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Monday, Nov. 28, 2011
Existential fear stalks M.D.s
The Japan Medical Association (JMA), once the most powerful lobby group with mighty political clout, still clings to its position of staunchly opposing any scheme to increase the number of doctors, in order to protect its own vested interests.
As the nation faces an increasing doctor shortage, there have been mounting calls for creating new medical schools. But the JMA is dead-set against that.
At a recent series of meetings of a study group sponsored by the health and welfare ministry, diametrically opposed views were expressed on whether the nation needs more doctors. Leading the proponents of increasing the number of medical students was Kozo Imai, head of the University of Tokyo's Institute of Medical Science. He argued that unless drastic measures are taken, areas like Hokkaido will face an acute shortage of medical doctors.
Toshio Nakagawa, JMA vice president, countered by saying that a further increase in the number of doctors would force them into the same plight as dentists, whose incomes have been dwindling because there are too many dentists.
In an interim report published in July, the study group hinted at the possibility of setting up new medical schools. Although Nakagawa vehemently opposed the suggestion at the time, his view was overridden by the ruling Democratic Party of Japan (DPJ), which came to power in 2009 on a platform that included a call for rectifying the shortage of doctors.
Around that time, the JMA was criticized by many members of the study group for "seeking to guarantee its members' income."
In September, following the resignation of Prime Minister Naoto Kan, the circumstances appeared to start changing in the JMA's favor with the appointment of Yuko Mori as senior vice health and welfare minister in the new administration of Prime Minister Yoshihiko Noda. She rides on the coattails of Ichiro Ozawa, a strongman within the ruling DPJ who is known to have established close relations with JMA President Katsuyuki Haranaka.
With Mori throwing her support behind the JMA, it appeared as though a plan for new medical schools had hit a snag. The trend was reversed again Sept. 27 when Tohoku Fukushi University and the Sendai Kosei Hospital, both situated in Sendai, the largest city in the Tohoku region, which was hit the hardest by the March 11 earthquake and tsunami, filed a report urging establishment of new medical schools to cope with the shortage of doctors in the countryside. Politicians and bureaucrats could not ignore this call because it came from the region devastated by the March 11 disasters.
But the JMA got unexpected help. Susumu Satomi, head of Tohoku University Hospital, who is to become the next president of Tohoku University, the largest academic institution in the Tohoku region, strongly opposed the move to create new medical schools. If new medical schools were opened in Tohoku, the monopolistic position of Tohoku University's medical school would be undermined.
Imai of the University of Tokyo's Institute of Medical Science fought against the JMA-Tohoku University alliance. He came up with a staggering report pointing to serious consequences if the number of doctors were not increased drastically.
In his report, which was supported by detailed statistics, Imai warned that if the working hours of doctors were to be restricted as they are in Europe and North America, even the present level of medical services could decline unless the number of medical students is doubled or even trebled in medical schools in large cities.
It has become clear that the current government plan to increase the number of medical students at existing medical schools is not enough to cope with the deteriorating situation.
According to the report, a particularly serious shortage of doctors will hit the Kanto regions, except Tokyo and Tochigi Prefecture. Even today, it says, the ratio of doctors to residents in Chiba, Saitama and Ibaraki prefectures is below that of countries like Mexico and is bound to get worse unless something is done.
In Chiba, the number of physicians younger than 60 years of age per 1,000 residents 75 years of age or older stood at 14.08 in 2010. That is projected to dwindle to 8.05 in 2030. Comparable figures for Saitama are 13.30 and 6.77; Ibaraki's numbers are 11.51 and 7.19. Tokyo has better ratios of 23.02 and 18.02.
Having seen these numbers, one doctor lamented that unless the situation is rectified drastically, there would be an increasing number of elderly persons who wouldn't receive medical treatment and would die in solitude.
Saitama Prefecture reacted promptly. Its prefectural assembly on Sept. 29 unanimously adopted a resolution calling on Gov. Kiyoshi Ueda to work toward creating a new medical school. Local newspapers reported this news with big headlines and the prefectural government immediately started preparations.
Ibaraki Prefecture has also asked Waseda University, one of the leading private universities, to build a new medical school in the prefecture, in line with Gov. Masaru Hashimoto's campaign pledge, which included creation of a new medical school in the prefecture. Waseda has promised to conduct a feasibility study.
Since Ibaraki is home to JMA President Haranaka, its prefectural chapter opposed the plan, alleging that the new medical school would require a large number of doctors to come to Ibaraki to teach there, which in turn would exacerbate the nationwide doctor shortage. The true intent of the chapter appears to be to strengthen its vested interests by re-electing Haranaka to the JMA's top post.
Kanagawa Prefecture, with a population of 9.06 million, just south of Tokyo, also faces acute shortages. There are only four medical schools in the prefecture — the same number as in Fukushima Prefecture, which has fewer than 2 million people. The ratio of doctors for the population around Atsugi City, Kanagawa Prefecture, is said to be lower than that of Egypt or Syria.
This has prompted Kanagawa Gov. Yuji Kuroiwa to start preparing for new medical schools. Local universites are opposed to his plan. Opinions within the JMA's prefectural chapter are divided. One of Kuroiwa's supporters stated that the governor thinks that the JMA's opposition will make it easy for him to win support from Kanagawa residents.
If the JMA tries to maintain its vested interests, the media reports it. This makes the general public aware of the reality. This has markedly weakened the influence of the JMA and the politicians with close ties to it, especially the likes of the DPJ's Ozawa.
The once powerful JMA may well be headed toward its doomsday, in step with Japan's deteriorating medical services.
This is an abridged translation of an article from the November issue of Sentaku, a monthly magazine covering Japan's political, social and economic scenes.