Transition of Physician Distribution (1980-2002) in Japan and Factors Predicting Future Rural Practice

Introduction: The geographic maldistribution of physicians (their concentration in urban areas and shortage in rural areas) has long been an important political issue in post-war Japan. The aim of this study was to evaluate long-term transition in the geographic distribution of physicians, and to reveal which rural physician characteristics predict their retention in rural areas after 22 years.

Methods: A record-linkage study was conducted to extract a physician cohort by merging the 1980 and 2002 Physician Census in which all licensed physicians are legally required to register. Physician characteristics in 1980 that predicted rural practice in 2002 were identified.

Results: Data were used from the 93 077 physicians who were recorded in both 1980 and 2002 Physician Censuses. The number of physicians increased by 52% between 1980 and 2002. In both 1980 and 2002, the physician-to-population ratios in rural areas were approximately half that in urban areas, indicating that the physician maldistribution had not improved. In 1980, 82 414 (88.5%) physicians worked in urban areas and 10 663 (11.5%) worked in rural areas. In 2002, 76 435 (92.7%) of the 1980 urban physicians were still practicing in cities, but only 5958 (55.9%) of the 1980 rural physicians had stayed in their rural area. Logistic regression analysis showed that primary-care discipline and rural practice in 1980 positively predicted rural practice in 2002 (OR [95% CI]: 1.28 [1.23-1.35] and 16.18 [15.43-16.95], respectively). However, female sex and age in 1980 were negative predictors for rural practice in 2002 (OR [95% CI]: 0.80 [0.74-0.86] and 0.91 [0.90-0.94], respectively).

Conclusions: The rapid increase of physicians between 1980 and 2002 has not substantially affected their geographic distribution. Baseline rural practice, primary care discipline and male sex of physicians were found to be predictors of rural practice after 22 years.