OBJECTIVES

: In many developed countries, the academic requirement for the entrance exam in medical universities has increasingly escalated because more and more students want to become physicians. However young physicians who passed very difficult entrance exam may not choose to become physicians in rural and remote area. This paper examines how rapid increase in the admissions magnification in medical universities in Japan affects the career choices among the graduates.

METHODS

: Census data of physicians as of 2017 are matched with the deviation score in entrance exam in the graduating medical universities. After adjusting the fixed effects for graduating medical universities, I evaluate the effects of the deviation score in the entrance exam on physicians' later career choice. Characteristics of the physicians’ practice location are measured as the population density in the cities where each physician works.

RESULTS

: The number of physicians included in the analysis is 248,564 which covers 83 percent of all physicians in Japan. The ordinary least square regressions which control for fixed effects from graduating medical university finds that increasing deviation score in the entrance exam is positively associated with urbanity in the physicians’ practice location as of 2017, suggesting that medical students who graduated from high rank medical university do not choose rural area as their practice location.

CONCLUSIONS

: While physicians have become more and more popular jobs and difficulties in the entrance exam also have been escalated in Japan, these trends may increase geographical mal-distribution in physicians in the long run. Policy makers should take more advanced strategies to counteract them in order to alleviate the concentration of physicians into urban area.