JMA journal · 2026
A Contract-based System for Physician Practice in Their Home Region in Japan: Follow-up Data of Graduates from Jichi Medical University (1978-2021).
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Watanabe Jun, Matsubara Daisuke, Nakamura Akihisa, Kotani Kazuhiko
Аннотация
INTRODUCTION: Jichi Medical University (JMU) was founded in Japan in 1972 to provide tuition-free medical education in exchange for a nine-year service commitment in graduates' home prefectures, with the mission of training physicians for rural practice. The long-term outcomes of this model remain incompletely characterized. We aimed to examine the long-term outcomes of JMU graduates.
METHODS: This descriptive, retrospective, repeated cross-sectional study followed JMU graduates from 1978 onward, with assessments in 2011, 2016, and 2021. The primary outcome was the proportion of graduates practicing in their home prefecture. Secondary outcomes were the proportions practicing in medically underserved areas, defined as municipalities designated as physician-shortage areas, and in primary care-related specialties (defined as internal medicine, surgery, pediatrics, community/rural/general medicine). Outcomes were reported separately for the during-obligation and post-obligation periods; for secondary outcomes, the during-obligation period excluded residency (postgraduate years 1-2 training). Proportions are reported with Wilson score 95% confidence intervals (CIs).
RESULTS: Among 4,610 graduates, we analyzed data from 4,534 individuals, of whom 19.0% were women. The proportion practicing in the home prefecture during the obligation period was 97.2% (4,408/4,534; 95% CI, 96.7-97.7) for up to nine years after graduation. In 2021, after the obligation period, the proportion currently practicing in the home prefecture was 71.0% (2,493/3,511; 95% CI, 69.5-72.5). The proportion of graduates practicing in medically underserved areas was 24.8% (195/787; 95% CI, 21.9-27.9) during the obligation period and 12.1% (426/3,511; 95% CI, 11.1-13.3) after the obligation period. The proportion of respondents reporting primary care-related specialties was 78.5% during the obligation period and 62.0% after the obligation period.
CONCLUSIONS: The proportions of JMU graduates practicing in their home prefecture and in medically underserved areas remained stable across survey years. Additionally, JMU graduates appeared to work largely in primary care-related specialties.
METHODS: This descriptive, retrospective, repeated cross-sectional study followed JMU graduates from 1978 onward, with assessments in 2011, 2016, and 2021. The primary outcome was the proportion of graduates practicing in their home prefecture. Secondary outcomes were the proportions practicing in medically underserved areas, defined as municipalities designated as physician-shortage areas, and in primary care-related specialties (defined as internal medicine, surgery, pediatrics, community/rural/general medicine). Outcomes were reported separately for the during-obligation and post-obligation periods; for secondary outcomes, the during-obligation period excluded residency (postgraduate years 1-2 training). Proportions are reported with Wilson score 95% confidence intervals (CIs).
RESULTS: Among 4,610 graduates, we analyzed data from 4,534 individuals, of whom 19.0% were women. The proportion practicing in the home prefecture during the obligation period was 97.2% (4,408/4,534; 95% CI, 96.7-97.7) for up to nine years after graduation. In 2021, after the obligation period, the proportion currently practicing in the home prefecture was 71.0% (2,493/3,511; 95% CI, 69.5-72.5). The proportion of graduates practicing in medically underserved areas was 24.8% (195/787; 95% CI, 21.9-27.9) during the obligation period and 12.1% (426/3,511; 95% CI, 11.1-13.3) after the obligation period. The proportion of respondents reporting primary care-related specialties was 78.5% during the obligation period and 62.0% after the obligation period.
CONCLUSIONS: The proportions of JMU graduates practicing in their home prefecture and in medically underserved areas remained stable across survey years. Additionally, JMU graduates appeared to work largely in primary care-related specialties.