EDITORIAL | Fix Doctor Distribution to Under-served Prefectures

Figuring out how to ensure necessary medical care reaches those who need a doctor the most is a great challenge. As the number of workers decreases due to declining births and an aging population, the problem has become more urgent. It is essential to allocate doctors appropriately, without partiality based on region, medical specialty, or other factors. 

The Ministry of Health, Labor and Welfare (MHLW) has published a draft outline of measures to correct this uneven distribution. It proposes amending laws to curb the opening of new practices in areas that already have many private practice physicians. In addition, it would expand quotas for medical school entrance exams on a regional basis.

Along with these steps, a new promotion headquarters has been established within the ministry. It is charged with compiling a comprehensive package of measures by the end of 2024. 

Manifestations of the Distribution Problem

There are three main ways the uneven distribution of doctors manifests itself. Those are by region, by medical specialty, and by the shortage of doctors working at hospitals. 

Public-private cooperation will be needed to deal with all three. Furthermore, local governments and other relevant organizations should steadily implement their own measures to address the situation.

Unsurprisingly, Tokyo is the region with the most doctors. Meanwhile, Iwate Prefecture has the fewest. According to the MHLW’s "Physician Distribution Index," there is a 1.9-fold difference between the two. The ratios in the index are calculated based on population, number of physicians, and medical demand within each prefecture. 

Shortages were especially pronounced in the Tohoku region, according to the results.

Shortages by Medical Specialty

There are also serious disparities by medical specialty. Enhanced restrictions on overtime work have been in effect since April 2024. However, they have exacerbated the shortage of doctors in departments with typically heavy patient loads outside normal hours. Those include surgery, obstetrics and gynecology, and emergency medical care. 

Considering these circumstances, it is appropriate that the MHLW outline includes an expansion of regional quotas for medical school entrance examinations. Under the existing regional framework, newly minted doctors need to work in designated regions and specialties after graduation. 

However, this medical school examination system has not been fully implemented in some regions. Therefore, allocating regional quotas from prefectures with many doctors to prefectures with fewer doctors should be considered.

Supporting Motivated Young Doctors

This news should also be welcomed by highly motivated students. We would like to see the establishment of a system in which the desire of young doctors to contribute to local medical care is recognized. They should also be assisted in establishing themselves as physicians.

However, effective measures are needed to restrain doctors from opening new practices in areas where there are already abundant doctors. During the COVID-19 pandemic, there were two kinds of doctors: those who risked their lives to treat patients and those who did not. There is no need to increase the number of private practitioners unwilling to cooperate in providing local medical care. That includes those who choose not to make house calls or work on shifts on holidays and at night.

Private Medical Treatments 

Along with the disparities in doctor distribution, in recent years, private medical treatments have been shifting to cosmetic medicine. Patients pay out of pocket for such treatment.

Kichiro Matsumoto, president of the Japan Medical Association, takes this into account in his analysis. He believes that, after graduation, new doctors should be required to participate in insurance-based medical treatment. That should continue for a defined period. 

We hope that a combination of measures will be adopted to optimally allocate physicians to meet society's greater needs. 

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(Read the editorial in Japanese)

Author: Editorial Board, The Sankei Shimbun