Effectiveness of Medical School Expansion & Home Medical Care Urgency [Forum]

The issues that have shaken our society, such as a shortage of doctors and an increase in the number of medical students, took a new turn with the announcement by the Minister of Health and Welfare on the 10th. There will be an increase of 490 people in 2027, 613 people each in 2028 and 2029, and 813 people each in 2030 and 2031.

Let’s reflect. When the Doctors’ Human Resources Task Force (TF) created by the government in 2012 discussed increasing the number of medical schools, the medical community lobbied to block it, saying why increase the ‘total number’ when the ‘distribution’ of doctors can be done well. When the government again announced in 2020 that it would increase the total number of doctors by 400, including 300 allocated to local doctors, the doctors blocked it with a resident strike, revealing their true intention of rejecting the total amount. In 2024, the government pushed for a drastic increase of 2,000 people, but stopped at an increase of 1,500 people per year. This decision is to allocate the 3,342 people to be increased over the next five years only to the ‘regional doctor system track’. This is the work of the current government that uses the failures of previous governments as a lesson.

This achievement was possible because both content and procedural legitimacy were secured. First of all, the ‘Act on the Training and Support of Local Doctors’, passed in December last year, allows not only the total amount but also the distribution to be determined at the admission stage (content justification). In addition, the Physician Supply and Demand Estimation Committee carried out the practical estimation process and the Health and Medical Policy Deliberation Committee carried out the social consensus process, and all processes were made public (procedural justification).

However, increasing the number of doctors by a few hundred doctors per year is only a small step in the long journey of medical reform. One of the necessary conditions was only partially met. There is a long way to go, including establishing a supply and demand mechanism for doctor manpower, expanding distribution of regional, essential, and public medical services, and establishing a training system network. One of them is the ‘regional doctor system selection’ allocation to 32 medical schools in non-metropolitan areas that must be confirmed immediately. Local medical schools are already competing fiercely to get as many as 490 students from regional admissions, which will be increased in 2027. The tug-of-war between regional organizations to ‘host’ local and public medical schools that will be newly established in 2030 is already at the level of war.

Even if the number of medical students is increased, results will be visible only after 10 years. And that too little by little. However, we cannot ignore the immediate medical needs in a super-aging society. We must secure manpower to supplement the shortage of doctors, and this must be premised on role coordination and flexibility among medical personnel. The licenses and roles given to doctors, oriental medical doctors, pharmacists, and nurses must be adjusted according to changes in the times.

Oriental medicine doctors’ participation in home primary care should be encouraged. The ‘Long-Term Care Home Medical Center Pilot Project’, which has been in progress for three years, has 40% of Oriental medicine doctors participating, which is on par with doctors. Nursing personnel must be able to fully participate in home nursing care, and ‘home nursing centers’ run by professional nurses must be expanded. In Japan, visiting nursing stations, introduced in 1992, played a major role in shifting the focus of seniors’ lives from ‘hospital to home’ in the face of a super-aging society. Now, nurses run 70% of the stations.

From March 27th, the ‘Act on Integrated Support for Local Care, including Medical and Nursing’ will come into effect. Initially, the framework of the integrated care project will likely be established with a focus on welfare and care. However, as time goes by, the demand for medical and nursing care for the elderly increases. At this time, we hope that they will become the central workforce that supports home medical care in the community. The completion of medical reform lies in a system where people receive appropriate medical care and care where they live.