Current Institutional Affiliation
Assistant Professor of Pediatrics/ Investigator, University of California / Los Angeles / David Geffen School of Medicine at UCLA

Award Information

Abe Fellowship 2011
Institutional Affiliation (at time of award):
Assistant Professor, Medical Education, Juntendo University School of Medicine
Geographic maldistribution of pediatricians: A comparison of Japan and the United States

Maldistribution of physicians is a socio-political concern in many countries. The shortage of pediatricians is a particularly serious problem in Japan, and there have even been reports of death from overwork while on duty and suicide after developing depression from overwork. There are regions without any pediatricians, and parents or guardians are forced to transport their ill children long distances for treatment. As can be seen, both medical practitioners and patients alike are adversely affected by the shortage of physicians. Several countries have attempted to implement political policies that would encourage a more balanced number of physicians per region. In Japan, attempts have been made to increase both the number of medical schools as well as medical student quotas in order to increase the number of physicians, however, this has not resolved the variation in numbers between urban and rural areas. In order to resolve the shortage and the geographic or specialty maldistribution of physicians, there is a need to understand the current number of physicians as well as establish the number necessary to plan the suitability and systematic distribution of physicians by region or specialty. The present study will focus on the number of pediatricians and use secondary medical care area as the unit of analysis. The specific aims of this study are as follows. First, pediatrician to child population ratios will be visually illustrated using a geographic information system (GIS). Second, the relationship between number of pediatricians and community level socio-economic factors will be determined. Third, semi-structured interviews will be conducted with pediatricians. Fourth, an anonymous questionnaire survey will then target the pediatricians. Fifth, multilevel analysis will be conducted using community level factors and individual level factors. In addition, it was thought that it would be helpful to compare results with those from another country before introducing the findings internationally. The United States was chosen as a comparator for several reasons. Firstly, there has been no resolution to regional disparities in the number of physicians despite political intervention to increase these numbers in both countries. Secondly, in both countries, physicians are free to decide the location and specialty of their work without political intervention. Both countries are similar in these two respects. On the other hand, the health insurance systems in the two countries are completely different. In Japan, as a rule, all citizens are members of the public health insurance scheme and everyone is insured; in the United States, with the exception of public insurance schemes aimed at the elderly (Medicare) and low-income families (Medicaid), people generally purchase private insurance. It is hoped that the results of a comparison between Japan and the United States will contribute to further discussion on the influence of insurance regimes. The results are intended, first, to provide fundamental data highlighting the seriousness of the geographic maldistribution of pediatricians at the community level and individual level and, second, to contribute to the planning of concrete improvement strategies to address disparities in pediatrics between regions.