Securing Physicians on RemoteIslands and in Remote Areas(Medical Support Centre
Project for Remote Islands andRemote Areas)

Nagasaki Prefecture

Background

Project Aims

Nagasaki Prefecture is one of the few prefectures in JapanThe concentration of physicians in big cities and theirwith remote islands. Currently, around 110,000 of its

uneven regional distribution have made it challenging toresidents live on 51 variously-sized islands.

secure medical professionals in remote islands and isolatedThis circumstance makes providing medical care on theseareas. Municipalities' independent efforts to attractislands a crucial aspect of the region's medical policies. Inphysicians are also reaching their limits. In response,

1968, the prefecture and its cities and towns united to form

Nagasaki Prefecture offers comprehensive support inthesecuring medical professionals for municipal clinics locatedNagasakiPrefecture

RemoteIslands

Medicalon remote islands.

Association, a partial-affairs-association. The prefecture has
been actively committed to remote island medical caresince 2009, operating eight hospitals and three clinics,

Project Outline

including Goto Chuo Hospital, under the Nagasaki

In April 2004, the Prefecture created the Nagasaki

Prefectural Hospital Corporation.

Prefecture Medical Support Centre for Remote Islands andThe provision of medical care on the islands is carried out

Remote Areas. The Centre ensures access to medical care inthrough close collaboration with local municipalities.

remote islands and areas by securing medical professionals

Residents have access to a comprehensive range of services,and promoting innovative community medicine.

including community health, home medical care, primary

To enhance its effectiveness, part of the Centre's operations

and secondary medical care, thanks to the presence ofwere outsourced to Nagasaki Medical Centre in Octoberprefectural health centres on each remote island. For more

2011 and later transferred to Nagasaki University Hospital

advanced tertiary care, the National Hospital Organizationin April 2016.

Nagasaki Medical Centre and Nagasaki University Hospital

As a Remote Area Medical Support Organization, the Centre

in the central part of the prefecture are available.

carries out its duties in accordance with the national
government's plan for remote area health and medical care.
It supports remote island and remote area clinics bydispatching full-time physicians and substitute physicians tothe municipal clinics in these areas.
The Centre also provides support for medical care in remoteislands and remote areas in cooperation with the Regional
Medical Resources Support Centre in Nagasaki, establishedin FY2012.
- About the Support Centre
1． Shimasuketto Group (April 2006 onwards)
The Centre helps ensure access to medical care in these1

areas by providing support services such as substitute or oncall physicians when regular full-time physicians attend

2. Dispatch of Substitute Physicians

conferences, etc. It also facilitates the arrangement ofThe prefecture ensures that medical care is provided in

substitute physicians from those registered with theremote islands and remote areas by dispatching full-timeCentre’s Shimasuketto Group in the event of a full-time

physicians from the Nagasaki Regional Medical Human

physician's retirement or short-term absence. By offering

Resource Support Centre at the request of municipalities

these services, the Centre supports the provision of medical

when their regular physicians are unavailable.

care in these remote communities.

When a local hospital in the area where a municipal clinic islocated cannot provide a replacement physician and the(1) Registration And Dispatch Procedures

clinic's full-time physician is unavailable due to reasons sucha. Physicians or medical institutions willing to support

as academic conferences, training, leave, bereavement,

remote islands and remote area clinics in the prefecture byillness, or hospitalization, municipalities can request a full-providing substitute or supplementary care, short-term full-time physician from the Nagasaki Regional Medical Humantime medical care, etc., can register with the Shimasuketto

Resource Support Centre to ensure medical care is available.

Group.

In FY2021, physicians were dispatched to six clinics for ab. If a clinic requires the services of a physician, they may

total of 121 days of treatment.

request a dispatch from the Shimasuketto Group throughthe Centre.

3. Recruitment, Placement, and Referring Full-Timec. The Centre will match the clinic with suitable physicians

Physiciansfrom the Shimasuketto Group, considering factors such as

The Centre also assists with recruiting and referring

their place of residence.

physicians by providing information about job opportunities

d. The clinic and the physician will negotiate regarding

through medical journals, websites, and recruitment events

details such as duration and cost.

and connecting interested physicians with remote areae. The municipality and the registered physician finalize theclinics.

agreement by signing a contract, with medical services then

The Centre acts as an intermediary for recruiting physicians

commencing.

by directly reaching out to municipalities, clinics, andhospitals of the Nagasaki Prefectural Hospital Corporation(2) Status of Registration(formerly the Nagasaki Prefecture Remote Islands Medical

So far, four medical institutions and 39 physicians fromAssociation) for those looking for job opportunities.

within and outside the prefecture have registered.

So far, 69 full-time physicians have been employed in

In FY2021, physicians were dispatched to four clinics for amunicipal clinics, hospitals within the Nagasaki Prefectural

total of 77 days of treatment.

Hospital Corporation, and municipal hospitals.
4. Medical Support
The Centre also offers guidance and support to clinic
physicians through various means, including informationtechnology.
5. Jurisdiction over Conference on Medical Support
Planning in Remote Areas
The Centre also implements a plan to support medical care

The Shimasuketto Group uses RIMCAS (Remote Island
Medical Co-operation Air Service) to provide medical support2

in remote areas and improve facilities and equipment atFuture Developmentsbase hospitals and clinics, to ensure that medical care isNagasaki Prefecture will persist in offering support toprovided effectively and efficiently in these areas.

ensure that remote island clinics have access to physicians,
as individual efforts by municipalities to secure physicians

6. Career Development System Grants

have reached their limits.

The Centre provides subsidies to cover the cost of training
for general practitioners to cities, towns, and other entities

Reference URLs

operating clinics in remote areas through its training

http://ncmsc.jp/

program for general practitioners. This gives newly-Contact

employed physicians the chance to learn general medicine.

Affiliation: Medical Personnel Office

Features and InnovationsThe

full-timephysicianPhone number: +81-095-895-2421
dispatchsystem

bytheE-mai: s04045@pref.nagasaki.lg.jp

Shimasuketto Group and the Centre has successfully
enabled the dispatch of substitute physicians, overcoming
the challenges that individual municipalities would face.
This dispatch system has assured physicians considering
working at clinics in remote areas, as they know they will
have backup support in emergencies. It is one of the factorsthat has encouraged them to take up positions in Nagasaki
Prefecture.
The Centre’s centralized information on hospital and clinic
job openings in the prefecture allows for efficient matchingof physicians with institutions that meet their desired
working conditions. The Centre's physicians offer guidanceand support for career development and medical issues
that administrative staff at municipalities may be unable tohandle. This support makes it easier for physicians to decideto work in Nagasaki Prefecture.

Issues, Problems and Responses
Despite some successes in securing physicians for remoteclinics and dispatching substitute physicians, the Medical
Support Centre for Remote Islands and Remote Areas has
yet to address the disparities between mainland andremote island healthcare.
To resolve this issue, the Centre will persist in actively
promoting physician recruitment through various channels,
including online.

3