'Japanese model of med school enrollment, regional quota system might be a lesson for Korea'

As the government and the medical community debate the increase in medical school enrollment quota, it has been suggested that Korea should learn from Japan, which increased medical school students and operates a regional quota system to solve the problem of regional medical disparities ahead of Korea.

The National Assembly Library recently released a report titled "Japan’s increasing medical school enrollment quota and regional quota system.”

"As Korea is in the midst of a sharp confrontation over the issue of increasing the number of doctors and regional medical disparities, it is necessary to take a closer look at the changing trend of medical school enrollment and the status of the regional quota system in Japan,” the report said.

According to the report, Japan has expanded medical school enrollment since 2006, focusing on municipalities with severe physician shortages. To secure local physicians, the number of medical school students increased from 7,625 to 7,793 in 2008, 8,469 in 2009, and 9,420 after 2010.

However, the number of medical school students in 2024 is 9,420, below the peak of 9,403 in 2019.

The Subcommittee on Physician Supply and Demand, which is part of the Review Committee on the Supply and Demand of Healthcare Workers within the Ministry of Health, Labor and Welfare, said, "Considering the estimate of physician supply and demand combined with reforms to physicians' working styles, the supply and demand will be balanced around 2029, after which the demand for physicians will enter a declining phase due to population decline, so it is necessary to reconsider the pace of physician growth in the future."

The library report also noted that Korea should take note of Japan's solution for addressing regional medical imbalance.

Japan officially introduced a regional quota system for medical schools in 2008 to increase enrollment in areas with severe shortages and address the shortage of doctors and regional medical disparities.

Last year, 71 of the 80 medical schools in Japan introduced and operated the regional quota system. The number of students selected through the regional quota system was 1,770, accounting for 19.1 percent of the total medical school admissions.

While the number of students admitted under the program varies by university and prefecture and the number of recruiters, mandatory work organizations, and obligations, the program has this in common: students receive a loan scholarship for the first six years of medical school. They are exempt from repaying the loan if they work as a designated worker in the local government for nine years, 1.5 times the amount of the loan period.

According to the report, the Japanese government explained that the regional quota system has contributed to the shortage of doctors but acknowledged its limitations. For instance, medical schools that adopted the regional quota system early are considering measures to deal with the exodus of students and physicians to other regions earlier than the set period.

According to a survey conducted by the Ministry of Health, Labor and Welfare from 2019 to 2020, 450, or 4.6 percent of 9,707 students selected through the regional quota system, left for other regions.

"While the regional quota system has some effect on the settlement of doctors in each prefecture, it is unclear how many doctors will remain in vulnerable areas after the mandatory period ends," the report said. "As Korea is discussing the expansion of medical students to prevent the collapse of regional and essential medicine, it is necessary to consider various flexible aspects of the Japanese regional quota system."

The report continued, “Japan's regional quota system provides various supports and options, including the recognition of the mandatory service period and conversion of student loans in the event of non-compliance, so it is worth paying attention to Japan's experience and practices to establish relevant policies."