Physician scarcity is a predictor of further scarcity in US, and a predictor of concentration in Japan

Health Policy. 2010 May;95(2-3):129-36. doi: 10.1016/j.healthpol.2009.11.012. Epub 2009 Dec 11.


Objectives: To assess the effects of geographic diffusion of physicians from medically oversupplied toward undersupplied areas driven by economic competition among physicians and political interventions in Japan and US.

Methods: A quantitative evaluation of physician workforce changes at the community level between 1980 and 2005, using municipality-based (Japan) and county-based (US) census data.

Results: The overall number of physicians per 100,000 population (physician-to-population ratio: PPR) increased from 130 to 203 in Japan and 158 to 234 in US. In this context, a higher proportion (30.1%) of the quintile communities with lowest PPRs in 1980 has further decreased their PPRs in US than in Japan (21.6% in 2005). In multivariate analysis low PPR was a positive predictor of PPR decrease in the US communities (odds ratio 1.26; 95% confidence interval 1.01-1.58), while it was a negative predictor in Japanese communities (0.69; 0.57-0.83).

Conclusions: Physician scarcity is associated with further scarcity in US communities, while scarcity is associated with recovery from scarcity in Japanese communities. Competition-based physician diffusion strategies and various interventions to address the maldistribution of physicians apparently have not worked effectively in US compared with Japan.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Censuses
  • Chi-Square Distribution
  • Demography
  • Economic Competition
  • Forecasting
  • Health Services Research
  • Humans
  • Japan
  • Logistic Models
  • Marketing of Health Services
  • Medically Underserved Area*
  • Multivariate Analysis
  • Personnel Staffing and Scheduling
  • Physicians / economics
  • Physicians / supply & distribution*
  • Physicians / trends*
  • Politics
  • Population Density
  • Professional Practice Location / economics
  • Professional Practice Location / trends*
  • Socioeconomic Factors
  • United States