Specialty choice and physicians' career paths in Japan: an analysis of National Physician Survey data from 1996 to 2006

Objectives: To investigate trends of specialty distribution and physicians' career paths in Japan, and to discuss potential policy implications.

Methods: Distribution of main area of practice, relation between board-certified specialists and reported main area of practice, and migration of main area of practice by career stage were analyzed in data from the National Physician Survey, collected between 1996 and 2006.

Results: The percentages of physicians involved in internal medicine, surgery, neurosurgery, pediatrics, ophthalmology, obstetrics and gynecology and otorhinolaryngology decreased from 1996 to 2006. Overall, the numbers reported for the main area of practice matched the number of board-certified specialists. Among physicians who began their careers as internal medicine physicians in the 1996 registration cohort, the proportion of those engaged in internal medicine fell from 82.5% in 1996, to 43.6% in 2000, to 37.0% by their 10th year. Among five registration cohorts analyzed, 9.1-16.8% of the surgical specialties group switched their main area of practice to internal medicine within 10 years.

Conclusions: While there is a general trend toward specialization, it is important to balance between general practice and specialization to strengthen health care systems. Developing a certification system and maintaining the quality of specialist physicians are also crucial.