寺裏 寛之

病院勤務医は,診療支援の目的で主たる従事先(主従事先)とは別に従たる従事先(従従事先)を有する場合がある。働き方改革の労働時間の規制は,従従事先の診療に影響することを危惧する声がある。そこで,その影響を推測するために地域医療支援病院の医師の従従事先の実態の把握を目的とした。調査は2018年の医師・歯科医師・薬剤師統計を用い,対象は病院の常勤医師(n=144383)とした。従従事先を有する医師の割合は,地域医療支援病院群(11.8%)がそれ以外の病院群(22.4%)と比較して有意に低かった。地域医療支援病院群の医師で従従事先が医師少数区域である割合は,医師少数県(17.9%)で医師多数県(10.6%)や医師中程度県(8.8%)よりも有意に高かった。地域医療支援病院群の医師の従従事先は,割合は大きくはないものの医師少数区域への医療支援を担っており働き方改革の影響を注視する必要がある。(著者抄録)

In Japan, there are rural clinics designated for areas without physicians to ensure the availability of medical care for rural area residents. The purpose of this study was to clarify the attributes of physicians working in the rural clinics. Using the 2018 Ministry of Health, Labour and Welfare data in Japan, we compared the attributes and board certifications of physicians in rural clinics with those of physicians in other clinics. The age group with the highest percentage of physicians was the over 70 group (16%) and the early 30s group (15%) at rural clinics; however, the highest percentage of physicians at other clinics was the 70 over group (20%) and the early 60s group (16%). The number of physicians working in the internal medicine field at rural clinics was 550 (89%). There were 147 (27%) board-certified physicians in that field. Among them, the number of board certifications in internal medicine, surgery, and other than internal medicine or surgery were 79 (54%), 17 (12%), and 51 (35%), respectively. The proportion of board-certified surgery physicians within the internal medicine field in rural clinics was significantly higher than in other clinics (5%). In rural clinics, the age distribution of physicians was different from that in other clinics, and many of the physicians worked in the internal medicine field, but some of them seemed to have a mismatch between their board-certifications and their fields of practice. Further studies are necessary to clarify what the mismatches mean in rural practice.