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Emigration of regional quota graduates of Japanese medical schools to non-designated prefectures: a prospective nationwide cohort study
  1. Shuhei Yoshida1,
  2. Masatoshi Matsumoto1,
  3. Saori Kashima2,
  4. Tetsuhiro Owaki3,
  5. Seitaro Iguchi4,
  6. Kazuo Inoue5,
  7. Susumu Tazuma6,
  8. Takahiro Maeda7
  1. 1 Department of Community-Based Medical System, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
  2. 2 Environmental Health Sciences Laboratory, Department of Development Technology, Graduate School for International Development and Cooperation, Hiroshima University, Higashi-Hiroshima, Japan
  3. 3 Education Center for Doctors in Remote Islands and Rural Areas, Graduate School of Medical Sciences, Kagoshima University, Kagoshima, Japan
  4. 4 Department of Community Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
  5. 5 Department of Community Medicine, Chiba Medical Center, Teikyo University School of Medicine, Chiba, Japan
  6. 6 Department of General Internal Medicine, Hiroshima University Hospital and Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
  7. 7 Department of Island Community Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
  1. Correspondence to Dr Shuhei Yoshida; yoshida.shuhei.0810{at}


Objectives This 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.

Design Prospective cohort study.

Setting Nationwide.

Participants Regional 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 outcome The emigration in 2016 of the participants from the designated prefectures.

Results Total 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.

Conclusions A 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.

  • health policy
  • Japan
  • geography
  • physician

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  • Contributors SY contributed to analysis and interpretation of data and writing of the draft. MM contributed to the study design, tools, study administration, data collection, analysis and interpretation of data and writing of the draft. TM contributed to the study design, tools, study administration and writing of the draft. SK contributed to the data analysis, data interpretation and writing of the draft. KI, TO, SI and ST contributed to the study design, data collection and writing of the draft.

  • Funding This study is funded by the Ministry of Education, Culture, Sports, Science and Technology KAKENHI Grant-in-Aid for Scientific Research (C), grant number (18K10084) and by the Satake Fund. This study was also funded by the Pfizer Health Research Foundation.

  • Competing interests None declared.

  • Ethics approval Ethical approval was granted by the Ethics Committee for Epidemiological Research of Hiroshima University (reference number 778) and the Research Ethics Committee of Nagasaki University Graduate School of Biomedical Sciences (reference number 13091342).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The titles of all relevant data sets in this study are described in the manuscript. Conditions of the ethical approvals permit the cohort office (Department of Community-Based Medical System, Institute of Biomedical and Health Sciences, Hiroshima University) and the sub office (Department of Community Medicine, Nagasaki University Graduate School of Biomedical Science) to share the original cohort data. Aggregated data are shared with stakeholders or other researchers.The data from the Survey of Physicians, Dentists and Pharmacists are third party data and are available from the Ministry of Health, Labour and Welfare ( for researchers whose study purposes and methodologies meet its criteria fo raccess to confidential data. The Ministry prohibits the researchers to open the data set to any other individual or party.

  • Patient consent for publication Not required.

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