Distribution Discrepancies Between Male and Female Physicians in Urban and Rural Japan: A Twenty-Year Longitudinal Study from 1994 to 2014

Abstract

Abstract Background The Japanese medical education system produces 9,000 graduates per year, but the government still struggles with a shortage of physicians in rural areas, despite the implementation of several strategies. Our study examines this problem in detail during the period 1994–2014, comparing data on gender, years of medical experience, and demographic and geographic factors. Methods We analyzed the Physician Census from 1994, 2004, and 2014, examining data on physicians’ gender and the number of years since licensure. To correct the impact of municipal mergers, the analysis was aligned with the number of municipalities in 2014 (1741). We examined data from each physician (gender and years of medical experience) and analyzed the demographic and geographic distribution trend using Spearman correlation coefficients. We then used the Gini coefficient to evaluate the distribution change of physicians based on gender and years of experience. Results The number of physicians increased 1.29-fold over the 20-year observation period (1.23-fold for male physicians and 2.17-fold for female physicians), and the percentage of female physicians increased from 13.4–20.4%. The top one-third of the most populous municipalities were served by 79.4% of the physicians, and 87.7% of all physicians work in the top 1/3 municipalities in terms of population in 2014. The number of female physicians was higher at 91.8% compared to 86.8% for male physicians. The Spearman correlation coefficient examining the relationship between “ratio of physicians to total population” and “distance from prefectural capital” was 0.194–0.222–0.270. The Gini coefficient for all physicians was 0.315–0.298–0.298 (male physicians: 0.311–0.289–0.283, female physicians: 0.394–0.385–0.395). The Gini coefficients were lower for veteran physicians of both sexes than for younger physicians. The Gini coefficients for female compared to male physicians were higher in all age groups, showing that females had a denser population in urban areas. Conclusion The distribution of female physicians was lower in rural areas compared to their male counterparts. An improvement in policies to improve work–life balance for female physicians might encourage them to move to rural areas and alleviate the chronic shortage of medical care in these locations.