Japan: Doctor shortage, the medical system in crisis

Together with the economic crisis the shortage of doctors (医師不足, ishi busoku in Japanese) is becoming more and more urgent in Japan. As a Fire and Disaster Management Agency survey pointed out in 2007, the causes are the uneven distribution of the doctors mainly settled in urban areas and the fact that the medical profession has lost its attractiveness, because of the work load and salaries which have lagged behind other professions. Also the increasing age of the Japanese population and the consequent rise in the patient numbers has contributed to an impending collapse of the medical system.


by flickr user pqw93ct, used with permission

Among the symptoms are the large number of cases, (the last one happened in February) which sees patients turned away by the hospitals because of the lack of beds or staff. Also the unduly long shifts for the few doctors left, with the attendant risk of accidents due to fatigue.

One patient, Seichiro Sonoda (園田 誠一郎), tells of his experience when he was startled by the large number of patients crowding the hospital waiting rooms.


I have just been to a university hospital and I was astonished by the number of patients waiting.
In the otolaryngology ward and the blood donation ward there was great confusion and all the seats were full. I had the feeling that I was really witnessing the parlous condition of the medical system
They call it “doctor shortage”.

At Isha Ni Naru Hoho (医者になる方法 lit. how to become a doctor), a blogger explains the problem of the uneven distribution of doctors in the country.

厚生労働省の調査によると、医療 法の定める医師の配置基準の充足率は、全国で約83.5%(2004年度)。東京や大阪などの首都圏・近畿圏は概ね90%前後の充足率を達成していますが、田舎へ行くほど充足率は下がり、全国最低の青森県ではわずか43%に過ぎないと言う惨状です。

According to a Ministry of Health and Welfare's survey (2004), the desirable rate for standard distribution of doctors is set by the Law on Medical Treatment at about 85% overall nationally. The area of the capital Tokyo and that of Kinki, with Osaka, reach more or less 90% but the rate gets lower in the countryside and particularly in Aomori Prefecture where it only reaches about 43%, unfortunately.


The cause of this uneven distribution is the fact that very few medical graduates want to work in remote villages or islands. Even though the autonomous universities have a system which allows graduates, who choose to work in the isolated areas, to have school fees exempted some 60% of the graduates decide to work in hospitals in the area around Osaka even though school fees must be repaid.


In particular, the shortage is worrying in the field of obstetrics and paediatrics. Ask any doctor and they will respond that “these are the most exhausting medical fields to work in”.

A Japanese girl who studies to work at the E.R. illustrates in detail the causes and the consequences of this shortage of doctors.


The problem of doctor shortage has several causes:


1. One of the cause is the stupid plan started by the Ministry of Health and Welfare in 2004. (The plan itself was not wrong in its purposes but it was too rushed and now we are experiencing the unintended consequences. )
They prolonged the training period by 2 years consequently, I forget the exact numbers, it's as if they had blocked the graduation of almost 16,000 new doctors.


But perhaps the causes lie in the basics of Japanese demographics.


2. Because of the unparalleled increase in elderly people, which is greater than in any other country, the number of patients has risen enormously in the last 10 years. In order to deal with this fact there is urgent need for both time and money to train new doctors.

[…] これは単に私の実感として常にあります。

3. There are many people who go to the hospital for even trivial reasons. […] This is simply my feeling but I think that many like my granny attend hospital merely to make new friends here and there and on different days of the week, as if it was both a hobby and an excuse to go for a walk.


4. In case of public universities, the Japanese doctors are paid with people's taxes.
Now, it depends on what you consider when you calculate the total amount of money but it is estimated that for each doctor trained more than 50 million Yen is spent. (Students are charged 3,3 million Yen for 6 years but if they can't afford this it may be waived).



5. In the past there was the obligation for those who had been educated with public money to render service in the area of the home-university, generally in the countryside for at least 8 years.
However in 2004 this condition was abolished and the number of doctors electing to work in the countryside drastically declined.
(Personally, I did it only for a short time but I have every intention to do it sooner or later)


⑥その税金への恩返しとして「noblesse oblige」という観念を叩き込まれます。[…]

Lastly, in case of [doctors graduated from] the public universities:
6. They have drummed into them a sense of responsibility and gratitude for the public money received, a sort of ‘noblesse oblige’ if you will. […]
In this sense and because of our culture where it is considered wrong to agitate loudly for a pay raise or more leave, truth is that improvement in the working environment still has far to go.

Lastly, blogger at labayame reflects on how the image of a doctor has changed over the years.


In the past many parents’ dream was to have a son become a doctor.
Entering the medical faculty of a famous university was considered a privilege.
But now?


Certainly many still desire to become doctors and obtain one of the most prestigious national qualifications but, after the graduation, do those who have become doctors work with the same dedication or does harsh reality change them?


As well as some public hospitals being closed by staff shortages, the number of private hospitals hasn't increased either. So where do those who have earned the license to practice medicine go?


Nowadays, with the evolution of both medical technology and the equipment for medical procedures, the risks in treatment are generally small. However, childbirth is still a mysterious event for some aspects and you can never know with certainty what may happen. The problem is that if for any reason, despite the advanced equipment, there are complications then [the patient] immediately threatens a lawsuit.



A doctor, even though he studies widely, may always have to face situations that he couldn't expect.
So the problem is…where is the meeting point [of patient/doctor responsibility]? In future maybe there will come a day when the doctor and his patient will agree on a medical treatment and on what the treatment can and cannot solve.
If that moment arrives, we may have to say to our doctor “I leave everything in your hands”, just as once we used to do.

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