How Specialists Become Primary Care Physicians in Japan

Abstract

Background: Most countries have a shortage of Primary Care (PC) physicians. Japan has mitigated this problem by specialists making a mid-career change to PC when they go into private practice. This study examines the circumstances under which specialists shift to PC. Methods: Since the division between specialists and PC physicians is blurred in Japan, we focus on Physicians Providing Home Visits (PPHV). The list of PPHV was obtained from the local medical associations in two neighboring medical planning areas in Japan. The methods used were a questionnaire and in-depth interviews. Results: Of the 46 listed as PPHV, 38 responded to the questionnaires. Physicians mainly acquired their knowledge and skills in primary care from post-graduate clinical training and on the job training after becoming PPHV. The specialists who had moved to PC were equally knowledgeable regarding PC as those had taken the PC accreditation exam. The in-depth interviews revealed that the higher income earned in clinics and being able to retain their identity as a specialist were also important factors. Conclusions: The factors that contributed to physicians making a mid-career change from specialists to PC were their experiences after being certified, the higher income in clinics and the ability to retain their professional identity as specialists. These enabling factors might also be applicable for increasing the ratio of PC physicians at the global level although further studies are required.