4th Place, Suekawa Trophy 2001

Mari Ayabe
Kansai University ESS

Recently, newspaper articles and TV programs have featured the shortage of pediatricians in Japan. As a result of this shortage, pediatrics doesn't always provide sufficient service. I was very shocked at this news because I was a victim of delayed treatment by a pediatrician when I was just three. So, I thought about why this situation has occurred, and reached the conclusion that, by and large, pediatric practice is inadequately paid. Actually, according to a survey, many medical students who originally wanted to be pediatricians have abandoned this goal, or at least hesitated over their choice, because of low rewards. Now, I would like to improve the system of pediatricians' fees in order to ensure an efficient pediatrics and care.

Let me give you an example of a graduate student at Showa University Hospital. From 7pm to 9am, for 14hours he has to work as the only doctor on night duty. He has to take care of not only inpatients but also outpatients continuously. However, the payment per hour for night duty is only 428yen. To my great surprise, like him, about 80% of training pediatricians have to do night duty for such low pay, according to a survey done by the All Japan Medical Student Union.

Compared with other medical departments, the medical treatment fees in pediatrics is about one-third due to the fact that the quantity of medicine for a child is less than an adult. In addition, the birth of fewer children has caused a decline in the number of child-patients. Because of these factors, they end up having financial difficulties.

Sad to say, there is often news of children being sent round in circles, from hospital to hospital or dying because of the lack of pediatricians. According to a survey in 1997, only 12% of emergency hospitals had pediatricians always on call. And, so many hospitals have closed their pediatric departments that, by now, this figure must be even lower.

In order to provide sufficient services and to meet patients' needs, pediatricians should be paid higher fees. In other countries, such as America and Germany, the number of pediatricians has not decreased, because those countries have adjusted pediatricians' fees to make them equitable. So in Japan, the system to be paid both from remuneration and medical treatment fees needs to be thought about considerably.

Well, what action has the Japanese Ministry of Health, Labor and Welfare taken to alleviate this situation? In 1999, in order to modify pediatrician's fees, the government asked 360 medical districts about their needs and demands. However, only 23 districts responded. Therefore, no fundamental remedies have yet been put forward.

Here comes another question. Why was the number of respondents so small in spite of the fact this attempt was a very good opportunity to improve the system for pediatricians? It is because more than half of the medical districts were not properly informed about this survey. Just recently, the All-Japan Pediatric Society has been trying to respond to the government. Ironically, the Ministry has hesitated to accept a proposal because the Society failed to propose it in the past. Though the Ministry has definitely tried to make changes, these have been reforms in name only.

Not to repeat the same mistake about estimating pediatrician's fees, our own understanding is essential. In order to allocate proper moneys to proper pediatrics, cooperation between the Ministry and the Pediatrics Associations such as All Japan Pediatric Society should be strengthened because the remedy will be very complicated and difficult without grasping the actual situation. So, Pediatric Associations should create a mutual communication network among them and report about the actual situation and the necessity of modifying the pediatrician's fees to the government immediately.

Also, Pediatric Associations should report about the pediatricians' serious situation via the media and Internet in order to build up public awareness and support because our concern is one of the most important factors for the government. This would be very effective since we can easily get in-depth information, and our response can easily be registered. This situation is not the pediatrician's personal problem but a social problem in Japan – because children are our common heritage.

Why not help to eliminate the deep-rooted financial problems of pediatricians? I am neither a pediatrician nor a financial specialist. I don't think that money can solve all of the pediatricians' problems entirely. Yet I do feel that situations like that of the graduate student at Showa University Hospital are too serious to ignore any longer. Now is the time to solve their financial difficulties, and to ensure that pediatricians are sufficiently available. We must be able to get the best treatment to care a lot about our children.