The shift of residents from university to non-university hospitals in Japan: a survey study.

Abstract

BACKGROUND: Between 2003 and 2004, when the new postgraduate medical education program was introduced in Japan, the number of university residents decreased from 5,923 to 3,264 (-31%), whereas the number of non-university residents increased from 2,243 to 4,110 (+45%). OBJECTIVE: To identify potential reasons for the shift of residents from university to non-university hospitals. DESIGN: Cross-sectional mailed survey. PARTICIPANTS: The subjects were 1,794 2nd-year residents at 91 university hospitals and 2,010 2nd-year residents at 659 non-university hospitals. MEASUREMENTS: Data on hospital demographics, resident demographics, and resident satisfaction with training were collected in 2006 and were compared between university and non-university hospitals. RESULTS: Compared to non-university hospitals, university hospitals were more likely to have >700 beds (55% vs. 10%, p<0.001) and to have more teaching resources and free access to international medical journals (84% vs. 62%, p<0.001). Nevertheless, one-half (47%) of the university residents reported that they were not satisfied with the residency system and clinical skills training and attributed their dissatisfaction to "daily chores," "low salary," and "poor clinical opportunities." Logistic regression analyses indicated that the proportions of residents who were satisfied with income (OR: 0.32, 95% CI: 0.26-0.40) and the residency system (OR: 0.52, 95% CI: 0.40-0.68) and clinical skills training (OR: 0.77, 95% CI: 0.60-0.99) were significantly lower for university residents than for non-university residents. CONCLUSIONS: Hospital size and teaching resources do not overcome the other characteristics of university hospitals that lead to residents' dissatisfaction.