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HIMEJI, Japan: Japan might boast universal health coverage and some
of the world’s best medical technology, but an acute shortage of
doctors is leaving some hospitals unable to treat even car crash
victims.
Grueling work hours are discouraging people from
entering the medical profession in a country where the population is
rapidly aging, foreign doctors are barred and a swelling public debt
caps doctors’ salaries.
The strains are even being felt here at the
Hyogo Brain and Heart Center in the western city of Himeji, one of
Japan’s best-known neurology and cardiology hospitals.
“It’s become the norm for doctors to
work 36 hours straight, and if this routine continues, doctors’
abilities during surgery will drop,” said Teishi Kajiya, the
hospital’s vice-director and a cardiologist.
The root of the problem is the steady decline in
the number of so-called level-two hospitals that treat common
injuries that require immediate hospitalization, particularly in
rural areas with falling populations.
The burden has shifted to “level-three”
hospitals which offer emergency services for patients with
life-threatening injuries.
“Since the number of level-two hospitals here
fell by half in the past 10 years, our hospital is overwhelmed by
patients,” Kajiya said. “Since we are forced to accept patients
with lesser injuries, there’s a great risk that we’re unable to
treat patients whose lives are truly in danger.”
He said the hospital has turned down at least
100 patients in each of the past two years, adding that he was
unaware of what happened to those who were rejected.
The hospital, which has a total of 60 medical
staff including doctors and resident students, is able to ensure
only a bare minimum of three doctors on duty at all times for
emergency patients, he said.
The situation is direr for level-two hospitals.
A recent poll by the Mainichi Shimbun showed that nearly 60 percent
of such non-emergency hospitals had only one doctor on duty after
hours. By medical standards, at least three doctors are required to
attend to a single emergency patient at any one time.
In January, an injured motorcyclist died from
his wounds after being forced to wait one hour before being
hospitalized, while Osaka, Japan’s second city, reported 3,800
cases last year in which ambulances had to call multiple hospitals
to ensure treatment.
Also, an 89-year-old woman stricken with
vomiting and diarrhea died of a heart attack after her local fire
department spent two hours contacting 30 medical facilities—all of
which refused to accept her, citing insufficient beds and shortage
of on-duty doctors.
In Japan’s health care system, the government
regulates the fees charged by all hospitals, both public and
private. Employers buy insurance for workers; those without stable
jobs can buy coverage through local governments.
The set-up provides equal care for the rich and
the poor, but doctors have often complained that it has kept their
salaries stagnant even though specialists would earn lucrative
incomes overseas.
Unlike in some countries that welcome medical
professionals from abroad, foreigners cannot fill the gap in Japan.
Japan has virtually no foreign doctors due to strict immigration
rules, although it took the landmark step in 2006 of allowing in a
limited number of nurses from the Philippines.
To encourage more people to become doctors,
reforms four years ago allowed medical school interns to choose
their specialization and work locations.
“Now, students prefer professions like
ophthalmology since all the wages are the same,” said Seizan
Tanabe, chief officer for emergency medical care at the health
ministry.
The risk of being hauled to court by patients
for malpractice is another reason why doctors are seeking to go into
less taxing fields rather than surgery, officials and experts said.
“For a senior doctor like myself, the priority
isn’t money but the patient’s recovery. For me, it is a holy
job. Now it’s a money job,” said Yasuhiro Yamamoto, chairman of
the department of emergency and critical care medicine at Nippon
Medical School.
The government recently earmarked 150 billion
yen ($1.4 billion) to ease the doctor shortage, but doctors say that
amount is a fraction of what is needed and is unlikely to trickle
down to salaries because of hospitals’ mounting debts.
-- AFP
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