FUKUSHIMA Lives on the Line

138Table 3: Changes in the Number of Physicians Working at Medical Facilities (Compared with March 1, 2011)Compared with data prior to the earthquake, Fukushima’s 138 hospitals saw a decrease of 71 physicians.Medical care areaNumber of hospitals (March 1, 2011)Actual number of full-time doctorsIncrease or decrease in full-time doctorsMarch 1, 2011August 1, 2011September 1, 2011March–AugustAugust–SeptemberMarch–SeptemberKenpoku3266568167916▲214Kenchu (Koriyama)22536521506▲15▲15▲30Kenchu (all other cities)11717272101Kennan101101161136▲33Aizu192382422394▲31Minamiaizu11215143▲12Soso161206161▲590▲59Iwaki27261258258▲30▲3Total1382,0131,9661,942▲47▲24▲71figures from 2008 to 2010, although the national average number of healthcare professionals per 100,000 people increased from 212.9 to 219.0, the figure in Fukushima decreased from 183.2 to 182.6. Fukushima was one of only two prefectures to show a decrease at the time (Reference 8). Fukushima’s population before the disaster was about 2.02 million people and, even before the disaster, there were about 735 physicians working at medical facilities, a small number when compared to the national average. Based on a prefectural survey completed after the disaster, the number of physicians at Fukushima’s 138 hospitals decreased by 71 between March 1 and December 1, 2011. Compared with the numbers effective August 1, there was a decrease of 24 doctors. These figures breakdown as a decrease of 59 physicians in the Soso area, which houses the nuclear power plant, and a decrease of 30 physicians in Koriyama. Meanwhile, Fukushima, home of FMU, and other parts of the Kenpoku area saw an increase of 14 physicians (Table 3). Thus, Fukushima could not take in all of Soso’s physicians who were forced to evacuate and could no longer practice at their respective hospitals and could not control the drain of physicians out of the prefecture. The Kenpoku area, including Fukushima, which was exposed to relatively high levels of radiation, did not have an outflow of physicians. Despite this, it is unclear why there was an outflow from Koriyama, which suffered similar conditions. We speculate the reason to be the retreat of physicians who had originally been sent from the Kanto region of Japan. The number of clinical residents has also been affected. Of the 70 physicians who started their residencies in Fukushima in April 2011, four of them changed their residency locations to those outside the prefecture; this was done after the disaster due to exceptional circumstances. For the 2012 matching program, the number of matches in Fukushima was 61 residents, the lowest number since the start of the new clinical residency program (the average number of matches in Fukushima for the past eight years is 76.6). This was also the ninth lowest number of matches in the country. The percentage of positions filled by matches (fill rate) was 41.8%, the lowest rate among 47 prefectural and city governments (Reference 6). We must work toward having more clinical residents throughout Fukushima by emphasizing a unique type of residency one can only get in Fukushima, based on our core prefectural clinical residency hospital network, and the Emergency Medicine Research Center. Residents living within 20 kilometers of the Fukushima Daiichi plant or in planned and specially recommended evacuation zones, with relatively high levels of radiation, lived as evacuees similar to those whose homes were washed away in the tsunami. In particular, Iwaki saw an influx of over 30,000 evacuees, surpassing the capacity of welfare, government, and medical facilities. Addressing the lack of doctors in the Soso area, on January 27, 2012, the Ministry of Health, Labour and Welfare renamed its Soso Region Medical Professionals Provision & Support Center, established in Minamisoma’s Soso Office of Health and Welfare, to the Soso Region Medical Treatment & Welfare Reconstruction Support Center. This resulted in an increase in Ministry personnel from two to three to bolster welfare services in Iwaki City.As of the end of December 2011, only three of the 16 inpatient medical facilities in the Soso area have resumed inpatient functionality to the pre-disaster level. Seven facilities within the 20-kilometer radius of the nuclear power plant have shut down altogether (Image 3). In particular, hospitals with psychiatric departments have lost all inpatient care, with one hospital reopening Great East Japan Earthquake and Tsunami and Ensuing Radiation Exposure Issues