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Differences in medical schools' regional retention of physicians by school type and year of establishment: effect of new schools built under government policy.

Kamitani S, Nakamura F, Itoh M, Sugiyama T, Toyokawa S, Kobayashi Y - BMC Health Serv Res (2015)

Bottom Line: 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).There 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. kamitanis@m.u-tokyo.ac.jp.

ABSTRACT

Background: Physician 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.

Methods: This 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.

Results: The 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.

Conclusions: There 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.

No MeSH data available.


Related in: MedlinePlus

Flow chart for inclusion criteria
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Related In: Results  -  Collection

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Fig1: Flow chart for inclusion criteria

Mentions: We analyzed a sample of 168,594 physicians. Figure 1 depicts the flowchart for sample selection. Table 1 lists subjects’ demographic characteristics, categorized according to the school’s funding mechanism and year of establishment. The numbers of years’ experience were similar across categories. Physicians who graduated from private medical schools were more likely to be in private practice relative to public medical school graduates. Private medical schools, regardless of the year of establishment, tended to be located in prefectures with densely populated cities, unlike public medical schools established post-1970.Fig. 1


Differences in medical schools' regional retention of physicians by school type and year of establishment: effect of new schools built under government policy.

Kamitani S, Nakamura F, Itoh M, Sugiyama T, Toyokawa S, Kobayashi Y - BMC Health Serv Res (2015)

Flow chart for inclusion criteria
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4696324&req=5

Fig1: Flow chart for inclusion criteria
Mentions: We analyzed a sample of 168,594 physicians. Figure 1 depicts the flowchart for sample selection. Table 1 lists subjects’ demographic characteristics, categorized according to the school’s funding mechanism and year of establishment. The numbers of years’ experience were similar across categories. Physicians who graduated from private medical schools were more likely to be in private practice relative to public medical school graduates. Private medical schools, regardless of the year of establishment, tended to be located in prefectures with densely populated cities, unlike public medical schools established post-1970.Fig. 1

Bottom Line: 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).There 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. kamitanis@m.u-tokyo.ac.jp.

ABSTRACT

Background: Physician 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.

Methods: This 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.

Results: The 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.

Conclusions: There 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.

No MeSH data available.


Related in: MedlinePlus