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Viewing cable 08TOKYO118, THE DOCTOR WILL NOT SEE YOU NOW - JAPAN'S

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Reference ID Created Released Classification Origin
08TOKYO118 2008-01-15 09:01 2011-08-25 00:00 UNCLASSIFIED Embassy Tokyo
VZCZCXRO2184
PP RUEHFK RUEHGH RUEHKSO RUEHNAG RUEHNH
DE RUEHKO #0118/01 0150901
ZNR UUUUU ZZH
P 150901Z JAN 08
FM AMEMBASSY TOKYO
TO RUEHC/SECSTATE WASHDC PRIORITY 0972
INFO RUEHBJ/AMEMBASSY BEIJING PRIORITY 1101
RUEHBY/AMEMBASSY CANBERRA PRIORITY 2494
RUEHJA/AMEMBASSY JAKARTA PRIORITY 4320
RUEHML/AMEMBASSY MANILA PRIORITY 1154
RUEHFK/AMCONSUL FUKUOKA PRIORITY 5478
RUEHHK/AMCONSUL HONG KONG PRIORITY 6421
RUEHNAG/AMCONSUL NAGOYA PRIORITY 4152
RUEHNH/AMCONSUL NAHA PRIORITY 7872
RUEHOK/AMCONSUL OSAKA KOBE PRIORITY 9143
RUEHKSO/AMCONSUL SAPPORO PRIORITY 6084
RUEHGH/AMCONSUL SHANGHAI PRIORITY 0317
RUEHIN/AIT TAIPEI PRIORITY 6856
RUCPDOC/DEPT OF COMMERCE WASHINGTON DC PRIORITY
RUEHBS/USEU BRUSSELS PRIORITY
RUEHGV/USMISSION GENEVA PRIORITY 3228
RUEAUSA/DEPT OF HHS WASHINGTON DC PRIORITY
UNCLAS SECTION 01 OF 02 TOKYO 000118 
 
SIPDIS 
 
SIPDIS 
 
PLEASE PASS USTR FOR CUTLER, BEEMAN, MEYERS 
HHS FOR OGHA, STEIGER AND BHAT 
PARIS FOR USOECD 
USDOC FOR 4410/ITA/MAC/OJ/MELCHER 
GENEVA PASS USTR 
 
E.O. 12958: N/A 
TAGS: ECON ETRD JA PGOV
SUBJECT: THE DOCTOR WILL NOT SEE YOU NOW - JAPAN'S 
PHYSICIAN SHORTAGE. 
 
REF: 07 TOKYO 5080 
 
1. (SBU) Summary:  Japan faces an acute shortage of hospital 
physicians, particularly in rural areas.  One expert 
estimated the country needs 55,000 new doctors to staff 
adequately its hospitals.  Harsh working conditions and low 
pay cause many doctors to enter private practice, a step 
which means they generally lose hospital privileges.  The 
Ministry of Health, Labor and Welfare (MHLW) is increasing 
the number of medical school scholarships at prefectural 
universities and requesting hospitals seek "volunteers" to 
practice in the countryside for stints of several months. 
Solving the problem, however, will require creativity and 
flexibility on the part of the GOJ, including allowing 
foreign physicians greater leeway to practice in Japan and 
developing new remote treatment technologies.  End summary. 
 
2. (SBU) In August 2007, eight separate hospitals in western 
Japan, claiming to have no physicians available, refused care 
to a woman in premature labor.  The woman was finally 
admitted to a ninth hospital, but only after the ambulance in 
which she was traveling crashed, causing her to miscarry. 
This incident highlights the shortage of doctors, 
particularly in rural areas. 
 
Doctor Shortage Acute 
---------------------- 
3. (SBU)  According to 2005 data, Japan has 1.9 physicians 
per 1000 people, ranking it 27 out of the 30 OECD member 
countries.  Nevertheless, the number of doctor consultations 
per capita on an annual basis is 13.8, perhaps the world's 
highest.  Specialists are in particularly short supply; 
estimates put the number of practicing obstetricians in Japan 
at only 8,000.  Japan Municipal Hospital Association Chairman 
Tetsuro Koyamada told emboff he estimates the country needs 
55,000 more doctors to staff adequately its hospitals. 
 
Underpaid and Overworked 
------------------------ 
4. (SBU) There are several reasons for the shortfall.  First, 
working conditions in Japanese hospitals are particularly 
harsh.  A recent survey revealed more than 30% of hospital 
doctors had worked an entire month without a day off and 70% 
had worked the day after night-shift duty.  Second, hospital 
physicians earn an average of $93,500, half the wage of 
private practice physicians and less than the average 
commercial airline pilot.  Doctors in private practice 
generally lose their hospital privileges. 
 
5. (SBU) Finally, changes made to Japan's medical residency 
program have contributed to the lack of doctors in rural 
areas.  Previously, medical schools had sole authority to 
determine where graduates could complete their residencies. 
The schools coordinated with regional hospitals and 
governments to ensure staffing needs were met.  The system 
came to be seen as draconian and in 2003 the Ministry of 
Health, Labor and Welfare (MHLW) revised the regulations 
allowing students more freedom.  As a result, most stay in 
the big cities to complete their training. 
 
The Countryside is Lovely This Time of Year 
------------------------------------------- 
6. (SBU) Responding to public pressure, MHLW is attempting to 
rectify the urban-rural disparity.  According to MHLW's 
Masatsugu Ashida, the GOJ has, among other things, increased 
the number of scholarships at prefectural medical schools for 
students who agree to practice in that prefecture for two 
years after obtaining a medical license.  In addition, MHLW 
has reduced the number of residency positions in Japan's big 
 
TOKYO 00000118  002 OF 002 
 
 
cities to force students to serve in prefectural hospitals, 
Ashida said. 
 
7. (SBU) The MHLW also, according to Ashida, has launched a 
program to recruit physicians to volunteer to practice in 
rural areas for several month stints.  These volunteers 
receive no incentive pay or benefits except experience, he 
noted.  The MHLW will, however, provide subsidies to 
hospitals that "encourage" doctors to participate and will 
also "suggest" how many doctors each hospital provide. 
Finally, the Ministry will assist physicians in compensating 
patients who successfully sue for malpractice.  Ashida said 
MHLW has requested a budget equivalent to $142 million to 
fund these initiatives.  (The Ministry of Finance is 
currently considering the request, but given the Cabinet 
mandate to curb healthcare spending by $1.9 billion annually 
for the next five years (reftel), even this modest funding is 
uncertain.) 
 
"Time is Running Out" 
--------------------- 
8. (SBU) Prefectural governments are also striving to address 
the shortage.  In November 2007, Niigata prefecture proposed 
the central government to create a "special zone" in which 
foreign doctors without a Japanese medical license, but who 
had studied or trained in Japan, could practice medicine. 
Established under former Prime Minister Koizumi, special 
zones allow Japan to implement reform on a trial basis in a 
limited area.  If successful, the measure can be expanded 
nationwide.  Niigata prefectural government office of 
healthcare and insurance official Hideo Teruta stated, that 
while the government has rejected similar proposals before, 
he is hopeful the gravity of the doctor shortage will result 
in an approval this time.  "Time is running out," Teruta said. 
 
Comment 
------- 
9. (SBU) As discussed in ref, Japan's overall healthcare 
system is in need of reform and solving the rural physicians 
shortage will require creative approaches beyond fiscal and 
commercial restructuring.  If resistance to expanding 
immigration for skilled professionals persists, Japan may 
once again turn to technological solutions, or 
"telemedicine," where U.S. firms in such sectors as 
telecommunications, homecare technologies, personal emergency 
response systems, and medical monitoring devices could reap 
the benefits.  End Comment. 
 
 
DONOVAN