Abstract
BackgroundJapan has established comprehensive education-scholarship programs to supply physicians in rural areas. Their entrants now comprise 16% of all medical students, and graduates must work in rural areas for a designated number of years. These programs are now being adopted outside Japan, but their medium-term outcomes and inter-program differences are unknown.MethodsA nationwide prospective cohort study of newly licensed physicians 2014–2018 (n = 2454) of the four major types of the programs—Jichi Medical University (Jichi); regional quota with scholarship; non-quota with scholarship (scholarship alone); and quota without scholarship (quota alone)—and all Japanese physicians in the same postgraduate year (n = 40,293) was conducted with follow-up workplace information from the Physician Census 2018, Ministry of Health, Labour and Welfare. In addition, annual cross-sectional survey for prefectural governments and medical schools 2014–2019 was conducted to obtain information on the results of National Physician License Examination and retention status for contractual workforce.ResultsPassing rate of the National Physician License Examination was highest in Jichi, followed in descending order by quota with scholarship, the other two programs, and all medical graduates. The retention rate for contractual rural service of Jichi graduates 5 years after graduation (n = 683; 98%) was higher than that of quota with scholarship (2868; 90%; P < 0.001) and scholarship alone (2220; 81% < 0.001). Relative risks of working in municipalities with the least population density quintile in Jichi, quota with scholarship, scholarship alone, and quota alone in postgraduate year 5 were 4.0 (95% CI 3.7–4.4; P < 0.001), 3.1 (2.6–3.7; < 0.001), 2.5 (2.1–3.0; < 0.001), and 2.5 (1.9–3.3; < 0.001) as compared with all Japanese physicians. There was no significant difference between each program and all physicians in the proportion of those who specialized in internal medicine or general practice in postgraduate years 3 to 5ConclusionsJapan’s education policies to produce rural physicians are effective but the degree of effectiveness varies among the programs. Policymakers and medical educators should plan their future rural workforce policies with reference to the effectiveness and variations of these programs.
Highlights
Japan has established comprehensive education-scholarship programs to supply physicians in rural areas
We calculated the proportion of those who specialized in internal medicine or general practice, which are Japan’s two major primary care specialities
Data for 483, 595, and 817 participants were subject to longitudinal analysis
Summary
Japan has established comprehensive education-scholarship programs to supply physicians in rural areas. Their entrants comprise 16% of all medical students, and graduates must work in rural areas for a designated number of years. The Japanese government has spent years formulating policies to increase and secure the number of physicians in rural areas. A typical example of the former is the "one prefecture one medical school" policy of the 1970s and 1980s, which has nearly doubled the total number of medical schools, and rapidly increased the number of physicians Representative of the latter is Jichi Medical University (Jichi), a special medical school founded in 1972 to produce rural physicians [3,4,5]. The regional quota and Jichi have been reported as a Japanese original policy for recruiting and retaining a rural health workforce [3, 15]
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