The planned introduction of a new program to train specialist doctors has been postponed for a year over concerns it will lead to a concentration of doctors in urban centers at the expense of rural areas. The parties concerned, including the government, universities, hospitals and medical professionals, should rethink the program to make sure it meets the medical needs of the nation’s citizens no matter where they live.

It will be vital to avoid repeating the policy mistake made in 2004 in connection with the system for training doctors. From that year the government made two years of clinical training mandatory instead of voluntary, and university medical schools and hospitals attached to university hospitals were no longer the sole providers of clinical training. Doctors were allowed to choose where to go, and many chose to do their clinical training at private hospitals in big cities, where they could learn more practical medical skills and receive better pay than at university hospitals.

This caused a serious shortage of doctors at university hospitals — which then served as a physician pool — and prompted them to stop dispatching experienced doctors to other hospitals. As a result, hospitals outside of urban centers experienced a doctor shortage, and in the worst cases were forced to shut down some departments. The policy wreaked havoc on medical services in rural areas, which had already been impacted by the closure of some public medical institutions amid the wave of municipal mergers that stared in the mid-1990s.

Subsequently, although the shortage of doctors in rural areas remained unaddressed, consideration began on the introduction of a new system to train specialist doctors — with the primary purpose of standardizing quality. To implement the new scheme, the Japanese Medical Speciality Board was established in 2014 as a neutral, third-party organization to qualify specialist doctors.

In addition to the mandatory two years of clinical training, doctors who choose to train as specialists must undergo three to four years of first-tier training in one of 19 basic fields — to be followed by second-tier training in one of 29 sub-specialities.

The training will be carried out within a group of hospitals, typically the region’s flagship hospital, such as a university medical center, along with its partner institutions. To qualify as specialists, trainee doctors must handle a certain number of cases and operations. Given these conditions, trainees will likely choose hospitals in major cities, which will then exacerbate the shortage of physicians in rural areas.

This concern has led various organizations, including local governments, the Japan Medical Association and associations of hospitals, to criticize the new scheme. The requirement that hospitals need to be designated as partners of the area’s leading institution to be able to provide training also restricts the number of eligible hospitals.

The criticism prompted the postponement of the new scheme’s introduction from fiscal 2017 to fiscal 2018, by which time the problems are supposed to have been discussed and resolved.

Another criticism of the new scheme raises the question of whether it is appropriate for doctors to be trained as specialists after only two years of clinical training. The concerned parties should consider whether this system will produce a solid pool of medical professionals and improve the overall ability of doctors and hospitals to meet patients’ needs, or whether it will produce a large numbers of doctors too specialized to cope with the real situation at hospitals or clinics.

Since the planned scheme will impact the nation’s health care, people outside of medical circles, including the general public, should participate in the discussions. The bottom line should be to ensure that everyone can receive adequate medical care irrespective of where they live.

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