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Potential Patholigist Shortages in Japan
 
Tomio Arai
A shortage of medical doctors in Japan is becoming an increasing problem. Mass media outlets have reported on surgeons, as physicians quit their chosen fields due to problems such as burn-out and increased risks of lawsuits. The situation regarding pathologists, however, is infrequently examined, as Japanese society does not adequately recognize the role of the pathologist in the health care system. Nonetheless, similar to other fields, pathology faces an imminent shortage of qualified practitioners.
 
The Japanese Society of Pathology reports a current membership that consists of 1,900 cer t i f ied pathologists and 400 trainee pathologists. Overall, pathologists account for 0.9% of all physicians in Japan. The average age of a practicing pathologist is 52; 430 pathologists are over the age of 60. Perhaps partly due to this age difference, young medical students tend to be wary of pathologists which limits their exposure to pathology as a specialty.
 
The number of certified pathologists is expected to decrease, reaching 1,600 in 2011. Only 580 of 8,000 hospitals report having a full time pathologist and it is not uncommon that 400 bed (or more) hospitals may lack a full-time pathologist on staff. Pathologists are also unevenly distributed throughout Japan. The number of certified pathologists per 100,000 population varies from 0.726 (Fukui) to 2.891 (Tokyo). Thus, a pathologist in Fukui is responsible for providing pathologic diagnoses to a population of 137,000 while a pathologist in Tokyo is responsible for only 34,600. In 70% of hospitals that do have a full-time pathologist, he/she frequently works as “Hitori byourii” or “a lonely pathologist”, meaning he/she is the only pathologist at that hospital; only 30% of hospitals have two or more pathologists who can divide work between them, consult with each other on cases, etc. In my experience, I worked in a municipal hospital as a “lonely pathologist” for three years. In that time period, I diagnosed 4,500 surgical biopsies, 4,000 cytology specimens, and did 60 autopsy cases per year, with minimal help from parttime pathologists.
 
Quote1Overall, pathologists account for 0.9% of all physicians in Japan.Quote2
The average age of a practicing pathologist is 52

 
 In 2004, the Ministry of Health, Welfare and Labours of Japan implemented a new trainee system for recently graduated medical doctors. Previously, trainee doctors had the option of going straight to the pathology department of a university or hospital when they finished medical school. Now, however, the current system prohibits junior residents from going straight to a pathology department. Instead, junior residents now are required to have a 2-year experience of clinical medicine and public health following graduation. This new system influences choice of speciality, and we are concerned this will decrease the number of patholog ist trainees even further.
 
There are signs of hope. An association of cancer patients have insisted that they wanted their operations at a hospital with a full-time pathologist. The Health Ministry has paid attention to this request and recognized the importance of pathology in medical service. It would appear that pathology is beginning to be recognized as an equal with fields such as surgery, paediatrics, etc. It is our responsibility now to try to increase the number of trainees entering the field of pathology. We should make an effort to expose medical students to pathology as a medical specialty, tell them what we enjoy about our jobs, and describe how pathology can be a very satisfying career choice.
 
Tomio Arai, MD, PhD
Department of Pathology
Tokyo, Japan
 
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