Situation ‘the old cure the elderly’

In Japan, many elderly doctors, aged 67 or 75, still have to perform surgery to treat geriatric patients.

Aging in Japan has long been a problem for the authorities. Public and private agencies have for many years strived to create a dynamic society, among the high average age community. But there are still many unsolved obstacles, one of which is health care.

Along with the rest of the country, Japanese doctors are getting older, both physically and productive. People use the term Ro-ro-iryo, or “the elderly looking after the elderly” to refer to the elderly doctors working in geriatric hospitals.

The elderly are more susceptible to the disease, the number of hospitalizations can quickly increase, while the working hours of the elderly health workers are not much.

Sparsely populated areas even have a serious shortage of doctors. The situation is brighter in the big city, but the population here will also age quickly. This reduces the time a doctor spends in a patient.

At a geriatric hospital in northern Akita prefecture, one-third of doctors are 65 or older. The duration of treatment for these patients is extremely short. For patients over 75 years old, they can only visit for more than 23 minutes per day.

Dr. Koichiro Okuyama, 62 years old, director of Akita Rosai Hospital is treating a patient. Image: Nikkei

Mr. Shuichi Yoshihara, 64, director of Odate City General Hospital, said: “The number of general practitioners in the area has decreased by a quarter compared to 10 years ago. The average age is now 70. Diseases people who cannot examine at the local medical center flock here, so the hospital is always crowded, “he said.

Some doctors are unable to continue because of health problems as a result of overwork. The hospital tries to make up space by hiring older people or squatting. Some doctors have to do surgery until age 78.

In 2020, Covid-19 suddenly arrived, attacking the already difficult workforce. The hospital is indicated to handle infectious cases. Many doctors, despite their old age, are still on duty until late at night. Some surgeries have been postponed.

As people get older, the number of complications also increases.

“Some patients need to be diagnosed from multiple departments. The burden on the doctor is really enormous,” said Mr. Yoshihara.

At Akita Rosai Hospital, about 10 km away, the situation is similar. Koichiro Okuyama, 62, an orthopedic doctor and hospital director, still performs surgery every two days. The facility does not have a full-time internal medicine doctor, so he visits dialysis patients.

“I am both an internist and a psychiatrist. I have to use all the skills I learned in my residency,” he said. “I can do them because I love my work.” But when the age is old, it becomes more difficult to make up for the lack of manpower.

This is also a common prospect in the future of the national health care system.

The Nikkei has analyzed the working time by age of doctors in 344 secondary medical areas in Japan. Experts compare the time they spend on healthcare for their patients each week in 2026 with 2016.

Four years ago, the average consultation time in 52 urban health areas (those with more than 1 million people) was 78.1 minutes. This number is expected to drop to 63.4 minutes by 2026.

Elderly volunteer at the Chiba Nursing Home, Japan.  Photo: WSJ

Elderly volunteer at the Chiba Nursing Home, Japan. Image: WSJ

In fact, the number of doctors in Japan is still increasing every year. In the past 10 years, the total number of doctors has increased by 14%, but the number of people aged 59 and under has only increased by 5%. Elderly doctors are not on duty for many consecutive hours. Male doctors in their 40s can work around 70 hours per week, but that number drops to between 50 and 60 hours by the time they reach 60.

Meanwhile, the proportion of patients aged 75 and over requiring medical treatment is 3 to 6 times higher than those aged 10 to 39 years old. Medical examination and treatment time also increased accordingly. Thus, the shortage of personnel still occurs.

One of the solutions given is home examination and treatment. The government seeks to move medical care that can be provided outside the hospital to the patient’s bedside, in an effort to balance the rising cost of social welfare in Japan. As this model develops, the scope of the physician’s work also widens.

However, the local infrastructure still has many factors that cannot meet the above trend.

“The number of patients who need medical care at home is increasing and there are not enough general practitioners to support them. Many hospitals lack the manpower to take over or fill the vacancy,” said Manabu Kazui, director of one. Home health center, said.

Hachioji City, Tokyo, has only about 20 doctors providing this service. More than half of them are 60 years old or older. Twelve general practitioners say they are on duty 24 hours a day if the patient has an emergency. This is quite difficult for older doctors.

Thuc Linh (Follow Nikkei)


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