General / Family Practice in Japan
-Its Potentiality and the Future-

Tomoyuki KIDO, MD, FAAFP
May 29, 2005, WONCA, Kyoto

　The equity and outcome of the Japanese medical care is one of the best in the world according to the 2000 report from The World Health Organization; The life expectancy is the longest and the neonatal death rate is the lowest in the world. It is because of the good accessibility to the primary care facilities both economically and geographically.
　Japanese primary care has been managed by "specialists" who are self trained to be generalists. Although there is the organization, The Japanese Society of Family Medicine, there is no post-graduating training system of family medicine here in Japan. Meanwhile, Japan has become an aging society very rapidly and at the same time the country with the lowest birth rate.
　Elderly people need well trained family physician rather than numerous specialists. Pediatric practice has become difficult recently because of the sudden decline of the pediatric population. The number of applicants to pediatrics department among medical students has decreased reflecting the social phenomenon. These two big social phenomena happening in Japan now is urging us the necessity of establishing the training system of the family medicine.

　In fact there are several optimistic signs for the creation of the family medicine in Japan recently. 1) The number of the member of The Japanese Society of Family Medicine has increased by 5 folds from 200 to 1000 for the last 8 years. The most of the new members are young generation in late 20s and early 30s. 2) In 2004 The Ministry of Health, Labor and Welfare of Japan started mandatory 2-year rotating internship, which hopefully provoke the interest for primary care among specialist oriented trainees. 3) In Japan, generalists in private practice earn twice as much than specialists working at hospitals with fixed salary. In most of the coutries, on the other hand, generalists earn much less than specialists. This income difference is one of the biggest negative incentive to become generalists in other countries than Japan. Therefore, the superiority in income for generalists in Japan could become the incentive to become generalist once the training system is established.

　We are trying to do our best to establish the residency training system in family medicine in Japan. At the same time, we try to appeal the necessity of the well trained family physician both to ordinary Japanese people and our fellow physicians through various media. I believe that the future of the Japanese general/family practice is rosy.