Japan Primary Care Association (JPCA)

The Japan Primary Care Association (JPCA) is the largest academic association of generalists in Japan, established on April 1, 2010 with the merger of the Japanese Academy of Primary Care Physicians, the Japanese Academy of Family Medicine and the Japanese Society of General Medicine.

The Japan Primary Care Association consists of practicing primary care physicians, hospital-based generalists and university-based generalists who are actively being involved in practice, education and research.

Office	：	Tokyo Medical Association bldg. 302, 2-5, Kandasurugadai Chiyoda-ku, Tokyo 101-0062, Japan
Phone	：	81-3-5281-9781
FAX	：	81-3-5281-9780
E-mail	：
URL	：	http://www.primary-care.or.jp
President	：	Masaji Maezawa, MD, PhD

Membership as of 8/26/2010

1st May 2010
Dr. Masaji Maezawa

It was an epoch making endeavour in the history of medicine in Japan that we have managed to integrate previous three primary-care related colleges and to inaugurate this single association, i.e. the Japan Primary Care Association. Until recently, novel sub-specialised colleges have launched from different background specialities by the group of physicians who share their interest. Thus the number of colleges in Japan has kept increasing. The increase in the number of colleges is a symbolic phenomenon reflecting on the medicine itself, which ever continues its progress and developing its layers of subdivided specialities. Each college, which has different group of members, emerged and emphasised their own strengths, specific roles and focuses. Hence it is quite unique and outstanding to be able to unite these different but related colleges together. This integration of the three primary-care related colleges was started in the discussion of how to collaborate and cooperate to work on current challenging situations in Japan such as (1) rapid change to the super-aged society and (2) lack or skewed supply of medical staff and health care resources. In order to make effective and efficient use of limited medical resource, it is essential to clarify the role and mission of the primary-care professionals who should be the key local providers of health care service in each community. Their role should not only be practising the narrowly defined primary-care but embracing and coordinating fruitful collaborations amongst multi-disciplinary professionals across medical and welfare service fields in order to support local people holistically. Thus it is absolutely essential to develop and educate “family doctors” in communities and “generalists” in hospitals, and to increase awareness nationally of the presence with the roles and mission. For this purpose, the three colleges agreed to be integrated into the Japan Primary Care Association.

The integrated Japan Primary Care Association (JPCA) consists of members from previous three colleges, namely the Japanese Academy of Primary Care Physicians (PC), Japanese Academy of Family Medicine (FM), and Japanese Society of General Medicine (GM). These had different mission statements and therefore members of each have different focus of interest. The PC consisted of mainly members who practise community primary-care privately as a solo or joint practice, and its members include dentists, pharmacists, nurses as well as doctors. The FM comprised and attracted many young doctors and medical students since the FM aimed to (1) develop the family medicine as a speciality, which covers across all the areas of medicine horizontally in primary-care setting, and (2) educate the ‘specialised family doctors’ who practise the family medicine. The majority of members in the GM were hospital doctors who practice general medicine as a generalist in relatively large hospitals and university hospitals, and the focus was mainly on developing research and educational aspects.

The number of members of these three colleges did not reach 6000 even in total. Therefore, their separated individual activities aiming to appeal the importance of primary-care practice had to be in a small scale and could not manage to formulate a coherent and significant message to the whole nation or to other medical societies in Japan. The present JPCA, in contrast, as an integrated representative organisation of primary-care professionals in Japan, can now express a transparent and impacting message aiming to convey what the primary-care practice and the primary-care physicians should be defined. Personally, I would like to emphasise on the fundamental role of us, primary-care professionals is being with a patient and guiding the patient throughout his or her lifetime health care needs.

As in the rapidly becoming super-aged society, it has been increasingly reported that an elderly patient with multiple problems was confused and could not decide which suggestion he or she can follow first after seeing many different specialists in several hospitals and being prescribed a number of medications separately. In this case, a named primary-care physician or hospital generalist for the patient can be a first contact who can treat patient holistically and prioritise the complex problems so as to become a bridge and facilitator between the different specialists’ cares. It has also been widely suggested in Japan that health care systems in most of rural areas experience their crisis. The expectation of patients becomes exceeding the reality and current health care service has not been able to meet the need of the patients in the local communities due to lack of resources. Also there are some identified problems to be addressed in the health care professionals side. In recent development of Japanese medical system, too much emphasis was given on advancing sub-specialisations and training their specialised doctors. This resulted in the situation where diversities in skills and knowledge between specialities broadened and one doctor who is specialised in a certain area cannot fill the gaps between them. This makes the delivery of quality service difficult in a rural area even in a core hospital in the region unless there is a doctor who can practise wide range of the fields, e.g. paediatrics and obstetrics & gynaecology as well as general medicine.

The new JPCA has been working on this current challenging situations and started creating an integrated speciality of the primary-care field with its accreditation system. This area of expertise should become the third category of the fields, i.e. Medicine, Surgery and Primary-care should be recognised as the three interdependent areas of expertise.

Previously, in line with the above plan, the three colleges have worked on their own accreditation systems. The PC had set up its accreditation system for primary-care professionals since 1993, and conducted the first accreditation examination for doctors in 2001, and also started its accreditation system for primary-care pharmacists recently. The FM had developed a postgraduate senior training programme to become a qualified “family doctor.” Its accreditation examination started from 2009. The GM also had been preparing its own accreditation programmes. Now that the JPCA has inaugurated as a single organisation encompassing these systems. An integrated accreditation system with a single coherent process needs to be set up urgently. In my personal opinion, the accreditation process should have two stages, e.g. one can firstly become a (pre-)registered member and then a specialised faculty and the assessments of these should preferably to be performed by the third party organisation in order for our association to gain the credibility and reliability from the nation.

The name of this JPCA was agreed after a long discussion amongst the three colleges. The key to develop our association successfully depends on how much and how well the significance of primary-care practice and professionals can be understood and acknowledged by the nation. We may need to continue discussing about the name of our association in order for the nation to understand our mission and practice more. Here, I would like to ask every member to share your wisdom and endeavours for creating the quality foundation of our health care system, i.e. the primary-care system in Japan.

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