A Contract‐Based Training System for Rural Physicians: Follow‐Up of Jichi Medical University Graduates (1978‐2006)

Abstract

JMU was successful in increasing the number and retention of rural physicians. Rural origin and primary care specialty have a positive impact on both recruitment and retention after the rural obligation.

Medical education program with obligatory rural service: Analysis of factors associated with obligation compliance

“…mother's high educational background and private high school) predict contract breach among JMU graduates support this assertion. It is further supported by results of our previous study that rural origin and primary care, not familial or financial factors, predict continuing rural practice after 9-year contractual obligation among JMU graduates [19]. Factors associated with after-duty rural practice are exactly the same as factors predicting rural practice among graduates of non-obligatory programs.…”

“…Some non-binding programs in U.S. such as the Physician Shortage Area Program (PSAP) of Jefferson Medical College and Rural Physicians Associate Program (RPAP) at the University of Minnesota Medical School have been reported to increase the number of rural physicians [35,37,43]. The proportions of graduates who practice in a county with fewer than 50,000 residents were reportedly 76% in PSAP and 79% in RPAP [44], which are comparable to the recruitment rates of JMU graduates in a municipality of the same population size: 85% for those under duty and 50% for those after duty [19]. Rabinowitz et al reported that, among variables of PSAP graduates, rural origin was independently predictive of rural primary care [45].…”

“…More than 90% of JMU graduates completed the contract, and almost all of them returned their home prefectures during the contract [17,18]. JMU graduates were 3-13 times more (under contract) and 2-5 times more (after contract) likely to work in rural areas than non-JMU Japanese physicians (the values fluctuate depending on the rural definition) [18,19]. Of all JMU graduates after contract, 69.8% settled in their home prefectures after the obligation periods.…”

Context counts: training health workers in and for rural and remote areas

“…6,20,21 In response to the shortage of rural doctors, various medical schools across the world have developed innovative approaches to producing doctors with the knowledge, skills and commitment to practice in underserved, rural and remote regions. [22][23][24][25] In general, evaluation of rural clinical placements has demonstrated that the rural setting provides a high-quality clinical learning environment that is of potential value to all medical students. 26 Specifically, rural clinical education provides more "hands on" experience for students such that they are exposed to a wide range of common health problems and develop greater procedural competence.…”

Characteristics of medical students who would like to be a generalist physician and contribute to remote area medicine

“…On the other hand, specialists have the specialized clinical abilities in a certain medical department (2). Therefore, generalists have been generally believed to have more important role than specialists in remote area because they have the greatest potential to redress the geographic imbalance of physicians (3). However, the number of specialists have been recently increased due to medical progress and subdivision in Japan (4).…”