The education ministry’s recent decision to approve creation of a new medical school at an existing university — for the first time in more than three decades — in Tohoku marks a new development in the government’s oscillating policy on the education of doctors.
While the decision is billed as a one-off measure to help facilitate reconstruction of the areas hit by the March 2011 earthquake-tsunami disasters, it sheds light on various problems of the national policy that has limited the number of doctors since the 1980s.
The government gave the go-ahead for opening a new medical school at a university in the Tohoku region in response to a plea by Miyagi Gov. Yoshihiro Murai in October. The education ministry says its ban on opening new medical schools will still stand and that its latest decision is an exception in view of the urgent need to rebuild the disaster-hit coastal areas of Tohoku.
The ministry will receive applications from universities until next May and then choose the institution that can open the medical school in the spring of 2015 if things go smoothly.
The number of medical schools and their enrolment limits were increased in the 1960s and 1970s as the nation faced a shortage of doctors in meeting the rising medical needs of the rapidly growing economy.
In 1972, then Prime Minister Kakuei Tanaka introduced a policy to have at least one medical school in each of Japan’s 47 prefectures, which resulted in the establishment of 15 new medical schools in seven years from 1973.
But a government policy turnaround in the early 1980s to limit the number of doctors — based on alleged fears of a future deluge of doctors — resulted in no new medical schools being given the official nod for opening after the last one was opened at the University of the Ryukyus in 1979. Enrollment limits at existing medical schools were also reduced and tightly capped until as recently as 2008.
Today Japan is confronted with a severe shortage of doctors, just as medical needs are increasing with the rapid aging of the population. The number of doctors per 1,000 people is 2.2 — about two-thirds of the average level in industrialized economies. The situation is even more serious in many rural parts of the country. According to a health and welfare ministry survey as of 2010, the number of doctors per 100,000 people in all of the six prefectures in the Tohoku region, for example, was below the national average. Roughly 70 percent of hospitals and clinics in Miyagi, Iwate and Fukushima prefectures polled by Kyodo News in 2013 said the shortage of doctors and nurses accelerated after the March 2011 disasters due to the increase in the number of patients and an exodus of staff.
However, the go-ahead for new medical school in Tohoku has been met with mixed reactions. The biggest concern cited by opponents is that already stretched staffing at hospitals in Tohoku could break down if doctors at the local institutions are recruited as teachers for the new school.
The Japan Medical Association says creation of a new medical school would require about 300 veteran doctors.
In maintaining its long-standing opposition to opening new medical schools, the association reportedly says that the shortage of doctors has been addressed by the increase in enrollment limits at existing schools in recent years and that the real issue is the regional imbalance in the number of doctors and the shortage of doctors in certain departments, such as emergency medicine, pediatrics, and obstetrics and gynecology.
In fact, the total number of students allowed in a year at the nation’s 80 medical schools has increased from 7,600 in 2007 to a record 9,040 in 2013, as the education ministry shifted its policy because of growing medical needs spurred by the graying of the population. The increase is said to have had the same effect as opening about 14 new medical schools in terms of the capacity to produce doctors.
Opening a new medical school in Tohoku alone will not help remedy the immediate shortage of doctors. It takes years — possibly more than a decade — before graduates from the new school can take on full-fledged roles in the region’s medical service. The current dire staffing conditions at medical institutions in the disaster-hit areas need to be addressed through other emergency measures.
There is no guarantee that students who graduate from a medical school will go on to work at a local hospital in the region. Schools in rural areas often face the problem of students from outside the local communities going on to work in urban areas after graduation.
When the education ministry raised the enrollment limits at medical schools in 2008, many of the schools set aside entrance quotas for graduates from high schools in their own areas. Scholarships were offered on condition that the students worked at local medical institutions for a certain period of time after graduation.
In giving the go-ahead for the new medical school in Tohoku, the ministry urged that a similar scholarship program be introduced to ensure that graduates from the school would in fact join medical services in the region. The effects of such measures need to be monitored to see if they are effective in encouraging more graduates from medical schools in rural areas to serve local medical needs.
Training of doctors to meet the nation’s medical needs requires a long-term policy approach that takes into account the nation’s future demographic trends. Regional disparity in the number of doctors is not a problem specific to Tohoku. The issue deserves a comprehensive review of the government policy.