A. Insufficiency of doctors is becoming a severe problem in Japan
B. Thesis statement
Ⅱ. Declining birthrate and aging society
A. Declining birthrate
B. Declining birthrate brings aging society
C. Comparison between other countries in OECD.
Ⅲ. Severe shortage of obstetricians and gynecologists
A. Situation of obstetricians and gynecologists
1. Article about Nara’s expectant mother
B. Government’s decision of curtailing medical expense
Ⅳ. Solutions to improve the situation of shortage of doctors
A. Change the admission
B. Use more GDP for medical expense
1. more payment for obstetricians
2. more medical equipments are needed
Ⅴ. Conclusion
Marie Muramatsu i101234
Prof. James
Theme Writing
February 21, 2008
Severe Shortage of Obstetricians and Gynecologists in Japan
Ⅰ. Introduction
Recently, mass media loudly points out Japanese medical issues, and tells citizens how serious these are. The low birthrate and the aging society in Japan are becoming a social problem more and more. As the aging society promotes, Japan needs more doctors because there will be more patients; however, from the result of low birthrate, it is difficult to support medical expenses by younger generation. Shortage of doctors recreates further low birthrate and medical issues; therefore, these social problems are closely linked to medical issues of insufficiency of doctors. Shortage of medical doctors, especially in obstetricians and gynecologists who are the specialists to help deliver a baby, is a noteworthy phenomenon, and is a severe issue in Japan (Nagata 21). Even though the problem is very obvious, there are no adequate action programs to solve this problem at governmental level. To improve this medical issue, government should take initiative to change entrance examination system for medical schools, and also to use at least 10% of GDP for the medical expense to have better obstetric wards.
Ⅱ．Declining birthrate and aging society
In Japan, a declining birthrate is becoming a very serious issue, and it influences the Japanese medical treatment area. Since there was a baby-boom after WWⅡ, the birthrate in Japan at that time was 4.54 per person (Shostak). However, the number of births rapidly became lower, and in 2005, the number was 1.26. The population itself will be declining when the birthrate is less than 2.0. The then Japanese Prime Minister, Toshiki Kaifu warned that if this low level of birthrate continued, Japan would suffer from shortages of workers (“Japan facing”). The major reason for the declining birth rate is because more people in Japan are deciding to marry late or stay single.
The declining birthrate will bring the aging society. Social insurance system is maintained by the structure that young generations take care of elderly. Therefore, balanced population is necessary; however, the continuous low birthrate will bring unbalanced population. There will be low population of younger people and high population in elderly. Social insurance will not work in the near future--- this fact became clear to everybody. In 2006, the population of elderly citizens (65 years and over) is 26.60 million, 20.8 percent of the total. In the United States, the percentage of elderly is 12 percent. Compared to the United States or western European countries, the speed of Japanese aging population is much faster. According to Japan's Ministry of Health and Welfare, “by 2015, one in four Japanese citizens will be 65 or older.” From the statistics in 2006, Japan became a world’s oldest society. This serious aging society leads to many unexpected impacts; and the typical example is kodokushi, meaning lonely death in Japanese, which is a situation that an elderly dies with no relatives or friends to provide care in the last days, weeks, or even months (“The Level”).
Even though Japan is the world’s most aging society, the number of doctor per population is surprisingly under the average of OECD countries (“Ministry of Health and Welfare”）.There are 290,000 doctors in Japan in 2005. This number seems to be enough; however, this number of doctors is 27th out of 30 OECD countries. For example, the number of emergency doctors per 1,000,000 people in Japan is only eight doctors. However, in France, the number of emergency doctors is 85, and in the United States, 114 doctors. From this result, the doctor insufficiency in Japan is quite obvious. Tokyo is the city where the most doctors in Japan lives. Nevertheless, the number of doctors in Tokyo is still under the average of OECD countries (“Statistical Handbook”). Fundamentally, there is a serious shortage of doctors in Japan.
Ⅲ．Severe shortages of obstetricians and gynecologists
Shortage of doctors, especially the obstetricians and gynecologists is one of the most critical issues in Japan. Since doctors do not know when an expectant mother labors with child and deliver a baby, they have to be ready for delivering a baby 24 hours a day, seven days a week (“Shortages of Obstetrician”). Doctor Mochimaru, an obstetrician in Hiratsuka Shimin hospital, says “I have to stay overnight at the hospital once every three days” (“Osan dekinaku naru”). Also, Osaka medical association investigated that obstetricians and gynecologists who overwork more than 20 hours a week is 29.3%. This is far more than the regulated overwork time to avoid death which Japan's Ministry of Health and Welfare allows. As a consequence, trainee doctors do not want to choose the obstetric department. Obstetrician is perhaps the toughest job among doctors.
One of the fundamental causes of this doctor shortage problem was the Japanese government’s decision of curtailing the medical expense. (“Seifu Seisaku”) Due to the government’s principle of reducing the burden of Japanese economy, they decided to curtail the medical expense.
Chart 1 Shujii ga mitsukaru shinryojo
Chart 1 is the data of how many percentages of GDP each country spends for the medical expenses. Compare to the different developed countries, Japan shows the lowest. From this graph, it is possible to say that Japanese government is not sufficiently concerned about medical issues. The government’s decision to curtail the medical expense promoted the insufficiency of obstetricians and gynecologists. It means there is a room for Japanese government can do to improve the situation.
In Japan, rural areas especially have an issue shortage of obstetricians and gynecologists more than urban areas. Due to the curtailed medical expense, small hospitals had to reduce a number of beds and medical equipments; therefore, it is hard to have a satisfied medical treatment for patients (Nagata, 64). There are some articles about the lack of quality in Japanese medical institution in rural areas. Aug.29th of 2007, incident happened in Nara. Expectant mother lost her baby because 12 hospitals refused her acceptance (“Ninpu Taraimawashi”). In Nara prefecture, there was a similar incident which expectant mother died; hence, problem of obstetricians was reconsidered seriously. One of the hospitals explained the reason why the rejected the patient. The two obstetricians at that hospital worked all night and they still were working the next day; therefore, they could not accept the patient. The other hospitals that rejected her also explained “we had no choice but to refuse care because of a lack of obstetric personnel and beds for babies” (“Sanfujinkai”). Recently, these kinds of incident, which hospitals reject patients, are increasing.
Ⅳ. Solutions to improve the situation of shortage of doctors
To reduce the shortage of obstetricians and gynecologists, Japan should refer to the American admission system for the medical school. There are many differences between entrance examinations to the medical school in Japan compared to the United States’ entrance exam. If Japanese government co-opts the system of the United States, it will make the things better. In the United States, admission to medical school is based mainly on GPA, (Grade Point Average) to know the efforts during school years. Other than GPA, there is the test called MCAT, the Medical College Admission Test. This is an exam to know the knowledge of English and science scores (Shteynshlyuger). Also, the medical school in the United States wishes students to do an essay, interview, and some volunteering activities, some kind of leadership project. In short, the United States system can chose the suitable students for doctors. Compared to the United States, in Japan, most of the medical schools take students only by the admission examination.
Chart 2. Shujii ga mitsukaru shinryojo
Chart 2 is my trial to show the entrance exam difference between Japanese and American medical school. As you see, Japanese entrance system is unbalanced. They only see the student’s knowledge by one exam, not student’s effort of keeping high GPA, the leadership skills, or volunteer spirits etc. Japanese medical school can gather only smart student who can react to written exam. To get into the medical faculty, the students have to pass very hard examination. Therefore, even though there are some students who wish to be doctors to help patients, they can not get into the faculty if their solitary exam scores do not reached to the point the faculty requirements (Fukao). The Japanese medical admission system kills the possibilities of future talented doctors, and that clearly connects to the shortage of doctors. The United States admission is underpinned by a whole system of education. To be effective, such a solution would require wholesale changes to the Japanese education system.
If Japanese government decides to use 10% of the GDP to the medical expense, it will definitely change the situation of lacking of the obstetricians and gynecologists in Japan. To improve this terrible situation is the primary importance rather than constructing a road or a dam, which Japanese government uses many GDP for. For example, Margaret Thatcher, the Prime Minister in England had end in failure by curtailing medical expense. The next Prime Minister, Tony Blair admitted the failure, and he declared to raise the medical expense 1.5 times more than Thatcher has decided. From this tack, the number of nurses is more than 50,000 increased (Nagata, 40). If Japanese government decides to concern to the medical issues, it will make a good progress. Even two percent of the GDP makes much difference (Shujii ga mitsukaru). To avoid the same mistake as England did, Japan should raise the GDP for medical expense.
To improve the shortage of obstetricians and gynecologists, more payment is needed. One of the reasons why the shortage of obstetricians and gynecologists happen among all medical departments is because the payment is low. Even though obstetricians and gynecologists have the duties twice as much compared to the other department, the payment is same as others (“Sanfujinkai”). The government should pay more to obstetricians and gynecologist to break the notion of “obstetrics and gynecology are hard but cheap payment” for future doctors in Japan. If the GDP for medical treatment becomes higher, it is possible to raise payment for obstetricians and gynecologists. The government can encourage students to be obstetricians and gynecologists by spending more medical expense.
Moreover, if the medical expense is higher, it is possible to buy more medical plants and equipments which improve qualities for medical treatment. Many Japanese hospitals had to reduce number of beds and equipments when the government decided to curtail the medical expense; however, hospitals seriously need number of beds. The expectant mother in Nara lost her baby because there was an issue of shortage of obstetricians, but also there were not enough bed in the hospital (“Shortage of obstetrician in Japan”). Many Japanese people live to a great age; however, hospitals have to eject them due to the lack of beds. To reduce the problem of patients sending from one hospital to another, government should immediately increase the number of beds.
Ⅴ．Conclusion
Because of the situation of declining birthrate and aging society, it promoted the shortage of obstetricians and gynecologists in Japan. To improve the obstetrical situation in Japan, the Japanese medical schools should revise the examination for future medical students. Also, to use more percentages, at least 10% of GDP for the medical expense is a must to have a better environment for medical cure and more payment for obstetricians and gynecologists. To reduce the patients’ fear for unsatisfied medical treatment, Japanese hospitals need as many obstetricians and gynecologists as possible. Therefore, Japanese government should take immediate actions for the people in this country, for doctors, for future doctors, and for patients. (2039 words)
Works Cited
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“Ministry of Health and Welfare” 2006. 16 Feb. 2008 >.
Nagata, Hiroshi. Binbounin ha isha ni kakaruna! Ishi busoku ga maneku Iryo houkai.
[Poor People Should Not Go to the Hospital! The Collapse of the Medical Services by the Shortage of Doctors] Shuei Shinsha.
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<>.
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<>.
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Annual Report on Health and Welfare 1999 .15 Feb. 2008.
(I could not use underline for works cited. I used italics for the chart (shujii ga mitsukaru shinryojo) but it is supposed to be underlined.)
This is the data of how many percentages of GDP each country spends for the medical expenses. Compare to the different developed countries, Japan has the worst result. From this graph, it is able to say that Japanese government is unconcerned about medical issues. The government’s decision of curtailing the medical expense promoted the insufficiency of obstetricians and gynecologists.
