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Original research
Temporal trends of physician geographical distribution and high and intermediate physician density areas and factors related to physicians’ movement to low physician density areas in Japan: a longitudinal study (1996–2016)
  1. Masatoshi Ishikawa1,2
  1. 1Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  2. 2Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
  1. Correspondence to Dr Masatoshi Ishikawa; masa.ishikawa1221{at}


Objectives A major issue in Japan’s health policy is the geographical maldistribution of physicians. This study aimed to analyse temporal trends in the geographical distribution of physicians and analyse physicians in high and intermediate physician density areas and factors related to their movement to low physician density areas in Japan.

Design A longitudinal study.

Setting All physicians in 344 secondary medical districts.

Participants I analysed data from the biennial national census, conducted by the Ministry of Health, Labour and Welfare between 1996 and 2016 and and divided it into two cohorts of 10 years each: 1996–2006 and 2006–2016.

Primary and secondary outcome measures I estimated the temporal trends in the number and percentages of physicians, and used logistic regression to analyse physicians in high and intermediate physician density areas and the factors related to their movement to low physician density areas.

Results The overall number of Japanese doctors increased by 31% between 1996 and 2016. The number of physicians per population in the physician high-density areas increased by 29%, while those in low-density areas increased by 32%, suggesting that the gap between areas marginally decreased. The multivariable logistic regression analyses revealed that academic hospital experience had the highest OR for predicting physician movement to low physician density areas after 10 years, both in the 1996 and 2006 cohorts. Other factors that positively correlated with physician movement were being male, being younger than 40 years, being qualified after the age of 30, urban area, intermediate physician density area and practice in a non-academic hospital.

Conclusions As less-experienced physicians demonstrate high mobility among geographic categories, and retention rates are low in low physician density areas, especially for less-experienced physicians, a new system that considers these factors would create opportunities for younger physicians to work in low-density areas.

  • health services administration & management
  • human resource management
  • health policy

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  • Contributors The author is solely responsible for all aspects of the study.

  • Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval I received the MHLW’s approval to use the data set, and this research was approved by the Harvard T.H. Chan School of Public Health institutional review board (No. 18-1422). The requirement for informed consent was waived by the review board as the original surveys were mandatory.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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