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

Health Policy. 2009 May;90(2-3):125-32. doi: 10.1016/j.healthpol.2008.09.004. Epub 2008 Oct 21.


Objectives: National or local governmental scholarship programs for medical students with a period of contractual obligation to serve in rural areas are a possible solution to the shortage of rural physicians in many countries. This study reports the outcomes of Jichi Medical University (JMU), one such program, and assesses which personal and familial factors of its graduates have positive impacts on their fulfillment of rural obligation.

Methods: JMU has a unique contract system under which all the graduates have the obligation to work in rural areas in exchange for having their undergraduate tuition waived. In this retrospective cohort study, personal, familial, and academic information of 2988 JMU students who graduated between 1978 and 2006 was collected on admission and graduation, and follow-up information on contract fulfillment status was collected every year after graduation.

Results: Overall 97% of JMU graduates have completed or are completing their contracts. Graduates who complied with the rural obligation were more likely to have attended public high schools, specialize in primary care, and have had shorter careers than those who broke the contract. The graduates who broke their contracts had mothers with higher academic background than compliers did.

Conclusions: JMU attained a high rate of obligation compliance. Familial background of entrants and primary care specialty of graduates may be key factors to the contract compliance.

MeSH terms

  • Contracts*
  • Education, Medical*
  • Female
  • Humans
  • Japan
  • Male
  • Retrospective Studies
  • Rural Health Services*
  • Schools, Medical
  • Social Responsibility*
  • Students, Medical / statistics & numerical data*
  • Workforce