriate to aim to reinforce the authority of and grant certain mandatory powers to prefectural governments, who are responsible for their healthcare service system.

Alleviate doctors’ concerns

By prefecture, the number of doctors per 100,000 people in Kyoto Prefecture, which has the largest number per capita, is twice that of Saitama Prefecture, which has the lowest number per head. There are also many areas where there are regional discrepanices of many times within the same prefecture. The real state of affairs is that a conspicuous number of medical institutions have either been scaled down or closed in regional areas.

The government has been promoting an increase in the enrollment quota at universities’ medical departments and the establishment of “regional quotas” aimed at fostering people who will provide local medical care services, but these efforts have so far failed to help solve regional imbalances.

Forty percent of doctors intend to work in regional areas. Among doctors in their 20s, the percentage is as high as 60 percent. However, many of these doctors have misgivings about their career development and working environments.

Creating a career development program that incorporates regional work, through cooperation between prefectural governments and medical offices at universities. And trying to lessen the burden on doctors by such measures as securing substitute personnel on their holidays. It is necessary to think hard, so as to alleviate this unease among doctors.

The report is also likely to include the idea of introducing a certification system for doctors who have worked in regional areas. It is aimed at encouraging people to work in regions beset by a shortage of doctors by requiring such experience in order to become a director at some hospitals.

Should the range of medical institutions that require this qualification to become a director be narrowly set, the effect will be limited. Some on the study panel are calling for regional experience to be required for opening a clinic.

There is also a need to limit the opening of medical offices in areas with an excess of doctors. The health ministry plans to provide region-specific information concerning supply and demand in medical services, thus encouraging doctors to make appropriate decisions.

If these corrective measures do not work well, more compulsory methods will also become a subject of study.

(From The Yomiuri Shimbun, Dec. 4, 2017)Speech



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