A comparative study of rural clinics in remote islands and inland areas

Job and life satisfaction and preference of future practice locations of physicians on remote islands in Japan

BACKGROUND

The objective of this research is to investigate job and life satisfaction and preference of future practice locations of physicians in rural and remote islands in Japan.

METHODS

A cross-sectional study was conducted for physicians who reside or resided on the Oki islands: isolated islands situated in the Sea of Japan between the Eurasian continent and the mainland of Japan. A questionnaire was sent to physicians on the Oki islands to evaluate physician satisfaction regarding job environment, career development, living conditions, salary, and support by local government.

RESULTS

Data was analysed for 49 physicians; 47 were male and 2 were female, and the mean ± SD age was 44.3 ± 10.9 years. Among the variables related to physicians' satisfaction, most of the physicians (>90%) were satisfied with "team work" and "salary". On the other hand, the majority of physicians (approximately 70%) were not satisfied with the "opportunity to continue professional development". Age ≥ 50 years, graduates of medical schools other than Jichi Medical University (established in 1972 with the aim to produce rural physicians), self-selected the Oki islands as a practice location, and satisfaction in "work as a doctor", "opportunity to consult with peers about patients", "relationship with people in the community", and "acceptance by community" were found to be significant factors influencing the choice of the Oki islands as a future practice location. Factors influencing future practice locations on the remote islands were included in a self-reported questionnaire which illustrated the importance of factors that impact both the spouses and children of physicians.

CONCLUSIONS

Improving work satisfaction, providing outreach support programmes for career development and professional support in rural practice, and building appropriate relationships between physicians and people in the community, which can in turn improve work satisfaction, may contribute to physicians' choices of practising medicine on rural and remote islands in Japan. Addressing family issues is also crucial in encouraging the choice of a rural medical practice location.

Progress in Island Health in the Asia-Pacific Region

The Asia-Pacific region contains many islands, perhaps up to 100 000. The provision of public health and health care to small isolated groups poses particular challenges in the 21st century. The health of island populations has improved over the past 3 decades, but maintaining and improving current levels of health is made more difficult by emigration and the difficulty of maintaining communications.

The shortage of pediatrician workforce in rural areas of Japan

The shortage of physicians is of great concern in Japan. We aim to assess the pediatrician workforce in rural areas of Japan. Data were obtained from a governmental survey that included the number of physicians and child population in each municipality (i.e., 888 cities and 1,466 towns, villages, or rural areas). The supply of pediatricians was evaluated by physician-to-child population ratios of pediatricians and non-pediatricians in pediatric practice, and geographical distributions using Lorenz curves and Gini indices. Lorenz curves are drawn to visualize geographical mal-distribution of physicians and the Gini indices range from 0 to 1, with higher values indicating larger inequity in physician distribution. Between 1996 and 2004, the numbers of pediatricians per 100,000 children increased from 69 to 84 and this increase was constantly observed both in cities, and towns/villages. Lorenz curves showed that both pediatricians and non-pediatricians in pediatric practice were relatively equally distributed in cities. The Gini indices in 1996 and 2004 were 0.337 and 0.321, respectively in pediatricians and 0.264 and 0.278, respectively in non-pediatricians in pediatric practice. In contrast, pediatricians were unequally distributed in rural areas (the Gini indices; 0.723 and 0.703, respectively). In such areas, non-pediatricians in pediatric practice were more equally distributed than pediatricians (0.419 and 0.482, respectively). These results suggest that non-pediatricians in pediatric practice have played a significant role in supporting pediatric care in rural areas. In conclusion, the absolute numbers of pediatricians increased in Japan between 1996 and 2004; however, they were mal-distributed in rural areas.