The current shortage and future surplus of doctors: a projection of the future growth of the Japanese medical workforce.

BACKGROUND: Starting in the late 1980s, the Japanese government decreased the number of students accepted into medical school each year in order to reduce healthcare spending. The result of this policy is a serious shortage of doctors in Japan today, which has become a social problem in recent years. In an attempt to solve this problem, the Japanese government decided in 2007 to increase the medical student quota from 7625 to 8848. Furthermore, the Democratic Party of Japan (DPJ), Japan's ruling party after the 2009 election, promised in their manifesto to increase the medical student quota to 1.5 times what it was in 2007, in order to raise the number of medical doctors to more than 3.0 per 1000 persons. It should be noted, however, that this rapid increase in the medical student quota may bring about a serious doctor surplus in the future, especially because the population of Japan is decreasing.The purpose of this research is to project the future growth of the Japanese medical doctor workforce from 2008 to 2050 and to forecast whether the proposed additional increase in the student quota will cause a doctor surplus. METHODS: Simulation modeling of the Japanese medical workforce. RESULTS: Even if the additional increase in the medical student quota promised by the DPJ fails, the number of practitioners is projected to increase from 286 699 (2.25 per 1000 persons) in 2008 to 365 533 (over the national numerical goal of 3.0 per 1000) in 2024. The number of practitioners per 1000 persons is projected to further increase to 3.10 in 2025, to 3.71 in 2035, and to 4.69 in 2050. If the additional increase in the medical student quota promised by the DPJ is realized, the total workforce is projected to rise to 392 331 (3.29 per 1000 persons) in 2025, 464 296 (4.20 per 1,000 persons) in 2035, and 545 230 (5.73 per 1000 persons) in 2050. CONCLUSIONS: The plan to increase the medical student quota will bring about a serious doctor surplus in the long run.

Qualitative and quantitative assessment of video transmitted by DVTS (digital video transport system) in surgical telemedicine.

Real-time video pictures can be transmitted inexpensively via a broadband connection using the DVTS (digital video transport system). However, the degradation of video pictures transmitted by DVTS has not been sufficiently evaluated. We examined the application of DVTS to remote consultation by using images of laparoscopic and endoscopic surgeries. A subjective assessment by the double stimulus continuous quality scale (DSCQS) method of the transmitted video pictures was carried out by eight doctors. Three of the four video recordings were assessed as being transmitted with no degradation in quality. None of the doctors noticed any degradation in the images due to encryption by the VPN (virtual private network) system. We also used an automatic picture quality assessment system to make an objective assessment of the same images. The objective DSCQS values were similar to the subjective ones. We conclude that although the quality of video pictures transmitted by the DVTS was slightly reduced, they were useful for clinical purposes. Encryption with a VPN did not degrade image quality.

Development of Secured Medical Network with TCP2 for Telemedicine.

We developed a secure medical image transmission system by using TCP2 which is a new technology that establishes secure communications in transport layer. Two experiments were conducted; TCP2 performance tests, and field tests that transmit real-time digital video image in domestic and international settings by equipping TCP2 with DVTS (Digital Video Transmission System). The results showed DVTS equipped with TCP2 has enough performance to send secure and high quality medical images. It was considered that medical network using TCP2 would contribute as an essential technology to telemedicine.

Toward secure distribution of electronic health records: quantitative feasibility study on secure E-mail systems for sharing patient records.

If the quality and efficiency of medical services are to be ensured, electronic health records (EHR) and EHR-supporting infrastructure must be prevalent. Many hospitals, however, have EHR systems for their internal use only, and the standardization process for the exchange of medical information is still in process. This standardization process addresses information security and is considering public key infrastructure (PKI) as one security measure, but PKI is rarely used by medical practioners because of its poor user-friendliness. Here we propose an effective use of the identity-based encryption (IBE) system as a security measure. This system enables us to send encrypted and signed messages without requiring the receiver to get a public key, and it enables us to deliver secured messages to ambiguous receivers like those to whom letters of reference are sent. We evaluated the feasibility of this technology by using the analytic hierarchy process, which is an effective analysis tool when selection and judgment depend on nonquantitative psychological factors, to analyze the results of an experiment in which medical workers used E-mail agents with and without PKI and IBE. We found that medical practioners and researchers avoid using PKI because of its poor user-friendliness and instead use IBE even though it is harder to install. We therefore think IBE would encourage medical institutions to share patient records.