2004年, 日本では(初期)医師臨床研修が必修化され, 若手医師と研修先病院の割当てには米国式マッチング制度が導入された。それまでは医局が研修医を含む医師の配置を集中的に決定してきたが, 臨床研近年, 日本の医療体制に次のような変化が起こってきたといわれている。
(1) 若手医師の都市部の病院への応募過多と大学病院への応募過少。
(2) 医療実務の一端を担ってきた若手医師を受け入れられなくなった民間の中小病院では診療科を減数せざるを得なくなり, それを受けて, 病院間での診療科の統廃合が進んだ。その結果として, 高齢または重篤な患者が適切な診療科を持つ遠方の病院にまで出向かなければならなくなった事例も報告されている。
(3) マッチングに参加できる病院は研修プログラムを提供できる病院だけであり, そうでない病院には若手医師を十分には確保できなくなっている。
(4) マッチングの導入が直接の原因であるとはまだ断定できないが, 臨床研修化以降, 医師と病院を仲介する業者の数が増加しているといわれている。
(5) 大学病院や医学研究科で開発された最新の医療技術が中小の病院に対して十分に移転されなくなってきた可能性がある。
(6) 若手医師は自らのキャリアについてより広範な選択肢を持てるようになった。
(7) 若手医師が複数の診療科にまたがる横断的な知識と技能の習得できるので, 患者がより適切な医療を受けられる可能性は広がった。
このような変化を定量的に確認するべく, 我々は医師を対象とするインターネットサーベイを実施した。2018年3月31日時点では, まだそのデータセットの統計的解析を完了していないが, 次年度に実施する病院を対象とする調査によって得られるデータと照合することにより, 医師のキャリア選択と医療教育の変化を数値で捉えることが可能になるだろう。
In 2004, the clinical training programs for young doctors was made compulsory in Japan, and a matching mechanism for assigning them to hospitals was introduced. Doctors' associations known as medical offices (centered on university hospitals) had intensively managed the provision of doctors to each hospital, including training hospitals. The following major changes to the existing medical system in Japan have started to occur.
(1) Too many applications by young doctors to urban hospitals, and too few applications to university hospitals.
(2) In private small and medium-sized hospitals that relied partly on young doctors for medical practice but can no longer accept them, there has been no option but to reduce the number of medical departments, leading to the consolidation and abolition of medical departments among hospitals. As a result, cases have been reported of elderly or seriously ill patients having to travel to distant hospitals with appropriate medical departments.
(3) The only hospitals that can participate in matching are the hospitals that can provide training programs, and other hospitals are becoming unable to secure enough young doctors.
(4) Although the introduction of matching cannot yet be considered a direct cause, the number of agencies mediating between doctors and hospitals is said to have increased since the introduction of mandatory clinical training.
(5) The latest medical techniques developed at university hospitals and graduate schools of medicine may no longer be being adequately transferred to small and medium-sized hospitals.
(6) Young doctors now have broader choices regarding their own careers.
(7) As young doctors can obtain cross-disciplinary knowledge and skills across several medical departments, possibilities for patients to receive more appropriate medical treatment have widened.
We conducted an internet survey to doctors in order to confirm these changes but have not completed the statistical analysis of the data set yet, as of March 31 in 2018. It is, however, expected that we can capture some solid features on changes in doctor's career development and clinical training programs, by collating the data set with another one obtained from another internet survey to hospitals and medical schools which we are supposed to conduct in the next academic year.