Particularly in maternity and emergency departments, physicians are unevenly distributed in certain regions, leading to acute shortages in rural hospitals.
Having more government involved in any part of this won't fix anything. People need to want to be in more rural areas. Making grads be in a certain place for x years, meeting specific quotas, making new laws, etc will only have the opposite effect. Less government, less taxes, less regulation fixes all things. When the free market can decide where, when, how, and how much then things society will find a way to make it work. Government creating artificial scenarios never works.
Thank you for reading and adding your perspective. In this particular case, I share your point of view. Forcing a doctor who would rather practice in a big city to move to the country is probably not going to work in the long run. There are many other options (e.g. empowering nurses and setting up a PA system) that would probably be more effective.
This is a major factor in my opinion that the Japanese Government’s push for moving families to rural areas from cities is ludicrous; younger folx without so many immediate medical needs or commitments should be the ones on the frontier, not Moms and Dads who are already having a hard time of it in Meguro.
As a former resident of Meguro-ku, I can attest to the relatively high cost of living there. While everyone's situation is different, you might be surprised at the high quality of life and relatively reasonable cost of living that is possible in rural Japan. Some villages - not just those that have already experienced significant depopulation - even offer all kinds of subsidies for young families with children.
Great piece, thank you. Here's an article (in Japanese) from the Yomiuri that highlights another dimension of the divide--the growing shortage of coroners, especially outside the major urban areas. Japan is already approaching the end of forensic pathology as a part of its medical system. https://www.yomiuri.co.jp/national/20241005-OYT1T50048/
Thank you for reading and the positive feedback. The acute shortage of pathologists is certainly another unintended consequence of depopulation, and the long-term population decline has only just begun. What a strange problem to have! Hopefully, would-be murderers are still unaware of this situation. If they were, however, the map would provide some clues as to where a would-be criminal might best be able to get away with such a heinous crime. This is worrying as I live in one of the dark shaded areas!
I think you're probably pretty safe from foul play where you live in Japan. I think you're also right about long-term population decline just beginning. People underestimate the entropy of depopulation. Immigration is not a solution, in light of declining birth rates around the world.
I wonder if some kind of rotation like a residency program could help. I am not familiar with how education is funded in Japan but, if medical students are running up a debt as in the US, there could be a debt forgiveness for practicing in a target region for a period of time. These new Drs might start off thinking they want to resettle to a big metropolis, but perhaps after they have a chance to build a sense of community in their underserved area, a percentage of them might change their minds and stay.
While I’m not personally for forcing someone to have to work in a certain place, I absolutely understand the problem going on. As someone who lives in Aomori prefecture, it’s easy to see that with the lack of doctors also means a lack of good healthcare. And probably one of the reasons Aomori the lowest life expectancy in Japan.
Thank you for reading and leaving a comment. You are on the front lines of this issue. I have a feeling that your belief about the possible connection to life expectancy is, in fact, probably true.
Thanks for reading and commenting. Yes, I agree that telemedicine should be an integral part of the overall strategy. It has already been adopted by some rural hospitals, but there is obviously much more room to encourage more widespread use.
As the populations gets even smaller doctors will shrink even more as well. True, less patients as well. But if they don't shrink proportionally its going to make it even worse.
I think you're right about financial incentives having a major role to play. I don't know about Japanese doctors; but my experience of doctors in other countries in which I have lived is that too many of them are in it for the money. I used to know a Scandinavian doctor who had a one-year contract to teach medicine to undergrads at a prestigious Asian university. He told me how shocked he was that his students showed little or no interest in how to be good doctors. They just wanted to know how to pass their exams.
Offering higher salaries and/or lower taxes to work in the relevant prefectures seems like a no-brainer. Importing trained medical staff from overseas has worked well in some countries. In Japan's case, the language barrier would be an issue; but doctors are smart people and would probably be willing to learn Japanese if the salary, terms and conditions of employment were right.
Having said all that effecting change will require leadership, common sense and imagination, all of which - perhaps like doctors - seem to be in short supply in Japan.
Despite my usual cynicism, however, I would like to pay tribute to the exemplary patience, care, kindness and professionalism of all the staff who took care of me at a Japanese hospital where I had surgery last week - and thank God for Google Translate!
Thank you for reading and leaving a comment. First of all, it sounds like you are making a speedy recovery from your surgery, which is great.
As I suggest in the article, I have a feeling that this problem is not going to be solved simply by offering financial incentives to get more doctors to practice in rural areas. Empowering advanced practice nurses and possibly establishing the role of a physician assistant would probably be more realistic in the long run.
Yes, I don't disagree; but I do think that financial incentives would be relatively quick and simple measure to take compared with re-structuring the care system. Provided that the financial incentives are not just a few yen here and there, they could be very effective. On the other hand, I doubt that the policrims in Tokyo with their grubby fingers on the purse strings would be too happy seeing their best doctors re-locating to the countryside to take care of the serfs! So maybe financial incentives are another non-starter?!
Come to think of it, I did read about a study which allegedly showed that AI is already better at producing accurate diagnoses than the human doctors involved in the study; so maybe AI is starting to offer a contribution to the problem at the primary care level?
Whatever happens, I do think that medicine is heading for a major shake-up. Apart from changes in technology, I think there is a lot of disillusionment with allopathic medicine, especially after all the propaganda, lies and nonsense in recent years about "safe and effective."
Yes, AI is already proving itself as a diagnostic tool. My feeling is, however, that there will always be a need for the human touch - literally - to provide quality medical care.
Having more government involved in any part of this won't fix anything. People need to want to be in more rural areas. Making grads be in a certain place for x years, meeting specific quotas, making new laws, etc will only have the opposite effect. Less government, less taxes, less regulation fixes all things. When the free market can decide where, when, how, and how much then things society will find a way to make it work. Government creating artificial scenarios never works.
Thank you for reading and adding your perspective. In this particular case, I share your point of view. Forcing a doctor who would rather practice in a big city to move to the country is probably not going to work in the long run. There are many other options (e.g. empowering nurses and setting up a PA system) that would probably be more effective.
This is a major factor in my opinion that the Japanese Government’s push for moving families to rural areas from cities is ludicrous; younger folx without so many immediate medical needs or commitments should be the ones on the frontier, not Moms and Dads who are already having a hard time of it in Meguro.
As a former resident of Meguro-ku, I can attest to the relatively high cost of living there. While everyone's situation is different, you might be surprised at the high quality of life and relatively reasonable cost of living that is possible in rural Japan. Some villages - not just those that have already experienced significant depopulation - even offer all kinds of subsidies for young families with children.
Great piece, thank you. Here's an article (in Japanese) from the Yomiuri that highlights another dimension of the divide--the growing shortage of coroners, especially outside the major urban areas. Japan is already approaching the end of forensic pathology as a part of its medical system. https://www.yomiuri.co.jp/national/20241005-OYT1T50048/
Thank you for reading and the positive feedback. The acute shortage of pathologists is certainly another unintended consequence of depopulation, and the long-term population decline has only just begun. What a strange problem to have! Hopefully, would-be murderers are still unaware of this situation. If they were, however, the map would provide some clues as to where a would-be criminal might best be able to get away with such a heinous crime. This is worrying as I live in one of the dark shaded areas!
I think you're probably pretty safe from foul play where you live in Japan. I think you're also right about long-term population decline just beginning. People underestimate the entropy of depopulation. Immigration is not a solution, in light of declining birth rates around the world.
I wonder if some kind of rotation like a residency program could help. I am not familiar with how education is funded in Japan but, if medical students are running up a debt as in the US, there could be a debt forgiveness for practicing in a target region for a period of time. These new Drs might start off thinking they want to resettle to a big metropolis, but perhaps after they have a chance to build a sense of community in their underserved area, a percentage of them might change their minds and stay.
Thank you for reading and leaving a comment. Yes, that is the intent of the quota system.
While I’m not personally for forcing someone to have to work in a certain place, I absolutely understand the problem going on. As someone who lives in Aomori prefecture, it’s easy to see that with the lack of doctors also means a lack of good healthcare. And probably one of the reasons Aomori the lowest life expectancy in Japan.
Thank you for reading and leaving a comment. You are on the front lines of this issue. I have a feeling that your belief about the possible connection to life expectancy is, in fact, probably true.
Thank you for another informative newsletter, Mark! I was surprised by some of the prefectures with the most doctors.
Create an effective telemedicine system nationwide. This could reduce pressure on all hospitals, freeing them up to deal with urgent cases.
Thanks for reading and commenting. Yes, I agree that telemedicine should be an integral part of the overall strategy. It has already been adopted by some rural hospitals, but there is obviously much more room to encourage more widespread use.
関東中央病院に勤務している在日朝鮮人のドクターは、6年前罹った時、忙しい時は35時間勤務していると言っていました。驚異的です。そういう人が国立や公立病院にはいらっしゃると思いますので、養老孟司先生が提唱している地方への定期的な参勤交代が必要だと思いました。首都圏で勤務する医者を地方で数週間ないし数年勤務させるのです。強制で。ワクチンでたくさん儲けたのでそのぐらいよろしくお願いしますよ🙏🙇♀️。
お読みいただき、コメントを残してくださりありがとうございます。医師に35時間または36時間のシフト勤務をさせるという慣行は、おそらく誰にとっても最善ではないという意見にケネディも同意します。間違いは起こるものです。
首都圏に勤務する医師に、地方でパートタイム勤務をさせるというアイデアは、メリットがあると思います。
As the populations gets even smaller doctors will shrink even more as well. True, less patients as well. But if they don't shrink proportionally its going to make it even worse.
Thank you for reading and sharing your perspective. I agree. The situation in Tohoku seems to be a classic case of how what you describe can play out.
I think you're right about financial incentives having a major role to play. I don't know about Japanese doctors; but my experience of doctors in other countries in which I have lived is that too many of them are in it for the money. I used to know a Scandinavian doctor who had a one-year contract to teach medicine to undergrads at a prestigious Asian university. He told me how shocked he was that his students showed little or no interest in how to be good doctors. They just wanted to know how to pass their exams.
Offering higher salaries and/or lower taxes to work in the relevant prefectures seems like a no-brainer. Importing trained medical staff from overseas has worked well in some countries. In Japan's case, the language barrier would be an issue; but doctors are smart people and would probably be willing to learn Japanese if the salary, terms and conditions of employment were right.
Having said all that effecting change will require leadership, common sense and imagination, all of which - perhaps like doctors - seem to be in short supply in Japan.
Despite my usual cynicism, however, I would like to pay tribute to the exemplary patience, care, kindness and professionalism of all the staff who took care of me at a Japanese hospital where I had surgery last week - and thank God for Google Translate!
Thank you for reading and leaving a comment. First of all, it sounds like you are making a speedy recovery from your surgery, which is great.
As I suggest in the article, I have a feeling that this problem is not going to be solved simply by offering financial incentives to get more doctors to practice in rural areas. Empowering advanced practice nurses and possibly establishing the role of a physician assistant would probably be more realistic in the long run.
Yes, I don't disagree; but I do think that financial incentives would be relatively quick and simple measure to take compared with re-structuring the care system. Provided that the financial incentives are not just a few yen here and there, they could be very effective. On the other hand, I doubt that the policrims in Tokyo with their grubby fingers on the purse strings would be too happy seeing their best doctors re-locating to the countryside to take care of the serfs! So maybe financial incentives are another non-starter?!
Come to think of it, I did read about a study which allegedly showed that AI is already better at producing accurate diagnoses than the human doctors involved in the study; so maybe AI is starting to offer a contribution to the problem at the primary care level?
Whatever happens, I do think that medicine is heading for a major shake-up. Apart from changes in technology, I think there is a lot of disillusionment with allopathic medicine, especially after all the propaganda, lies and nonsense in recent years about "safe and effective."
Yes, AI is already proving itself as a diagnostic tool. My feeling is, however, that there will always be a need for the human touch - literally - to provide quality medical care.