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Background: Geographical maldistribution of physicians, and their subsequent shortage in rural areas, has been a serious problem in Japan and in other countries. Family Medicine, a new board-certified specialty started 10 years ago in Japan by Japan Primary Care Association (JPCA), may be a solution to this problem. Methods: We obtained the workplace information of 527 (78.4%) of the 672 JPCA-certified family physicians from an online database. From the national census data, we also obtained the workplace information of board-certified general internists, surgeons, obstetricians/gynaecologists and paediatricians and of all physicians as the same-generation comparison group (ages 30 to 49). Chi-squared test and residual analysis were conducted to compare the distribution between family physicians and other specialists. Results: 519 JPCA-certified family physicians and 137,587 same-generation physicians were analysed. The distribution of family physicians was skewed to municipalities with a lower population density, which shows a sharp contrast to the urban-biased distribution of other specialists. The proportion of family physicians in non-metropolitan municipalities was significantly higher than that expected based on the distribution of all same-generation physicians (p<0.001). Conclusions: Family physicians distributed in favour of rural areas much more than any other specialists in Japan. The better balance of family physician distribution reported from countries with a strong primary care orientation seems to hold even in a country where primary care orientation is weak, physician distribution is not regulated, and patients have free access to healthcare. Family physicians comprise only 0.2% of all Japanese physicians. However, if their population grows, they can potentially rectify the imbalance of physician distribution. Government support is mandatory to promote family medicine in Japan.
Keywords
geography; health policy; Japan; family physician
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CURRENT STATUS: Published
View the published article at BMC Primary Care.
No community comments so far
Submission checks complete
On 06 Nov, 2019
Editorial decision: Accept
On 16 Oct, 2019
Editor assigned
On 16 Oct, 2019
Editor invited
On 15 Oct, 2019
Version 2
Posted 11 Oct, 2019
No comments provided
Editorial decision: Minor revision
On 10 Oct, 2019
Editor assigned
On 09 Oct, 2019
Submission checks complete
On 08 Oct, 2019
Editor invited
On 08 Oct, 2019
No comments provided
Editorial decision: Major revision
On 12 Sep, 2019
Review #2 received
Received 19 Aug, 2019
Review #1 received
Received 17 Aug, 2019
Reviewers invited
Invitations sent on 08 Aug, 2019
Reviewer #1 agreed
On 08 Aug, 2019
Reviewer #2 agreed
On 08 Aug, 2019
Submission checks complete
On 25 Jun, 2019
Editor invited
On 10 Jun, 2019
Editor assigned
On 10 Jun, 2019
First submitted
On 07 Jun, 2019
Metrics
Comments: 0
PDF Downloads: ...
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Subject Areas
General Practice
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at BMC Primary Care.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Primary Care.
No community comments so far
Submission checks complete
On 06 Nov, 2019
Editorial decision: Accept
On 16 Oct, 2019
Editor assigned
On 16 Oct, 2019
Editor invited
On 15 Oct, 2019
Version 2
Posted 11 Oct, 2019
No comments provided
Editorial decision: Minor revision
On 10 Oct, 2019
Editor assigned
On 09 Oct, 2019
Submission checks complete
On 08 Oct, 2019
Editor invited
On 08 Oct, 2019
No comments provided
Editorial decision: Major revision
On 12 Sep, 2019
Review #2 received
Received 19 Aug, 2019
Review #1 received
Received 17 Aug, 2019
Reviewers invited
Invitations sent on 08 Aug, 2019
Reviewer #1 agreed
On 08 Aug, 2019
Reviewer #2 agreed
On 08 Aug, 2019
Submission checks complete
On 25 Jun, 2019
Editor invited
On 10 Jun, 2019
Editor assigned
On 10 Jun, 2019
First submitted
On 07 Jun, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
General Practice
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Primary Care.
Background: Geographical maldistribution of physicians, and their subsequent shortage in rural areas, has been a serious problem in Japan and in other countries. Family Medicine, a new board-certified specialty started 10 years ago in Japan by Japan Primary Care Association (JPCA), may be a solution to this problem. Methods: We obtained the workplace information of 527 (78.4%) of the 672 JPCA-certified family physicians from an online database. From the national census data, we also obtained the workplace information of board-certified general internists, surgeons, obstetricians/gynaecologists and paediatricians and of all physicians as the same-generation comparison group (ages 30 to 49). Chi-squared test and residual analysis were conducted to compare the distribution between family physicians and other specialists. Results: 519 JPCA-certified family physicians and 137,587 same-generation physicians were analysed. The distribution of family physicians was skewed to municipalities with a lower population density, which shows a sharp contrast to the urban-biased distribution of other specialists. The proportion of family physicians in non-metropolitan municipalities was significantly higher than that expected based on the distribution of all same-generation physicians (p<0.001). Conclusions: Family physicians distributed in favour of rural areas much more than any other specialists in Japan. The better balance of family physician distribution reported from countries with a strong primary care orientation seems to hold even in a country where primary care orientation is weak, physician distribution is not regulated, and patients have free access to healthcare. Family physicians comprise only 0.2% of all Japanese physicians. However, if their population grows, they can potentially rectify the imbalance of physician distribution. Government support is mandatory to promote family medicine in Japan.
Figure 1
Figure 2
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