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Uneven Distribution and Facility-Level Allocation of Infectious Disease Specialists in Japan: A National
Shinnosuke Fukushima1, Hideharu Hagiya2
1Department of Infectious Diseases, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; Department of Infectious Diseases, Okayama City hospital, Okayama, Japan.
Background:
The coronavirus disease 2019 (COVID-19) pandemic exposed the vulnerability of Japan's infectious disease (ID) healthcare infrastructure, driven by an absolute shortage and regional maldistribution of ID specialists. While their clinical and administrative demands have expanded, many community hospitals continue to face a critical staffing deficit, potentially predisposing them to burnout.
Objective:
This study aimed to comprehensively quantify and map the nationwide distribution of board-certified ID specialists, and to elucidate the geographical distribution and institutional patterns of facilities with multiple affiliated specialists across Japan.
Methods:
Descriptive statistics, prefecture-level correlation analyses, and population-adjusted geospatial four-quadrant mapping were employed to evaluate the regional distribution of ID specialist resources.
Results:
Of 1,846 institution-affiliated specialists distributed across 1,021 facilities, 761 (41.2%) worked singly at each facility, while 1,085 (58.8%) were affiliated with 260 facilities with multiple specialists. A multi-specialist presence was predominantly observed in university-affiliated facilities (77.5%), whereas it was present in 18.5% of university-unrelated facilities. The population-adjusted geospatial four-quadrant mapping demonstrated clear regional clustering: highly populated metropolitan areas such as Tokyo, Kanagawa, Fukuoka, Aichi, and Osaka exhibited a high density of multi-specialist presence, whereas other regions showed a shortage of either multi-specialist presence or certified facilities.
Conclusion:
Although the national pool of board-certified ID specialists continues to grow, stark regional and institutional disparities persist. Transitioning from facilities with a solo-specialist presence to those with a multi-specialist presence at regional core hospitals is essential to supporting sustainable specialist coverage and building a resilient, sustainable ID response system in Japan.
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