Association between physicians’ maldistribution and core clinical competency in resident physicians
Authors: Shikino Kiyoshi , Nishizaki Yuji , Kataoka Koshi , Nojima Masanori , Shimizu Taro , Yamamoto Yu , Fukui Sho , Nagasaki Kazuya , Yokokawa Daiki , Kobayashi Hiroyuki , Tokuda Yasuharu 
Published: October 2023

ABSTRACTImportanceThis study highlights the association between physicians’ maldistribution and core clinical competency of resident physicians and emphasizes the global significance of addressing healthcare access disparities.ObjectiveTo investigate the relationship between a prefectural program with and without physician maldistribution and core clinical competency, measured using the General Medicine In-Training Examination (GM-ITE).DesignCross-sectional study.SettingData from the GM-ITE survey were collected in January 2023.ParticipantsResident physicians in their first and second postgraduate year (PYG-1 and PGY-2) who were employed at Japanese hospitals that required the GM-ITE or resident physicians who voluntarily participated in the GM-ITE.ExposurePhysician uneven distribution (PUD) index is a policy index developed and adopted in Japan. It serves as an indicator of regional disparities among physicians within the country. A low PUD index indicates that there is an insufficient medical supply relative to the medical demand in that region.Main Outcomes and MeasuresThe GM-ITE scores of resident physicians.ResultsThe high PUD index group included 2,143 participants and the low PUD index group included 1,580 participants. After adjusting for relevant confounders, multivariable linear regression analyses revealed that the low PUD index group had a significantly higher GM-ITE score compared to the high PUD index group (adjusted coefficient: 1.14; 95% confidence interval: 0.62–1.65; p<0.001).Conclusions and RelevanceResident physicians in regions with low PUD indices had significantly higher GM-ITE scores. These findings underscore the significance of addressing physician maldistribution to enhance the clinical competency of resident physicians and emphasize the potential benefits of reducing regional healthcare disparities, particularly in terms of medical education and training. These insights have broader relevance for healthcare policies and medical training programs worldwide, highlighting the need to consider physician distribution as a critical factor in improving healthcare access and quality.KEY POINTSQuestionHow does physician maldistribution, indicated by the physician uneven distribution (PUD) index, impact resident physicians’ clinical competence based on performance in the General Medicine In-Training Examination (GM-ITE) in Japan?FindingsIn this nationwide cross-sectional study, resident physicians affiliated with hospitals in regions with a lower PUD index (indicating insufficient medical professional supply relative to healthcare demands) had significantly higher scores on the GM-ITE than those in regions with a higher PUD index.MeaningTraining resident physicians in areas short of physicians does not adversely affect their education; rather, it can enhance medical education and address the physician maldistribution issue.