In Japan, the shortage of hospital-based specialists has become so acute that it regularly makes headlines. Newspaper reports have described women giving birth in taxis after being shuttled from hospital to hospital because
no obstetricians were available. A root cause of the shortage is the fact that specialists earn markedly less than their colleagues in primary care do. In Japan, the government imposes heavy restrictions on hospital reimbursements, which limits the salaries paid to specialists,
who are hospital employees. As a result, many specialists switch to primary care, where
there are fewer restrictions and potential earn- ings are much higher.