Introduction
Signified in part by its average lifespan of 82.8 years for women and 79.0 years for men, Japan has long enjoyed the universal health care system and its benefits. Japan’s medical system has always scored high as rated by the U.N. in quality and cost-effectiveness, spending a mere 7.9% of GDP on health care, compared to 15.0% of the U.S. However, Japan’s health system relies heavily upon overworked, undercompensated health care workers. Japan’s aging population and low birth rate has further strained this low-budge health system in the recent years; currently, one in five Japanese persons is 65 years of age or older. The number of rural towns and villages where only the elderly are left is growing rapidly, forcing schools and hospitals to shut down. Overall, the on-going iryo-Hokai, or “health care system collapse” has been a hot topic in Japan.
Education of Nurses and Doctors
To become a registered nurse in Japan, one must complete a 3-year Associate’s Degree, 3-year Non-degree training course, or a 4-year Bachelor’s degree. Medical doctorate is a 6-year Undergraduate program, followed by 2 years of residency.
TABLE 1: SALARY COMPARISON
Average Salary of various professionals in Japan
($1=105yen. In thousands of dollars)
Doctor 104.9
Nurse (female) 40.1
Nurse (male) 46.1
Airline Pilot 123.4
College Professor 107.9
Accountant 77..9
High School Teacher 68.9
Note: Cost of living in Tokyo and Osaka are 22% and 8% more than
New York City, respectively.
In Japan, doctors who are either academics or work for hospitals, whether private or public, receive lower salary and work longer hours than their peers who open up their own practices. With less money and little time, these “salaried” physicians have little power over the political decisions within the Japanese Medical Society and ultimately, within the broader political environment. A surgeon, whose practice is usually limited to working for the hospital with no chance of owning a clinic, is one of the least popular specialties among medical students. The shortage of surgeons is expected to worsen in the coming years.
“One person does it all” System
When compared to a similar hospital in the U.S., Japanese hospital employs much fewer cleaning staff, secretaries, administrative assistants, and billing staff. There is no such thing as medical assistants. As a result, nurses are often assigned to physical straining work that may require their nursing expertise: distributing feed trays, changing bed sheets, and cleaning up the spills. Similarly, a doctor’s time is often consumed by tasks that do not require his or her specialized knowledge. A surgeon, for example, may provide most of the pre-op counseling, conduct the pre-op physical, suturing, and monitoring of the patient post-operatively in addition to the actual surgery itself. Both nurses and doctors are often forced to work overtime without pay. Needless to say, job satisfaction is low, and “burnt out” syndrome may push much needed skilled workers into quitting the field altogether.
Nurse Practitioners and Physician Assistants
In December of 2007, the government made a landmark statement that a delegation of medical tasks to non-physician personnel is to be encouraged. After a few years of preparation, the very first Nurse Practitioner program has started just two months ago in one nursing school in Southern Japan, a relatively rural area. These three NP students are expected to graduate in March 2010. Currently, there is no Physicians Assistant program.
While there has been emerging interest from nurses, doctors, and the general public towards establishing non-physician clinicians in the past few years, there is no such policy, law, or regulations in place. Establishing an NP or PA system in Japan would require extensive involvement from all stakeholders as it requires modifying a law (very difficult to achieve in Japan), the longstanding law that acknowledges the exclusive rights of doctors to practice medicine.
Therefore….
The goal is to create a future in which a variety of clinicians complements each other’s strengths to provide a care that is low in cost and high in not only patient satisfaction but also clinician well-being. Several other schools are planning to start NP programs in 2009 or 2010. Japan Surgical Society and Japanese Society of Anesthesiologists are collaborating to establish a NP (or PA) model that serves as both nurse anesthetist and a surgical PA.
You can play a significant role in shaping Japan’s NP/PA system’s future. Your time and input are greatly appreciated.
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