Policy implications of a financial incentive programme to retain a physician workforce in underserved Japanese rural areas

After-service effects of a financial incentive programme for return of service in underserved areas: implications for policies to retain a physician workforce in rural areas

Matsumoto Masatoshi

Inoue Kazuo

Kajii Eiji

Social Science and Medicine

Existing evidence supports the effectiveness of financial incentive policy for medical students and early-career physicians in return for obligatory rural service. But whether the experience of contractual rural service affects the physician’s choice of practice location after the service is completed is unknown. This study analysed practice location of Jichi Medical University (JMU) graduates. JMU is a Japanese medical education programme with a contract system under which all the graduates have the obligation to serve in underserved areas for about six years in exchange for having 6-year undergraduate tuition waived. 484 JMU graduates who were under rural service in 2000 and had completed the service by 2006 were enrolled. Rurality of communities was determined by population density quintiles. The proportion of those practicing in the communities of highest rurality quintile in 2000 (30.8%) decreased dramatically (8.7%) in 2006, but the geographic distribution of the participants after contract was still biased toward rural areas compared with the distribution pattern of all Japanese physicians. The flow of participants from rural to urban was almost unidirectional. 452 (93.4%) in 2006 practiced in places with the same or lower rurality, while only 32 (6.6%) practiced in places with higher rurality as compared to the placements of 2000. Multivariate analysis showed that service experience in the communities of the first and second highest quintiles of rurality was associated with choosing such places even after contract (odds ratio 4.65; 95% confidence interval 2.37-9.13), independently of known predictors of rural practice, such as having rural background (2.85; 1.58-5.17) and primary care specialty choice (3.13; 1.43-6.87). Although the effect of contractual rural service substantially decreased after finishing the service, the experience of rural service early in the physician’s career has a positive impact on the later choice of rural practice, supporting a policy that attracts early-career physicians to rural areas.

physicians

medically underserved areas

rural health service

medical education

health policy

eng

Elsevier

© 2010. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/

This is not the published version. Please cite only the published version. この論文は出版社版でありません。引用の際には出版社版をご確認、ご利用ください。

[ISSN] 0277-9536

[DOI] 10.1016/j.socscimed.2010.05.006

[PMID] 20542362

[DOI] https://doi.org/10.1016/j.socscimed.2010.05.006