Geographic distribution of physicians in Japan.
In the 1970s, Japan's physician manpower policy was to increase the number of medical students and medical schools to ease the difficulties caused by shortage of doctors and their maldistribution. 34 medical schools were established during this time, which eventually doubled the number of newly certificated physicians from about 4000 to about 8000 per year by the mid 1980s. To examine the success of this policy, we analysed the numbers of physicians in relation to the population in all municipal bodies (n = 3268) in Japan. Between 1980 and 1990, the number of practising physicians increased by about 37%, and the ratio of physicians per 100,000 population increased from 127 to 165 throughout the country. However, analyses by the Lorenz curve and the Gini coefficient indicated that the inequality in physician distribution did not improve. While municipal bodies with a population over 30,000 gained proportionally more physicians, most communities with fewer than 10,000 residents showed little gain. Our findings have important implications for policy changes now being considered by the government to plan the future supply of physician manpower in Japan. A policy that will alleviate physician maldistribution also needs to be devised.