Résumé
Akita has the fastest aging community in Japan. Increasing demand for emergency care and subsequent hospital care for elderly patients is placing excessive pressure on community hospitals because of the chronic shortage of doctors and other medical staff. The characteristic features of these patients are comorbidities, high incidence of cognitive disorders of varying degrees, and physical frailty. To address these urgent problems in a comprehensive manner, the creation of a special department, the ER and GP (general practitioners) department, might be an effective solution. The absence of a GP section in the hospital and lack of family physicians is a major problem in the Japanese medical system. In this context, Akita prefectural government established a training institute for general practitioners and family physicians in Akita Kousei Medical Center in 2012. Only 6 trainees have joined the program in 4 years, so major problems remain. One is the limited human resources available: young doctors and students are still not familiar with the specific area of GP. This is because of the long history of Japanese postgraduate training that is focused on cultivating specialist physicians. The second major problem is the differences that often exist between these doctors─generalists include both hospitalists and family physicians─and these two groups sometimes have completely different mentalities. More time is needed to establish a new style of hospital medicine.