Doctor shortage predicted in major urban areas in 2035

JAPAN -There will be a critical shortage of doctors in major urban areas-including the Tokyo metropolitan area, Aichi Prefecture and Osaka Prefecture-in 2035, when people aged 75 or older will account for about 20 per cent of the nation’s population, a team of researchers has forecast.

It has generally been believed that the shortage of doctors will worsen in rural areas in the future, and measures are being taken to cope with the situation. However, the team’s trial calculations revealed that the demand for terminal care is expected to rise sharply in major cities and surrounding areas, which may be densely populated 20 years from now. The government must devise medical policies to cope with the aging of the nation.

The calculations were made by a team led by Koichiro Yuji, a project assistant professor with the Research Hospital of the University of Tokyo’s Institute of Medical Science. Yuji specializes in internal medicine.

Because about 80 per cent of people die in hospitals in Japan, it is assumed that as the population ages, more doctors will be needed. According to the team’s estimates, as of 2035, doctors in the Tokyo metropolitan area will be observing a particularly high number of elderly deaths at hospitals and clinics over a five-year period. The highest rate will be seen in Saitama Prefecture, where one doctor will observe the deaths of 38.2 patients over a five-year-period.

“We must take action to help areas where the number of elderly people dying will sharply increase,” Yuji said.

Estimates by the team were based on each age group’s population as of 2010, together with such data as survival rates, inflow and outflow rates of the population in each prefecture, and data on the number of doctors.

Partly due to an increase in university medical departments’ quota of students and a decrease in the nation’s population, the number of doctors per 1,000 people nationwide will rise from two in 2010 to 3.14 in 2035.

However, the ratio of people aged 75 or older relative to the total population will likely rise from 12.3 per cent in 2013 to about 20 per cent in 2035. The number of deaths is also expected to increase.

Thus, the number of elderly deaths one doctor will observe over a five-year period will edge up from 23.1 in 2010 to 24.0 in 2035.

As of 2035, Aomori Prefecture will be in second place with 36.9 elderly deaths seen by one doctor and Ibaraki Prefecture will be third with 36.1 such deaths.

Elderly deaths will increase the most in Saitama Prefecture, with the 2035 figure 1.34 times that of 2010. Saitama will be followed by Chiba, Kanagawa, Aichi and Osaka prefectures.

The growth rate will be the lowest in Shimane Prefecture, which will see 0.8 times as many elderly deaths in 2035 as 2010. Fukui and Kochi prefectures will see 0.83 times as many deaths.

Preparation necessary

The current doctor shortage partly stems from an uneven distribution of doctors, as they are currently concentrated in urban areas.

The medical departments of universities and local governments in rural areas have taken measures to encourage doctors to settle in more remote areas. For example, they exempt young doctors from repaying their scholarship loans, or allow them to pay at a reduced rate on the condition they work in hospitals in such areas for several years.

However, the latest forecast clearly shows Japan will face a doctor shortage even in major urban areas such as the Tokyo metropolitan area about 20 years from now.

On a nationwide level, the doctor shortage will likely be eased due to the expected further decline of the nation’s population. In 2035, however, the number of deaths of people aged 75 or older will increase to 1.88 times the level in 2010. Thus, in urban areas, where the graying of the population will have sharply progressed, the supply of doctors for terminal care will be unable to meet the increasing demand.

The research group also estimated that the number of doctors aged 60 or older in 2035 will be 141,000-nearly triple the 2010 number. The percentage of elderly doctors among all doctors will also rise from 20 per cent in 2010 to 36 per cent in 2035.

Elderly doctors treating elderly patients will likely become the norm in urban areas.

“We can predict not only a shortage of doctors, but also of nurses and nursing care workers,” said Toshihito Nakamura, a specially appointed instructor of medical management studies at Chiba University Hospital.

The government should go beyond promoting a more even distribution of doctors. For example, implementing “remote medical care”-remote medical treatment provided using information technology-and more effectively utilizing certified nurses and public health nurses for patients’ daily health care.

Source: The Yomiuri Shimbun
Published: 11 Jan 2014

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