The shortage of pediatrician workforce in rural areas of Japan.

The shortage of physicians is of great concern in Japan. We aim to assess the pediatrician workforce in rural areas of Japan. Data were obtained from a governmental survey that included the number of physicians and child population in each municipality (i.e., 888 cities and 1,466 towns, villages, or rural areas). The supply of pediatricians was evaluated by physician-to-child population ratios of pediatricians and non-pediatricians in pediatric practice, and geographical distributions using Lorenz curves and Gini indices. Lorenz curves are drawn to visualize geographical mal-distribution of physicians and the Gini indices range from 0 to 1, with higher values indicating larger inequity in physician distribution. Between 1996 and 2004, the numbers of pediatricians per 100,000 children increased from 69 to 84 and this increase was constantly observed both in cities, and towns/villages. Lorenz curves showed that both pediatricians and non-pediatricians in pediatric practice were relatively equally distributed in cities. The Gini indices in 1996 and 2004 were 0.337 and 0.321, respectively in pediatricians and 0.264 and 0.278, respectively in non-pediatricians in pediatric practice. In contrast, pediatricians were unequally distributed in rural areas (the Gini indices; 0.723 and 0.703, respectively). In such areas, non-pediatricians in pediatric practice were more equally distributed than pediatricians (0.419 and 0.482, respectively). These results suggest that non-pediatricians in pediatric practice have played a significant role in supporting pediatric care in rural areas. In conclusion, the absolute numbers of pediatricians increased in Japan between 1996 and 2004; however, they were mal-distributed in rural areas.