Emigration of regional quota graduates of Japanese medical schools to non-designated prefectures: a prospective nationwide cohort study

Objectives This study examined the retention of regional quota graduates of Japanese medical schools and prefecture scholarshiprecipients within their designated prefectures where they are obliged or expected to work and revealed the personal and regional characteristics associated with their emigrationto non-designated prefectures. Regional quota and prefecture scholarshipare 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 scholarshipand non-quota graduates with scholarshipof Japanese medical schools who obtained their physician license between 2014 and 2016. Primary outcome The emigrationin 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 scholarship387, quota alone 358 and scholarshipalone 243). The percentage of those who emigratedwas 11.9% (118/988). The mean (±SD) proportion of subjects who emigratedwas 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 scholarshiprecipients emigratedto non-designated prefectures. Emigrationsshould be reduced by improving the potential facilitators for emigrationsuch as discordance in location between medical school and designated prefecture.