[Effect of physician shortage on today's Hansen's disease management]

In recent years, the total patient population of Hansen's disease has been rapid declining throughout Japan by as many as 200 - 250 each year. This decline is due to the aging of existing patients, and scarcity of new cases. Less patients are a welcome phenomenon. However, existing treatment facilities are now confronted with problems. The most serious problem is shortage of treating physicians. The causes of the shortage are (1) the aging of the existing patient population that creates mounting need for medical-surgical care and (2) the nation-wide shortage of physician in national sanatoria all over Japan. Let me present a sketch of the current situation at Amamiwakouen Hospital as an illustration. Amamiwakouen is a government-run sanatorium. It is responsible to take care of inpatient as well as out patients. Currently, there are 70 long term inpatients, who are handicapped by Hansen's disease sequela of various degrees. 11 minimally former inpatients are followed at the outpatient clinic. The clinic is also open to all community citizens. The number of annual clinic visitors averages 6,500 - 7,000. They come with wide range of problems requiring a dermatologist. While the total number of full-time staff is 100, only two are licensed physicians at present. This is indeed a disastrous situation. Therefore a number of contract physicians are recruited from nearby medical institutes to meat the demand.