title: A contract-based training system for rural physicians: follow-up of Jichi Medical University graduates (1978-2006).
abstract: BACKGROUND
  The number of studies on long-term effects of rural medical education programs is limited. Personal factors that are associated with long-term retention of physicians in rural areas are scarcely known.
  
  
  OBJECTIVE
  The authors studied the outcomes of Jichi Medical University (JMU), whose mission is to produce rural doctors, and analyzed the characteristics of its graduates who engaged in rural practice even after their 9-year obligation of rural practice.
  
  
  METHODS
  A retrospective cohort study was conducted including 2,988 JMU students who graduated between 1978 and 2006. Baseline data were collected at matriculation and graduation. Workplace addresses were surveyed in 2000, 2004, and 2006. Follow-up rates were 98.7%, 98.2%, and 98.0% respectively.
  
  
  RESULTS
  After their obligation period, JMU graduates were 4 times more likely than non-JMU graduates to work in rural areas. The higher proportion of JMU graduates in rural areas did not change significantly between 1994 and 2004. The rural recruitment rate of post-obligation JMU graduates was somewhat lower than rates reported for top rural medical education programs in the United States. In multivariate analyses, rural upbringing and primary care specialty were positively associated with having a rural address in at least one post-obligation study year (OR 1.89 [95% CI 1.27-2.81]; and 7.63 [4.37-13.34], respectively) and settlement (ie, having a rural address over multiple years) after the contract (1.90 [1.04-3.48]; and 32.07 [4.43-232.24], respectively). Graduation from a private high school had a negative association with recruitment (0.56 [0.33-0.96]).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Community and Family Medicine, Centre for Community Medicine, Jichi Medical University, Tochigi, Japan. matmo10@jb3.so-net.ne.jp
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Matsumoto
authors.forename: Kazuo
authors.initials: K
authors.lastname: Inoue
authors.forename: Eiji
authors.initials: E
authors.lastname: Kajii
mesh_terms: D002321:Career Choice; D015331:Cohort Studies; D016001:Confidence Intervals; D032982:Contracts; D004501:Education, Medical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D008507:Medically Underserved Area; D015999:Multivariate Analysis; D016017:Odds Ratio; D010560:Personnel Selection; D010820:Physicians / Q000191:economics / Q000600:supply & distribution*; D011365:Professional Practice Location / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D019035:Rural Health Services; D012424:Rural Population / Q000706:statistics & numerical data*; D012577:Schools, Medical / Q000458:organization & administration; D000078329:Workforce