George Kujo has published a peer-reviewed article, “Physician workforce imbalances in Japan: how structural incentives shape hospital-based acute-care capacity,” in Human Resources for Health.
The study examines Japan's physician workforce challenge not simply as a question of the total number of physicians, but as a problem involving distribution and retention: where physicians work, in which specialties, and whether they remain in hospital-based practice.
Key Points
Japan's physician workforce has grown over time, yet national physician headcounts alone do not explain the capacity of hospitals to sustain acute-care services.
The article highlights several issues:
- Physician shortages may reflect not only absolute scarcity but also maldistribution across regions, specialties, and practice settings.
- Hospital and clinic practice can involve different workloads, remuneration structures, and career incentives.
- In high-intensity areas of medicine, including emergency and surgical care, increasing the overall number of physicians may not by itself preserve hospital-based capacity.
- Longitudinal physician career transitions, including movement from hospitals to clinics, warrant greater attention alongside static workforce distributions.
Is Increasing Physician Supply Enough?
Policies addressing physician shortages often focus on medical-school capacity and the overall supply of doctors. The number of physicians who remain in hospital practice, however, is a separate question.
Even if the national physician workforce grows, hospital-based acute-care capacity may not increase proportionally when the burdens of hospital practice are high and physicians have incentives to move into other practice settings.
Workforce policy therefore needs to distinguish among three questions:
How many physicians are there? Where are they distributed? Why do they remain in—or leave—particular forms of practice?
Policy Implications
The article does not argue for a single policy intervention.
Instead, it suggests that physician-workforce policy should be evaluated using measures extending beyond national headcounts, including hospital retention, specialty distribution, workload, and career transitions.
Longitudinal data capable of tracking movement between hospitals, clinics, and specialties would be particularly valuable for evaluating whether workforce policies are sustaining the areas of the health system where physician labor is most difficult to replace.
Publication
George Kujo.
“Physician workforce imbalances in Japan: how structural incentives shape hospital-based acute-care capacity.”
Human Resources for Health. 2026;24:44.
DOI: 10.1186/s12960-026-01099-3
About the Researcher
George Kujo
Independent Researcher
George Kujo conducts independent research on health policy, medical ethics, public policy, institutional design, and accountability, with a particular interest in how institutional incentives shape individual and organizational behavior.
Research contact: Research@georgekujo.com