Association between physicians’ maldistribution and core clinical competency in resident physicians

Importance This study highlights the association between physicians’ maldistribution and core clinical competency of resident physicians and emphasizes the global significance of addressing healthcare access disparities. Objective To 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). Design Cross-sectional study. Setting Data from the GM-ITE survey were collected in January 2023. Participants Resident 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. Exposure Physician 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 Measures The GM-ITE scores of resident physicians. Results The 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 Relevance Resident 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. Question How 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? Findings In 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. Meaning Training 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. ### Competing Interest Statement KS received an honorarium from JAMEP as speakers of the JAMEP lecture and exam preparers of GM-ITE. YN received an honorarium from JAMEP as a GM-ITE project manager. YT is the JAMEP director, and he received an honorarium from JAMEP as a speaker of the JAMEP lecture. HK received an honorarium from JAMEP as speakers of the JAMEP lecture. TS and YY received an honorarium from JAMEP as exam preparers of GM-ITE. ### Funding Statement This study was supported by the Health, Labor, and Welfare Policy Grants of Research on Region Medical (21IA2004) from the Ministry of Health, Labour and Welfare (MHLW). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was approved by the Ethical Review Committee of the Japan Organization for Advancing Medical Education (approval no. 23-9). All participants provided informed consent prior to their participation in the study in accordance with the Declaration of Helsinki. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors