Editorials

Training and certifying medical specialists

A new system has been launched this month to certify medical specialists under a common set of standards — whereas previously the specialist doctors in each of the medical fields were tested and certified according to different rules set by their respective medical societies. Creation of the new system under the Japanese Medical Specialty Board, set up in 2014 by the medical societies, the Japan Medical Association and representatives of university medical schools, is aimed at upgrading the quality of specialists — defined as doctors trained in their respective fields of specialty to “provide trustworthy and standard medical service.” It needs to be made certain that the reform will fulfill its intended purpose and serve the interests of the patients.

Progress in medical science has entailed divisions into specialized fields. Young doctors who have passed state exams and finished the initial basic training will acquire the knowledge and experience, and learn the medical technology, in their respective specialty under the guidance of senior doctors. In today’s clinical practice, qualification as a specialist is said to be more valued than a medical doctorate.

Since the Japanese Society of Anesthesiologists first launched its own specialist system in 1962, one medical society after another created a system for specialization in their respective fields — and number more than 100 today. However, the standard for certifying and the method for testing specialists have varied within each medical field. Concern over the situation led to the creation four years ago of the Japanese Medical Specialty Board, which prepared a new regime for certifying medical specialists under standard rules. The regime was put into practice this month.

Under the new regime, most of the young doctors who have completed mandatory two-year basic clinical training — about 8,400 of them — began their training as specialists. They will first be trained three or four years at a medical institution to become a specialist in one of 19 basic fields, such as internal medicine or surgery. Once they have finished this course, they will enter the second phase of training to gain expertise in a specialty in their chosen field, such as cardiology or respiratory medicine.

It will take a total of nearly 10 years for a graduate from a university medical school to be trained as a specialist in, for example, neurology. A standard program is set for each of the departments. In surgery, for example, a trainee is required to take part as a surgeon in more than 100 operations that deal with various organs. The trainees will be tested and judged by the relevant medical society covering their specialty, to be certified by the Japanese Medical Specialty Board. It is hoped that such processes will help ensure the quality of medical specialists and the services they provide.

It has been pointed out that medical institutions that can train the young doctors — possessing the resources, manpower and the annual number of surgeries required to meet the program standards — will be major hospitals and those affiliated with university medical schools, which tend to be located in large urban areas. In fact, the institutions in which doctors wish to be trained are concentrated in such prefectures as Tokyo, Osaka, Aichi and Kanagawa. The number of doctors who wanted to receive surgical training at hospitals in Tokyo starting in April reached 170, whereas the figure was fewer than 10 in 27 other prefectures — and only one each in Gunma, Yamanashi and Kochi. It is said that many such doctors tend to stay with the institutions where they have been trained after they have finished the courses.

Such a regional imbalance may be expected given demographic trends — and inevitable in light of the capacity and resources needed of the hospitals that train the doctors. The point is to ensure that the doctors get high-quality training to become medical specialists. Regional distribution of the specialists should be a separate issue for consideration — along with the broader issue of how to maintain efficient medical service for people in depopulated rural areas.

There is a concern that the new system may prompt more young doctors to become specialists, thus draining the pool of those aspiring to take up general practice, which will be a necessity in community-level medical services. General practice was in fact included as one of the 19 basic fields from which the trainees will choose, but only about 160 of them have reportedly opted for that course.

This may be a worrying trend given that general practitioners will need to play a key role in providing comprehensive care for elderly patients in Japan’s rapidly aging society.

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