For decades, a chronic shortage of anesthesiologists in Japan has been a serious problem. According to a personal survey conducted from 2002 to 2006 by Koichi Tsuzaki, MD (Associate Professor of Anesthesiology, Keio University School of Medicine, Tokyo Japan), more than one million surgical procedures required general anesthesia while only 6207 qualified anesthe-siologists were available. The annual procedure volume per anesthesiolo-gist ranges from 174 to 209 in Japan (Table 1; these data were obtained from our written communication with Dr Tzuzaki on December 20, 2008). However, anesthesiologist manpower is much less than this. The actual number of surgeries requiring general anesthesia was underestimated by this survey, which did not collect data from all Japanese medical institutions. Moreover, the Japanese Society of Anesthesiologists (JSA) reported that over 30% of general anesthetic practices are provided by surgeons, and not by anesthe-siology specialists.1 While the shortage of surgeons has recently emerged as a critical issue, this crisis jeopardizes the already depleted manpower for anesthetic practice.
In Japan, only medical doctors (MDs) are allowed to administer general, spinal, and epidural anesthesia and nerve blocks. Therefore, it has been suggested that non-MDs should be trained to administer anesthesia. These non-MDs include both nurses and dental anesthetists (dentists who admin-ister general anesthesia in orofacial and dental surgeries).
The Ministry of Health, Labor and Welfare in Japan has proposed the introduction of a nurse anesthetist. Critical debate has been ongoing but the proposal remains controversial.2 The JSA strongly opposes this idea, insisting that anesthesia is a medical practice and has to be performed by well-trained MDs. Moreover, the JSA argues that the lack of governmental resources hinders the establishment of the alternative pathway of educa-ting a registered nurse into becoming a qualified nurse anesthetist because it will necessitate additional manpower and cost. We believe that we have to refuse a system such as that of the Certified Registered Nurse Anesthetists in the United States, where nurse anesthetists can administer anesthesia without supervision by MD anesthesiologists. The Japanese Association of Nursing also disagrees with the idea of nurse anes-thetists. At present, the Ministry of Health, Labor and Welfare in Japan has not introduced the sys-tem to Japan.
In Japan, there are two certification systems issued for anesthesiology. The Board Certified Anes-thesiologist is certified by the JSA while the Reg-istered Anesthetist is certified by the Ministry of Health, Labor and Welfare. In contrast to all other Japanese specialties, whose certification is issued exclusively by their respective medical societies, the Registered Anesthetist system is the only med-ical specialty certification issued by the Japanese government. No specialty other than anesthesiol-ogy has an alternative pathway of registration from the government. Despite this, there is still a lack of certified anesthesiologists throughout Japan and so any board certified MD is allowed to administer anesthesia.
To be a Registered Anesthetist, a physician must be trained under the supervision of Registered Anesthetists for at least 2 years, or has to administer more than 300 general anesthesia procedures. The JSA board certification requires training in anesthe-sia or related areas (intensive care, pain manage-ment, etc.) for at least 4 years and the practitioner must successfully complete the board examination.3
The unique Registered Anesthetist system was started to promote training of anesthetists because,at that time, non-anesthetist physicians caused a number of anesthesia-related accidents.
Now, the Ministry of Health, Labor and Welfare is attempting to deregulate the system of certified anesthesiologists. A system whereby all physicians are allowed to provide general anesthesia without any restrictions may be introduced to Japanese medicine. To counteract this move, the JSA has made suggestions to combat the anesthesiology man-power shortage. The suggestions are: (1) continuous appeals to medical students and trainee doctors to train in anesthesiology; (2) improvement in the working environment for female anesthesiologists with children; (3) making anesthesia practice more organized and reducing working hours.3 It is the opinion of the JSA that practicing anesthesiologists are struggling with the new requirements in an-esthesia practice.