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.
Acad Med. 2019 Aug;94(8):1244-1252. doi: 10.1097/ACM.0000000000002688.
To show the practice location of graduates from two Japanese programs recruiting 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.
A nationwide cohort study was conducted for three groups of participants graduating between 2014 and 2016: quota graduates without scholarship (quota alone), nonquota 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 with data for other physicians in the census. Comparisons were conducted with Mann-Whitney and chi-square tests.
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.
The regional quota and prefecture scholarship programs succeeded in producing physicians who practiced in rural areas of Japan.
展示两所招收医师到农村地区的日本项目的毕业生的执业地点：医学院的区域配额项目和县级奖学金项目（县是行政地理分区）。每个项目的毕业生都必须在指定的农村县工作一定期限。
对 2014 年至 2016 年毕业的三组参与者（无奖学金配额毕业生、有奖学金非配额毕业生和有奖学金配额毕业生）进行了全国性的队列研究。通过医学院或县政府向每个潜在的对象发送了一份问卷，以收集基线个人数据，包括原籍县和毕业年份。通过医师识别号将数据与厚生劳动省 2016 年医师普查数据进行了连接，以确定对象的执业地点，并与普查中其他医师的数据进行了比较。使用 Mann-Whitney 和卡方检验进行了比较。
仅配额（244 名中有 185 名，75.8%）、奖学金（363 名中有 305 名，84.0%）和配额与奖学金（384 名中有 341 名，88.8%）的医师在非大都市自治市工作的比例显著高于其他医师（22906 名中有 13299 名，58.1%）。仅配额（每平方公里 1042.4 人）、奖学金（613.5）和配额与奖学金（547.4）的参与者工作的自治市的人口密度中位数明显低于其他医师（3214.0）。这些差异随着毕业后的年限而增加。
区域配额和县级奖学金计划成功地培养了在日本农村地区执业的医师。
