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Title: Evaluating the effect of Japan's 2004 postgraduate training programme on the spatial distribution of physicians.
Authors: Sakai, Rie
Tamura, Hiroshi  kyouindb  KAKEN_id
Goto, Rei
Kawachi, Ichiro
Author's alias: 田村, 寛
Keywords: Human resources
Physician distribution
Postgraduate medical training
Issue Date: 24-Jan-2015
Publisher: BioMed Central Ltd.
Journal title: Human resources for health
Volume: 13
Thesis number: 5
Abstract: [Background] In 2004, the Japanese government permitted medical graduates for the first time to choose their training location directly through a national matching system. While the reform has had a major impact on physicians’ placement, research on the impact of the new system on physician distribution in Japan has been limited. In this study, we sought to examine the determinants of physicians’ practice location choice, as well as factors influencing their geographic distribution before and after the launch of Japan’s 2004 postgraduate medical training programme. [Methods] We analyzed secondary data. The dependent variable was the change in physician supply at the secondary tier of medical care in Japan, a level which is roughly comparable to a Hospital Service Area in the US. Physicians were categorized into two groups according to the institutions where they practiced; specifically, hospitals and clinics. We considered the following predictors of physician supply: ratio of physicians per 1, 000 population (physician density), age-adjusted mortality, as well as measures of residential quality. Ordinary least-squares regression models were used to estimate the associations. A coefficient equality test was performed to examine differences in predictors before and after 2004. [Results] Baseline physician density showed a positive association with the change in physician supply after the launch of the 2004 programme (P-value < .001), whereas no such effect was found before 2004. Urban locations were inversely associated with the change in physician supply before 2004 (P-value = .026), whereas a positive association was found after 2004 (P-value < .001). Urban location and area-level socioeconomic status were positively correlated with the change in hospital physician supply after 2004 (P-values < .001 for urban centre, and .025 for area-level socioeconomic status), even though in the period prior to the 2004 training scheme, urban location was inversely associated with the change in physician supply (P-value = .015) and area-level socioeconomic status was not correlated. [Conclusion] Following the introduction of the 2004 postgraduate training programme, physicians in Japan were more likely to move to areas with already high physician density and urban locations. These changes worsened regional inequality in physician supply, particularly hospital doctors.
Rights: © 2015 Sakai et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
DOI(Published Version): 10.1186/1478-4491-13-5
PubMed ID: 25617944
Appears in Collections:Journal Articles

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