Comparing medical school strategies to reduce regional physician shortages: lessons from the United States and Japan.

backgroundRegional maldistribution of physicians remains a global challenge undermining equity in healthcare access. While numerous studies have examined the impact of student recruitment and training strategies on rural retention within single countries, comparative analyses across nations with contrasting systems remain limited. This study aimed to compare student admission policies and educational programs of medical schools in the United States (US) and Japan to address regional disparities in physician distribution and draw implications for countries facing similar challenges.

methodsTen medical schools in the US and Japan were compared. Data were collected from institutional resources, national reports, and peer-reviewed literature, and analysed using Bereday's comparative framework. Implications for adopting strategies were drawn from Phillips and Ochs's educational policy borrowing model.

resultsThe US medical schools employ decentralised, pipeline-based admission strategies that intervene prior to matriculation, while Japanese institutions rely on a nationally led regional quota system with post-graduation service obligations supported by financial incentives. Despite these differences, both countries emphasized the selection of students with regional backgrounds with similar selection criteria and tools. Educational programs in both countries were more convergent in program objectives-cultivating knowledge, skills and attitudes necessary for rural physicians-and community members were actively involved in facilitating learning. However, contextual differences in the community healthcare of each country were reflected in educational contents and US medical schools had more diverse organisational structures for operating programs.

conclusionTargeted recruiting strategies of the medical schools to select prospective physicians for future regional workforce vary according to the degree of centralization of its medical education system in each country. Despite the contextual differences, educational programs to promote students' willingness in regional healthcare commonly focus on providing them with practice-based experiences. Medical schools in the countries facing a similar challenge in their regional physician workforce should consider adopting practices from the US and Japan into their local contexts and internalizing them to ensure selection and training are integrated with each other.