Board certification and urban-rural migration of physicians in Japan
Soichi Koike1,2, Masatoshi Matsumoto3, Hideaki Kawaguchi4
1Division of Health Policy and Management, Center for Community Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan. koikes@jichi.ac.jp.
Insights
Newly board-certified physicians are more likely to move to urban areas. Rural physicians face challenges maintaining board certification, highlighting the need for support systems and rural training quotas.
Area of Science:
- Health Policy
- Medical Education
- Physician Workforce Distribution
Background:
- Physician board certification is a key quality assurance mechanism.
- Independent academic societies manage Japan's board certification system, unlinked to reimbursement.
- Concerns exist regarding physician maldistribution and rural shortages, particularly among younger specialists.
Purpose of the Study:
- To investigate associations between physician geographical migration and board certification status.
- To examine the relationship between rural practice and maintaining board certification.
- To inform health policy regarding physician distribution and certification.
Main Methods:
- Analysis of 2012 and 2014 national physician census data.
- Examined practice location transitions (rural, intermediate, urban) by board certification status (new, lost, consistently certified/uncertified).
- Used logistic regression to assess migration odds and rural practice impact on certification maintenance.
Main Results:
- Newly certified physicians showed higher odds of migrating to urban areas.
- Physicians in rural areas had lower odds of maintaining board certification.
- Among newly certified physicians, 94.9% in urban areas stayed urban, vs. 64.6% in rural areas.
Conclusions:
- Newly board-certified physicians tend to relocate to more urban settings.
- Policies such as increasing rural training quotas may help balance specialist distribution.
- Support systems are crucial for physicians maintaining board certification in rural practice.
Background:
The board certification system serves as a quality assurance system for physicians, and its design and operation are important health policy issues. In Japan, board certification was established and operated independently by academic societies and has not been directly linked to reimbursement systems. The phenomenon of younger physicians seeking specialist careers has raised concerns about acceleration of the tendency of fewer physicians working in rural areas and the maldistribution of physicians. Little is known about the associations between physicians' geographical migration patterns and board certification status changes or between the continuation of urban/rural practice and the maintenance of board certification. This study aimed to identify these associations and to discuss their policy implications.
Methods:
We analyzed 2012 and 2014 data from the Survey of Physicians, Dentists, and Pharmacists, a national census survey. To analyze geographical migration patterns, transitions in practice location (rural, intermediate, and urban) were analyzed by board certification status change (new, lost, consistently certified, and consistently uncertified). Logistic regression analysis was conducted to assess whether the odds of migrating to more urban/rural municipalities were associated with board certification status changes, adjusting for covariates, and whether practicing in a rural area was associated with maintaining board certification.
Results:
Among 18,726 newly board-certified physicians, 94.9% (13,435/14,150) of those working in urban areas before certification remained in urban areas, whereas 64.6% (393/608) of those working in rural areas stayed in rural areas. Those who were newly certified had higher odds of moving to more urban areas, adjusting for covariates. Those who stayed in rural areas showed lower odds of maintaining board certification, adjusting for covariates.
Conclusions:
Newly board-certified physicians are more likely to migrate to other types of areas, particularly more urban areas, than other physicians. Allocating more training quotas to rural areas could be one option for leveling the distribution of specialists. It also appeared that those practicing in rural areas have difficulty maintaining their certification, so the need to establish a support system for already-certified physicians in rural areas should be emphasized.
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