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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

Distribution of retention rates in the additional analyses. Retention rates are the proportion of medical school graduates practicing in the prefecture of the medical school or neighboring prefectures. Retention rates are sorted according to rank
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Fig4: Distribution of retention rates in the additional analyses. Retention rates are the proportion of medical school graduates practicing in the prefecture of the medical school or neighboring prefectures. Retention rates are sorted according to rank

Mentions: Additional analyses of the secondary outcome, in which the definition of retention was broadened from practicing within the prefecture of the medical school to practicing within the prefecture of the medical school or neighboring prefectures, showed almost identical trends to those observed in the primary outcome (Figs. 4 and 5). However, physicians who graduated from private medical schools did not show a statistically significant tendency to practice beyond the borders of neighboring prefectures relative to those who graduated from public schools (adjusted OR: 0.85; 95 % CI: 0.66–1.08; Table 3). In contrast, physicians who graduated from post-1970 schools were more likely to practice beyond the borders of neighboring prefectures relative to those who graduated from pre-1970 schools (adjusted OR: 0.63; 95 % CI: 0.51 to 0.79; Table 3).Fig. 4


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)

Distribution of retention rates in the additional analyses. Retention rates are the proportion of medical school graduates practicing in the prefecture of the medical school or neighboring prefectures. Retention rates are sorted according to rank
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig4: Distribution of retention rates in the additional analyses. Retention rates are the proportion of medical school graduates practicing in the prefecture of the medical school or neighboring prefectures. Retention rates are sorted according to rank
Mentions: Additional analyses of the secondary outcome, in which the definition of retention was broadened from practicing within the prefecture of the medical school to practicing within the prefecture of the medical school or neighboring prefectures, showed almost identical trends to those observed in the primary outcome (Figs. 4 and 5). However, physicians who graduated from private medical schools did not show a statistically significant tendency to practice beyond the borders of neighboring prefectures relative to those who graduated from public schools (adjusted OR: 0.85; 95 % CI: 0.66–1.08; Table 3). In contrast, physicians who graduated from post-1970 schools were more likely to practice beyond the borders of neighboring prefectures relative to those who graduated from pre-1970 schools (adjusted OR: 0.63; 95 % CI: 0.51 to 0.79; Table 3).Fig. 4

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