The emigration of regional quota graduates of Japanese medical schools to non-designated prefectures: a prospective nationwide cohort study.
The emigration of regional quota graduates of Japanese medical schools to non-designated prefectures: a prospective nationwide cohort study.
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日本医学院地区配额毕业生向非指定县的移民：一项前瞻性全国队列研究。
DOI：
10.1136/bmjopen-2019-029335
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发表时间：
2019
期刊：
影响因子：
2.9
通讯作者：
Maeda T.
中科院分区：
文献类型：
--
作者：
Yoshida S;Matsumoto M;Kashima S;Owaki T;Iguchi S;Inoue K;Tazuma S;Maeda T.
本研究调查了日本医学院校的地区配额毕业生和县奖学金获得者在其有义务或期望工作的指定县内的留存情况，揭示了他们移民到非指定县的个人和地区特征。地区配额和县奖学金是日本在招募医生到农村执业方面最雄心勃勃的两项政策。设计前瞻性队列研究。设置全国范围。参与者有县奖学金的地区配额毕业生，没有奖学金的配额毕业生和2014-2016年间获得日本医科学校奖学金的非配额毕业生。主要结果2016年指定县的参与者移民。结果总共有991名医生，其中3名因关键项目缺失而被排除在外，剩下988名参与者进行分析(有配额387人，仅有配额358人，仅有奖学金243人)。移民比例为11.9%(118/988)。各地市移民的平均比例(±SD)为11.7%(±10.3)，各地市差异较大(0%~44.4%)。多水平Logistic回归分析显示，获得地级奖学金(OR 0.23；95%CI为0.08~0.67)和指定地市(即大城市)的移民较少(OR为0.47；95%CI为0.24~0.90)。相反，来自指定地区以外的医学院的毕业生(OR 4.20；95%CI 2.20~7.67)和有权推迟其义务服务(OR 3.42；95%CI 1.52至7.67)的毕业生更有可能移民到非指定地区。应该通过改善潜在的移民促进者来减少移民，例如医学院和指定的县之间的位置不协调。
ObjectivesThis study examined the retention of regional quota graduates of Japanese medical schools and prefecture scholarship recipients within their designated prefectures where they are obliged or expected to work and revealed the personal and regional characteristics associated with their emigration to non-designated prefectures. Regional quota and prefecture scholarship are two of the most ambitious policies ever conducted in Japan for recruiting physicians to practice in rural areas.DesignProspective cohort study.SettingNationwide.ParticipantsRegional quota graduates with prefecture scholarship, quota graduates without scholarship and non-quota graduates with scholarship of Japanese medical schools who obtained their physician license between 2014 and 2016.Primary outcomeThe emigration in 2016 of the participants from the designated prefectures.ResultsTotal participants were 991 physicians, three of whom were excluded due to the missing values of crucial items, leaving 988 participants for analysis (quota with scholarship 387, quota alone 358 and scholarship alone 243). The percentage of those who emigrated was 11.9% (118/988). The mean (±SD) proportion of subjects who emigrated was 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.ConclusionsA substantial proportion of regional quota graduates and prefecture scholarship recipients emigrated to non-designated prefectures. Emigrations should be reduced by improving the potential facilitators for emigration such as discordance in location between medical school and designated prefecture.