title: Differences in medical schools' regional retention of physicians by school type and year of establishment: effect of new schools built under government policy.
abstract: BACKGROUND
  Physician maldistribution is an ongoing concern globally. The extent of medical schools retaining graduates within their geographical areas has rarely been explored in Japan or in other countries. This study aimed to investigate whether the proportion of medical school graduates practicing in the vicinity of medical school (retention rate) differs by the year of the school's establishment and by the school's funding source.
  
  
  METHODS
  This cross-sectional study used a set of databases on medical institutions and personnel. We analyzed a sample of 168,594 clinically active physicians practicing in institutions as of May 2014, who passed the National Medical Practitioners Examination between 1985 and 2013. We assessed the retention rate and the schools' establishment period and funding source (pre-1970/post-1970, private/public), using a hierarchical regression model with random intercept unique to each medical school. We used the following factors as covariates: gender, physicians' length of professional experience, and the geographical features of the medical schools.
  
  
  RESULTS
  The retention rate was widely distributed from 16.2 to 81.5 % (median: 48.4 %). Physicians who graduated from post-1970 medical schools were less likely to practice in the prefecture of their medical school location, relative to those who graduated from pre-1970 medical schools (adjusted odds ratio: 0.75; 95 % confidence interval: 0.62-0.90). Physicians who graduated from private medical schools were also less likely to practice in the prefecture of their medical school location, relative to those who graduated from public medical schools (adjusted odds ratio: 0.63; 95 % confidence interval: 0.51-0.77). In addition, the ability to retain graduates varied by school according to the school's characteristics.
  
  
  CONCLUSIONS
  There was a considerable difference between medical schools in retaining graduates locally. The study results may have significant implications for government policy to alleviate maldistribution of physicians in Japan.
authors.affiliation: Department of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. kamitanis@m.u-tokyo.ac.jp.
authors.forename: Satoru
authors.initials: S
authors.lastname: Kamitani
authors.affiliation: Department of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. f-naka@m.u-tokyo.ac.jp.
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Nakamura
authors.affiliation: Department of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. mitsu110@m.u-tokyo.ac.jp.|Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan. mitsu110@m.u-tokyo.ac.jp.
authors.forename: Mitsuko
authors.initials: M
authors.lastname: Itoh
authors.affiliation: Department of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. tsugiyama-tky@umin.ac.jp.|Department of Clinical Study and Informatics, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan. tsugiyama-tky@umin.ac.jp.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Sugiyama
authors.affiliation: Department of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. toyokawa@m.u-tokyo.ac.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Toyokawa
authors.affiliation: Department of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. yasukik@m.u-tokyo.ac.jp.
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Kobayashi
mesh_terms: D002983:Clinical Competence / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D006076:Government; D006801:Humans; D007564:Japan; D008297:Male; D010563:Personnel Turnover; D010820:Physicians / Q000600:supply & distribution*; D017149:Private Sector; D017150:Public Sector; D012577:Schools, Medical; D013997:Time Factors; D000078329:Workforce