医師不足対策

(Jul. 22, 2008) The Yomiuri Shimbun

Urgent action needed to solve doctor shortage

医師不足対策　増員だけでは１０年かかる（7月22日付・読売社説）

Drastic measures must be taken to solve the serious shortage of doctors faced by the nation.

医師不足を解決するには、相当に思い切った対策が必要だろう。

A panel of experts has been established by the Health, Labor and Welfare Ministry to give body to the vision set out by the ministry in the hope of securing safe, accessible medical care.

厚生労働省がまとめた「安心と希望の医療確保ビジョン」を具体化するための有識者会議が発足した。

In its new vision, the ministry made an about-face from the conventional policy of limiting the number of medical students to a new policy of increasing the enrollment quotas of medical schools.

厚労省は新ビジョンで、医師の養成数をこれまでの「抑制」から「増員」へと方針転換した。

(about-face=180度方向転換) (quotas=quota=割り当て人数)

It is necessary for the panel to first show to what extent it will increase the enrollment quota of medical schools from the current 7,800.

医学部の入学定員を現在の約７８００人から、どこまで増やしていくのか。有識者会議はまず、これを明示する必要がある。

Prior to the adoption of the policy to curtail the number of medical students, up to 8,300 medical students had been trained annually. It is necessary to immediately return to the number of trainee doctors produced during the peak period. In addition, the panel must consider whether to further widen the enrollment quota in excess of the earlier peak.

(curtail=削減する、切り詰める)

医師数の抑制方針がとられる以前は、最大で年間８３００人の医師を養成していた。ピーク時の水準までは早急に回復させるべきだろう。その上でさらに増員するのか、展望も示さねばなるまい。

However, it takes about 10 years for freshmen in university medical departments to become full-fledged doctors. Measures that will have a more immediate impact are need in addition to the plan to increase enrollment quotas.

だが、医学部の入学者が一人前の医師になるまでには、１０年程度かかる。増員計画と同時に、即効性のある対策も不可欠である。

One pressing issue is improving the clinical training system for newly graduated doctors.

喫緊の課題は、新人医師の臨床研修制度の改善だ。

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Fix clinical training system

（新人医師の臨床研修制度の確立）

In the past, most new medical school graduates started out working as interns under supervising doctors at university hospitals. But a new clinical training system has allowed them to choose to train at ordinary private hospitals because, in many cases, the conventional system has resulted in increased overspecialization of doctors.

かつて新人医師の大半は、大学病院の医局で研修していた。しかし、専門分野に偏った医師が育つ弊害が目立ったために、一般病院でも研修できるようになった。

(overspecialization=専門分野に偏りすぎていること)

The goal of the new system--enabling young doctors to acquire a broad range of clinical experience--is a sensible one.

若い医師に幅広い臨床能力を身につけさせるという、制度の目的は理にかなっている。

But university hospitals, which found themselves short of staff after the number of trainee doctors coming to them decreased more than expected, have recalled more experienced doctors they previously dispatched to hospitals run by local governments.

ところが、研修医が予想以上に減って人手不足となった大学病院が、自治体病院などに派遣していた中堅医師を引き揚げた。

This is a major reason for the sharp decline in the number of doctors in provincial cities. As many medical school graduates choose to do their internships at hospitals in major cities, the uneven distribution of doctors has been aggravated.

これが急激な医師不足現象の大きな要因である。研修医の多くは都市部の病院を研修先に選び、医師偏在に拍車もかけつつある。

(aggravate=悪化させる)

To amend such a situation, alternative ways are needed to handle the selection by aspiring doctors of the hospital at which they will train. It is necessary to adjust the quota for trainee doctors so that they can be assigned more equitably to each prefecture.

これを改めるには、研修先の選択方法に工夫が求められる。各都道府県に満遍なく研修医が配属されるような定員調整が必要だ。

(aspire=待ち望まれた、待望の) (equitably=公平に、同様に)

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Help local govt-run hospitals

（地方自治体運営の病院への支援）

Hospitals run by local governments have been entirely dependent on university hospitals dispatching doctors to them. It is important to create a system or body under which doctors will be assigned to local hospitals that need them.

また、これまで大学の医局に医師派遣を頼ってきた自治体病院に対し、必要な医師を配置する仕組みや組織作りも重要である。

We hope the panel will also delve deeper into the issue of medical treatment fees.

有識者会議は、診療報酬の在り方にも踏み込んでもらいたい。

(delve=探求する)

The current doctor shortage is really a shortage of staff physicians at hospitals.

今日の医師不足は、言い換えれば「勤務医不足」だ。

In general, doctors working at hospitals make less money than those in private practice and work longer hours.

総じて勤務医は、開業医より収入が低く、長時間勤務で医療に従事している。

The working conditions are tougher for hospital staff doctors who may be required to provide medical care at any time day or night, especially obstetricians, pediatricians and doctors engaged in emergency medical care.

産科や小児科、救急など、昼夜を問わず診察を求められる部門は過酷だ。

（obstetrician=産科医） (pediatrician=小児科医)

Doctors who cannot cope with such working conditions are shifting to private practice.

耐えかねた医師が開業医に転身している。

To resolve the current crisis a drastic increase in the medical treatment fees paid to hospital doctors is needed.

現状に歯止めをかけるには、勤務医向けの診療報酬を大胆に手厚くする必要があろう。

Support work by doctors in private practice who take turns providing medical care at night at hospitals should be properly rewarded.

開業医が交代で病院の夜間診療を応援する、といった取り組みにも、大いに報いるべきだ。

(reward=報いる)

It is important to concentrate financial sources on essential medical services.

本当に必要な医療に、財源を集中することが重要である。

(From The Yomiuri Shimbun, July 22, 2008)

（2008年7月22日01時27分  読売新聞）