Factors related to Japanese internal medicine doctors' retention or migration to rural areas: a nationwide retrospective cohort study

BACKGROUND@#Internal medicine (IM) doctors in Japan play the role of primary care physicians; however, the shortage of rural physicians continues. This study aims to elucidate the association of age, sex, board certification, type of work, and main clinical work with the retention or migration of IM doctors to rural areas.@*METHODS@#This retrospective cohort study included 82,363 IM doctors in 2010, extracted from the national census data of medical doctors. The explanatory variables were age, sex, type of work, primary clinical work, and changes in board certification status. The outcome was retention or migration to rural areas. The first tertile of population density (PD) of municipalities defined as rural area. After stratifying the baseline ruralities as rural or non-rural areas, the odds ratios (ORs) of the explanatory variables were calculated using generalized estimation equations. The analyses were also performed after age stratification (<39, 40-59, ≥60 years old).@*RESULTS@#Among the rural areas, women had a significantly higher OR for retention, but obtaining board certification of IM subspecialties had a significantly lower OR. Among the non-rural areas, physicians who answered that their main work was IM without specific subspecialty and general had a significantly higher OR, but obtaining and maintaining board certification for IM subspecialties had a significantly lower OR for migration to rural areas. After age stratification, the higher OR of women for rural retention was significant only among those aged 40-59 years. Those aged under 40 and 40-59 years in the non-rural areas, who answered that their main work was IM without specific subspecialty had a significantly higher OR for migration to rural areas, and those aged 40-59 years in the rural areas who answered the same had a higher OR for rural retention.@*CONCLUSIONS@#Obtaining and maintaining board certification of IM subspecialties are possible inhibiting factors for rural work, and IM doctors whose main work involves subspecialties tend to work in non-rural areas. Once rural work begins, more middle-aged female IM doctors continued rural work compared to male doctors.

Why did You Choose not to be a Generalist? A Qualitative Study About Career Decision-Making Among Physicians who were Interested in General Practice but Chose to be a Specialist / 日本プライマリ・ケア連合学会誌

Background: There is an increasing demand for general practitioners capable of examining patients from a broad perspective. Although the training of such doctors is urgently needed, the accreditation system was only recently put into place.Purpose: Our aim was to identify factors that influence career decision-making among doctors who were interested in general practice but chose to be specialists, in addition to finding methods to improve general practitioner training in the future.Method: From April 2017 to April 2018, we conducted semi-structured interviews with five subjects to understand the process leading up to the selection of their current careers. The verbatim records were analyzed using the modified grounded theory approach.Results: The reasons given for choosing specialist careers included "attraction as a field of study", "being relied upon by other doctors", and "the sense of security from having a specialty". Cited barriers to entering general practice included "uncertainty about the future" and "criticism from specialists".Conclusion: Improving the training curriculum for general practitioners will require improvement of the quality of community-based medical education and the general practice board certification system, in addition to the implementation of general practice retraining for specialists.

Los especialistas en psiquiatría en México: año 2016 / Specialty in psychiatry: Mexico 2016

RESUMEN: Introducción: En el año de 2011 había en México 3 823 psiquiatras, con una tasa estimada de 3.4 por cada 100 mil habitantes. Es necesario mantener actualizada esta información para alcanzar los objetivos globales de atención a la salud mental. Objetivo: Estimar el número total de psiquiatras en México en 2016; determinar su distribución geográfica y comparar los resultados con los obtenidos en el año 2011. Método: Estudio comparativo y longitudinal. Se consultaron diversas fuentes para actualizar el número de psiquiatras en 2016 y conocer sus características sociodemográficas. Se compararon estas características con las encontradas en 2011. Resultados: Un total de 4 393 psiquiatras ejercen su especialidad en México en 2016. Sobre una población de 119 530 753 habitantes, se obtuvo una tasa de 3.68 psiquiatras por cada 100 000 habitantes. Existe una pobre distribución de estos especialistas en el país. Alrededor del 60% de todos los psiquiatras ejercen en las tres mayores ciudades de México. Discusión y conclusión: La tasa nacional de psiquiatras se incrementó en comparación con la obtenida en 2011, sigue siendo inferior a la recomendada por la Organización Mundial de la Salud (OMS). La distribución geográfica de los psiquiatras es inequitativa debido a la centralización y a factores económicos.

ABSTRACT: Introduction: In 2011 we had 3823 psychiatrists in Mexico, with an estimated rate of 3.4 per 100 000 inhabitants. In order to achieve the global targets of mental health attention, it is important to update this information. Objetive: To estimate the total number of psychiatrists in Mexico in 2016; detemine their geographic distribution and compare the results with the ones obtained in 2011. Method: Longitudinal and comparative study. Diverse sources of information were consulted in order to update the number of psychiatrists in 2016 and to know their sociodemographic characteristics, that were compared with the ones obtained in 2011. Results: 4 393 psychiatrists practiced their specialty in Mexico in 2016. With a population of 119 530 753 inhabitants, we obtained a rate of 3.68 psychiatrists per 100 000 inhabitants. There's a poor distribution of theese specialists in the country. Around 60% of all psychiatrists practice in the tree major cities of Mexico. Discussion and conclusion: The national rate of psychiatrists increase in comparisson with the one we found in 2011, it remains lower that the one recommended by the World Health Organization (WHO). Geographic distribution of the psychiatrists is inequitative because of centralization and economic factors.

A Model of Accreditation System for Medical Subspecialty Board Certification in Korea

Subspecialty board certification is a post-graduate program in which clinicians can acquire the qualifications for special areas or techniques, after they have received a board certification in a specialty in clinical medicine. Considering the trend of increasingly sub-classified and professionalized medicine and the higher demand on specialized medical services, introduction of subspecialty board certification is inevitable. However, given the characteristics of the medical environment in Korea, such as the medical payment system, a possibility of undesirable outcomes should not be overlooked. An imprudent administration of the specialty board system would cause conflict and split within communities of medical professionals and also produce confusion among medical consumers. Accordingly, the establishment of subspecialty board system should proceed based on academic communications as well as organic collaboration with the parent academic society and/or the relevant academic societies. Individuals can submit an application for a subspecialty board qualification under the agreement of specialized academic societies which have already been authorized, but the authorization of the societies is determined following a rigorous assessment by the Korean Academy of Medical Sciences (KAMS). An active intervention by KAMS is essential for maintaining the quality of specialty board system and preventing imprudent administration. KAMS will make the best effort to prevent distribution of unauthorized certificates and to rectify rational implementation of the subspecialty board certification system.