BMJ Open
Volume 9, Issue 7, 2019

Emigration of regional quota graduates of Japanese medical schools to non-designated prefectures: A prospective nationwide cohort study (Article) (Open Access)

Yoshida S.* , Matsumoto M. , Kashima S. , Owaki T. , Iguchi S. , Inoue K. , Tazuma S. , Maeda T.
  • a Department of Community-Based Medical System, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
  • b Department of Community-Based Medical System, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
  • c Environmental Health Sciences Laboratory, Department of Development Technology, Graduate School for International Development and Cooperation, Hiroshima University, Higashi-Hiroshima, Japan
  • d Education Center for Doctors in Remote Islands and Rural Areas, Graduate School of Medical Sciences, Kagoshima University, Kagoshima, Japan
  • e Department of Community Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
  • f Department of Community Medicine, Chiba Medical Center, Teikyo University School of Medicine, Chiba, Japan
  • g Department of General Internal Medicine, Hiroshima University Hospital, Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
  • h Department of Island Community Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan

Abstract

Objectives: This study examined the retention of regional quota graduates of Japanese medical schools and prefecture scholarship recipients within their designated prefectures where they are obliged or expected to work and revealed the personal and regional characteristics associated with their emigration to non-designated prefectures. Regional quota and prefecture scholarship are two of the most ambitious policies ever conducted in Japan for recruiting physicians to practice in rural areas. Design: Prospective cohort study. Setting: Nationwide. Participants: Regional quota graduates with prefecture scholarship, quota graduates without scholarship and non-quota graduates with scholarship of Japanese medical schools who obtained their physician license between 2014 and 2016. Primary outcome: The emigration in 2016 of the participants from the designated prefectures. Results: Total participants were 991 physicians, three of whom were excluded due to the missing values of crucial items, leaving 988 participants for analysis (quota with scholarship 387, quota alone 358 and scholarship alone 243). The percentage of those who emigrated was 11.9% (118/988). The mean (±SD) proportion of subjects who emigrated was 11.7% (±10.3) among all prefectures and the proportion varies widely among prefectures (0%-44.4%). Multilevel logistic regression analysis showed those who received prefecture scholarship (OR 0.23; 95% CI 0.08 to 0.67) and whose designated prefecture has an ordinance-designated city (ie, large city) were less likely to emigrate (OR 0.47; 95% CI 0.24 to 0.90). In contrast, graduates from a medical school outside the designated prefecture (OR 4.20; 95% CI 2.20 to 7.67) and who have a right to postpone their obligatory service (OR 3.42; 95% CI 1.52 to 7.67) were more likely to emigrate. Conclusions: A substantial proportion of regional quota graduates and prefecture scholarship recipients emigrated to non-designated prefectures. Emigrations should be reduced by improving the potential facilitators for emigration such as discordance in location between medical school and designated prefecture. © 2019 Author(s).

Author Keywords

Japan geography health policy Physician

Index Keywords

prospective study rural area multicenter study health care policy human recipient geography male Japan female Article major clinical study adult human experiment physician outcome assessment cohort analysis licence medical school
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85070399613&doi=10.1136%2fbmjopen-2019-029335&partnerID=40&md5=8a03cde1d06c75b5c19741def3a1a695
DOI: 10.1136/bmjopen-2019-029335
ISSN: 20446055
Original Language: English