Abstract
BackgroundPhysician maldistribution is an ongoing concern globally. The extent of medical schools retaining graduates within their geographical areas has rarely been explored in Japan or in other countries. This study aimed to investigate whether the proportion of medical school graduates practicing in the vicinity of medical school (retention rate) differs by the year of the school’s establishment and by the school’s funding source.MethodsThis cross-sectional study used a set of databases on medical institutions and personnel. We analyzed a sample of 168,594 clinically active physicians practicing in institutions as of May 2014, who passed the National Medical Practitioners Examination between 1985 and 2013. We assessed the retention rate and the schools’ establishment period and funding source (pre-1970/post-1970, private/public), using a hierarchical regression model with random intercept unique to each medical school. We used the following factors as covariates: gender, physicians’ length of professional experience, and the geographical features of the medical schools.ResultsThe retention rate was widely distributed from 16.2 to 81.5 % (median: 48.4 %). Physicians who graduated from post-1970 medical schools were less likely to practice in the prefecture of their medical school location, relative to those who graduated from pre-1970 medical schools (adjusted odds ratio: 0.75; 95 % confidence interval: 0.62–0.90). Physicians who graduated from private medical schools were also less likely to practice in the prefecture of their medical school location, relative to those who graduated from public medical schools (adjusted odds ratio: 0.63; 95 % confidence interval: 0.51–0.77). In addition, the ability to retain graduates varied by school according to the school’s characteristics.ConclusionsThere was a considerable difference between medical schools in retaining graduates locally. The study results may have significant implications for government policy to alleviate maldistribution of physicians in Japan.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-1240-2) contains supplementary material, which is available to authorized users.
Highlights
Physician maldistribution is an ongoing concern globally
Physicians who graduated from private medical schools were more likely to be in private practice relative to public medical school graduates
Physicians who graduated from post-1970 medical schools were less likely to practice in the prefecture of their medical school relative to those who graduated from pre-1970 medical schools
Summary
The extent of medical schools retaining graduates within their geographical areas has rarely been explored in Japan or in other countries. In Japan, 34 new medical schools were established during the 1970s and early 1980s, with the intention of building at least one medical school in each prefecture to tackle the issue of physician shortage and maldistribution. Physicians have been steadily supplied, but with different increase rates by area; the growth rate of Kamitani et al BMC Health Services Research (2015) 15:581 medical doctors from 1986 to 2010 by prefecture was 145.5 % on average, and the rate varied geographically from 129.7 to 205.9 % [11]. As Additional file 1: Table S1 shows, even though the number of physicians increased in total, geographical maldistribution has persisted and still remains an issue [4, 6, 12,13,14]. A postgraduate residency training program implemented in 2004, which permitted medical graduates to choose their preferred residency setting through a national matching system, is considered to have accelerated the physician maldistribution [15, 16]
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