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Geographic Distribution of Regional Quota Program Graduates of Japanese Medical Schools

A Nationwide Cohort Study

Matsumoto, Masatoshi, MSc, MD, PhD; Kashima, Saori, MEnvSc, PhD; Owaki, Tetsuhiro, MD, PhD; Iguchi, Seitaro, MD, PhD; Inoue, Kazuo, MD, PhD; Tazuma, Susumu, MD, PhD; Maeda, Takahiro, MD, PhD

doi: 10.1097/ACM.0000000000002688
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Purpose: To show practice location of graduates from two Japanese programs to recruit physicians to rural areas: a regional quota program of medical schools and a prefecture scholarship program (a prefecture is an administrative geographic division). Graduates of each program must work in a designated rural prefecture for a fixed period.

Method: A nationwide cohort study was conducted for three groups of participants graduating between 2014 and 2016: quota graduates without scholarship (quota alone), non-quota graduates with scholarship (scholarship alone), and quota graduates with scholarship. A questionnaire was sent via medical school or prefecture office to each potential subject to collect baseline individual data, including home prefecture and graduation year. Data were connected through physician identification number to the Physician Census 2016 of the Ministry of Health, Labour and Welfare to identify the subjects’ practice location and compared to data for other physicians in the census. Comparisons were conducted with Mann-Whitney and chi-square tests.

Results: The proportion of physicians working in nonmetropolitan municipalities for quota alone (185/244; 75.8%), scholarship alone (305/363; 84.0%), and quota with scholarship (341/384; 88.8%) was significantly higher than for other physicians (13,299/22,906; 58.1%). Median population density of the municipalities where subjects worked for quota alone (1,042.4 persons per square kilometer), scholarship alone (613.5), and quota with scholarship (547.4) was significantly lower than that for other physicians (3,214.0). These disparities increased with number of years since graduation.

Conclusions: The regional quota and prefecture scholarship programs succeeded in producing physicians who practiced in rural areas of Japan.

M. Matsumoto is professor, Department of Community-Based Medical System, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; ORCID: http://orcid.org/0000-0002-8341-9303.

S. Kashima is assistant professor, Department of Public Health and Health Policy, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.

T. Owaki is professor, Education Center for Doctors in Remote Islands and Rural Areas, Graduate School of Medical Sciences, Kagoshima University, Kagoshima, Japan.

S. Iguchi is professor, Department of Community Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.

K. Inoue is professor, Department of Community Medicine, Chiba Medical Center, Teikyo University School of Medicine, Chiba, Japan.

S. Tazuma is professor, Department of General Internal Medicine, Hiroshima University Hospital and Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.

T. Maeda is professor, Department of Community Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan.

Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A647.

Funding/Support: This study was funded by the Japanese Ministry of Education, Culture, Sports, Science and Technology KAKENHI Grant-in-Aid for Scientific Research (C), Grant Number (25460803) and (18K10084).

Other disclosures: None reported.

Ethical approval: Ethical approval was granted by the Ethics Committee for Epidemiological Research of Hiroshima University (ref. no. 778) and the Research Ethics Committee of Nagasaki University Graduate School of Biomedical Sciences (ref. no. 13091342).

Correspondence should be addressed to Masatoshi Matsumoto, Department of Community-Based Medical System, Graduate School of Biomedical and Health Sciences, Hiroshima University. 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 Japan; telephone: 81-82-257-5894; email: matmo10@hiroshima-u.ac.jp.

© 2019 by the Association of American Medical Colleges