• Kyodo


A group of veteran doctors in private practice in southwestern Japan will launch a training program for young doctors currently working at general hospitals across the country.

The two-year program set to start next spring, organized by a doctors association in Masuda, Shimane Prefecture, is intended to provide young doctors with training opportunities that can be hard to arrange at hospitals in urban areas. For example, they will be taught primary-care services, a field where doctors in private practice have built up expertise.

In exchange for receiving training, doctors who take part in the program will be required to work as general practitioners at Masuda Medical Association Hospital, a local general hospital facing a chronic staff shortage.

The training program will be launched in step with a plan next fiscal year by a third-party medical entity to certify general practitioners as a new category of medical doctor.

“The program in Masuda will be a useful business model for other communities understaffed with doctors,” said an official linked to the association, which has been exploring ways to secure manpower in the region.

Masuda Medical Association Hospital is one of the two hub medical institutions in the city, which has a population of nearly 50,000. The number of full-time doctors at the hospital has dropped to 11 from 19. Its internal medicine and surgery departments have been staffed with only one full-time doctor each since February.

The general decline in doctors at regional hospitals has been blamed on the fiscal 2004 shake-up in the nation’s postgraduate clinical training system.

Medical students are required to train for at least two years at hospitals after obtaining a state-certified doctor’s license. Previously, most trained at hospitals attached to their medical schools. Where to work after the internship was largely controlled by paternalistic professors at the hospitals. Under the old system, regional hospitals were able to secure medical staff through the dispatch from affiliated medical schools.

In fiscal 2004, however, doctors fresh out of school had more leeway in choosing where to train. The new system became an incentive for novice doctors to go to hospitals not linked to any medical schools. Seeking to woo doctors with high potential, such hospitals offer better pay and other labor conditions.

Under the new internship system, university-linked hospitals have lost their influence and are unable to dispatch a sufficient number of young doctors to affiliated regional hospitals, causing staff shortages.

The planned training program by Masuda was proposed by Chiba Prefecture-based general practitioner Manabu Saito in May after Minehisa Karino, head of Masuda Medical Association Hospital, turned to him for advice.

“I hit upon the idea when I met with local doctors in private practice. They are highly experienced doctors and their passion for serving the interests of local people on the medical front impressed me a lot,” said Saito.

Saito asked Karino to mobilize local doctors to launch the new training program. Saito’s business entity, Genepro, will organize it, and, since all the doctors who have offered to teach are seasoned male physicians, the program has been named Oyaji no Senaka. The name literally means “dad’s back” and is an idiom describing children learning from their parents.

Doctors who participate in the program need to have a minimum of five years of medical practice. They will be asked to work in the internal medicine department, while the training by local doctors will focus on such fields as orthopedics and dermatology.

Costs associated with the program and salaries for the trainee doctors will be shouldered by the association, not by the hospital.

In late September, 16 young doctors from all over Japan participated in a workshop the association sponsored to explain the concept of the program and the health care situation in the region.

Takao Inoue, a 55-year-old orthopedics doctor running a clinic in the city, taught how to apply a plaster cast to a patient and demonstrated surgical techniques using a pig’s leg.

The workshop was received favorably, by one participant, who said, “I have come to realize that regional health services are in peril.”

Another participant said: “I was amazed by the high level of expertise displayed by local doctors, even outside their specialties, in a depopulated and aging community.”

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