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

Abstract

Background

Regional 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.

Methods

Ten 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.

Results

The 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.

Conclusion

Targeted 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.

Background

The global phenomenon of an uneven distribution of physicians between urban and rural areas has been a crucial social agenda. Primary care, typically including family medicine, internal medicine, and pediatrics, is especially fundamental to guarantee the rights to equal access to healthcare and the right to a healthy life. However, according to the American Medical Association’s Physician Professional Data, 7.2% of the United States (US) counties did not have a primary care physician at all in 2019. Rural areas in the US were shown to have 5.1 primary care physicians per 10,000 residents, while urban areas had 8.0 in 2020 [1]. In Japan, general internists and family physicians are significantly more oriented to the urban areas than the US [2]. European nations or Australia are not exceptional from the shortage of general practitioners in “medical deserts” or the “bush” [3, 4]. Collectively, these trends underscore that the urban-rural divide in healthcare is a structural global crisis, necessitating comprehensive policy interventions to mitigate regional imbalance of physicians.

Educational interventions at the medical school level have been considered effective in establishing a sustainable workforce. Two primary strategies—recruiting students who may pursue a career as rural physicians and providing educational programs that encourage such career choices—have been recognized as crucial [5, 6]. Studies have revealed that selecting students with rural backgrounds [7, 8] or those who express willingness to practice in rural areas at admission [9, 10] are effective selection strategies. Furthermore, providing students with authentic educational experiences within communities has exhibited a positive impact on their training as future rural physicians [11, 12].

The US and Japan have been notable in such institutional efforts. States and universities have undertaken bottom-up initiatives to address the rural physician shortage in the US since the 1920s [13]. Rurally targeted admission policies of each medical school, as well as state-level initiatives, such as Area Health Education Centres (AHEC), are examples. The effectiveness and sustainability of these distinctive student selection policies and educational programs have been investigated [14–16]. In Japan, physician supplies and distributions have been dealt with by several policies since the 1970s. The establishment of ‘Jichi University’ and the implementation of the ‘regional quota system’ illustrate the nationally led, top-down educational approach in Japan. Several studies have investigated their outcomes [17, 18] as well as the association between specific elements of the regional quota system and physician supplies in underserved areas [19, 20]. Despite these systemic differences, both countries have implemented strategies to address regional disparities in physician workforce, making them ideal cases for identifying transferable approaches across different healthcare contexts.

Countries where improvements in educational policies of medical schools for addressing regional imbalance of physician workforce are required, may benefit from deriving insights from precedents in the US and Japan. A comparative study can be conducted as an initial stage for designing strategies applicable to other national contexts. Previous studies on the effect of student selection or education on rural physician supply, covering multiple institutions within a single country, have been retrieved in the US [21], Australia [22] and several Asian nations [18, 23]. Studies that address multiple countries include the research of Tesson et al. [24] involving Canada, the US and Australia; Kumar and Clancy [25] including North America, Australia, Asia and Africa; Yazdani and Heidarpoor [26] comparing Canada, Australia, the Philippines, Sudan and Iran. These studies yet primarily focus on the quantitative analysis of the effectiveness of educational strategies on rural retention or the categorisation of multiple cases into several typologies.

However, the contextual, including economic, political, and cultural, differences between nations need to be carefully considered when drawing implications applicable to other societies from comparisons. Especially, educational strategies of medical schools regarding physician disparities are heavily influenced by factors surrounding medical education and physician workforce system. Therefore, this study aimed to explore similarities and differences in student admission policies and educational programs designed to address regional physician disparities in the US and Japanese medical schools. Moreover, we generated several insights for adopting their policies in other countries facing similar challenges based on the educational policy borrowing model. This study makes a unique academic contribution by applying a structured comparative framework—Bereday’s comparative method—alongside an educational policy borrowing model to analyze the admission and training strategies of medical schools in two countries with fundamentally different medical education entry systems and healthcare governance structures. While previous comparative studies have largely focused on quantitative outcomes or broad typologies across multiple countries, this study provides a qualitative, context-sensitive analysis that illuminates the mechanisms and contextual factors underlying each approach, offering actionable insights for policy borrowing by other nations.

Methods

Institution selection

Medical schools served as the units of analysis of this study. Initially 10 medical schools from each country were selected using purposive sampling based on the 2023–24 Best Medical Schools ranking in Primary Care, published by US News and World Report and EduRank. Japanese institutes in Tokyo and Osaka were excluded from the initial selection regarding the study topic. Five schools satisfying all of the following criteria were then selected: (1) accessibility: the availability of institutional resources concerning student admission policies and educational programs to address regional physician shortages(e.g. websites, reports); (2) sufficiency: having at least one program related to community, primary, or rural healthcare beyond the core clerkship program (required for all students) in the institution; and (3) evidence: presence of documented evidence of outcomes (e.g. academic articles or reports) on the effectiveness of admission policies or educational programs. Final subjects are listed in Table 1.

Table 1.

Comparison subjects and final subject selection criteria

Country	Institution	Accessibilitya	Sufficiencyb	Evidencec	Decision
United States	Washington (Seattle)	√	√	√	√
	Minnesota	√	√	√	√
	New Mexico	√	√	√	√
	California, Davis d	√	√	√	√
	Nebraska	√	√	√	√
	Oregon Health and Science	√
	California, San Francisco	√	√
	North Carolina, Chapel Hill		√	√
	Colorado	√	√
	California, Los Angeles	√	√	√
Japan	Jichi	√	√	√	√
	Nagoya	√	√	√	√
	Hiroshima	√	√	√	√
	Tsukuba	√	√	√	√
	Chiba	√	√	√	√
	Tohoku	√
	Kyushu	√
	Kochi	√
	Hokkaido	√
	Mie	√

The checkmark(√) represents the fulfilment of each criterion by the institution. A blank cell indicates that the criterion was not met.

^aAccessibility: availability of institutional resources regarding student admission policies and educational programs for rural physician production

^bSufficiency: having at least one program in each institution for rural physician upbringing beyond the formal curriculum

^cEvidence: presence of documented evidence of outcomes on the effectiveness of the admission policies or programs

^dUniversity of California, Davis—who has more available information for their educational programs and ranked higher than the University of California, Los Angeles—was finally selected to avoid duplication within California.

Data collection and selection

Data collection was carried out between May to July 2024, employing multiple sources to ensure comprehensive coverage and methodological triangulation. Primary sources included institutional websites and official program materials, published annual reports, admissions guidelines, student handbooks, curriculum documents, and course descriptions. Secondary sources comprised peer-reviewed literature, and publications from government and national healthcare organisations or research institutes.

Among information collected, we included data according to the following criteria: admission policy excluded programs or tracks for which participation is identified after confirming admission. Courses or programs focusing solely on rural or primary care in community settings or providing community placements were included. Programs partially covering rural or community health-related topics were excluded based on the descriptions in the syllabus. Student-led volunteer activities or clubs related to rural health, community health, or primary care were also excluded.

Data analysis

The comparative analysis followed Bereday’s four-stage comparative framework: (1) description of institutional approaches, (2) interpretation of the characteristics of each country with concerns of contexts surrounding the healthcare system, (3) juxtaposition of findings of each country to induce comparison criteria, and (4) simultaneous comparison to synthesize similarities and differences [27]. Through iterative analysis, comparison criteria were identified.

Based on the comparative findings, we discussed implications for other countries through the lens of Philips and Ochs’s policy borrowing model [28]. The model conceptualises the borrowing process as four distinct stages—cross-national attraction, decision, implementation, and internalisation—with concerns about contextual forces that affect each stage [29].

Results

Admission policies and student selection

The analysis of admission policies and student selection between the United States and Japanese medical schools is summarized in Table 2. The biggest difference was that the US institutes operated within a decentralized admission system, whereas Japanese institutes followed a nationally coordinated ‘regional quota’ system. Medical schools in the US implemented institution-specific targeted admission policies tailored to the state and organizational context. In contrast, Japanese medical schools operated a standardized quota system in their own manner.

Table 2.

Comparative overview of admission policies

Criterion	United States	Japan
System structure	Decentralized, institution-specific; pipeline or special track-based	Centralized, nationally coordinated; regional-quota based
Regional eligibility	State residency preferred in most institutes; rural origin required in some pipeline programs or tracks	Prefectural origin (high school graduation or/and parental residency) required in most institutes
Selection methods	Selection criteria including academic performance, intellectual abilities (e.g. problem-solving and critical thinking), communication and interpersonal skills, empathy and ethical responsibility, motivations or interests for rural careers
	Holistic assessment	Designated weights for each selection tool
Support and obligations	Academic support pre-matriculation; educational support during medical school	Tuition coverage during medical school; mandatory service commitment post-graduation

Pipeline development vs. national coordination

The Japanese system featured a standardized, national model in collaboration with regional governments. It selected students within pre-determined seats allocated based on regional physician needs in each prefecture. Selected students in every institute were provided with financial support during medical school and mandated to work in their designated regions after graduation in exchange of tuition coverage. Although the amount of coverage and the specific requirements of mandatory service varied across the institutes, the admission policies of the Japanese medical schools were overall centralized within quota system.

In contrast, each medical school in the US developed their own pipeline programs and specialised tracks in addition to the general admission, which were categorized into three types: pre-admission intervention programs, including AvenueM at the University of California, Davis and the Rural Health Opportunities Program at the University of Nebraska, supported committed students with rural backgrounds from their high school or undergraduate years through their matriculation into medical school. Combined degree programs, including the BA/MD Joint Admission Scholars Program of the University of Minnesota and the Combined BA/MD Degree Program of the University of New Mexico, guaranteed admission for students with rural backgrounds to medical school upon completing specific undergraduate requirements. Targeted education tracks, including the Targeted Rural Underserved Track(TRUST) and the Community-Focused Urban Scholars Program of the University of Washington, admitted rural students into special cohorts and provided them with a tailored curriculum after matriculation. These pipeline-based strategies highlighted educational support before matriculation to prepare for the entrance to medical school. Some admission programs further required selected students to participate in educational activities, such as academic seminars or living learning communities, during medical school to maintain their intentions for rural practice.

Application eligibility

Two countries demonstrated differences in terms of application eligibility associated with regional residency. The medical schools in the US prioritised applicants from or with ties to rural areas, but out-of-state applicants were also being selected except University of New Mexico. Conversely, Japanese medical schools, except Chiba University, were imposing stricter regional eligibility for the regional quota system, requiring applicants to be from or have ties with the same region as the institute. Notably, pipeline programs or special tracks in the US medical schools were comparable to the Japanese regional quota system, as they were also permitting in-state applicants only.

Selection methods

Both countries employed various selection criteria which encompass cognitive, affective and psychomotor domains. Common elements included academic and intellectual abilities of applicants such as problem-solving and critical thinking, communication and interpersonal skills, empathy and ethical responsibility, and motivation or interest in medicine and rural service. Respect for diversity, growth mindset, breadth of interests or experiences were only assessed in the US, whereas adaptability and creativity were exclusive to Japan.

Regarding selection tools, every institute in both countries commonly employed specific metrics related to academic abilities and an interview for assessment. However, undergraduate grade point average (GPA) and standardised examinations, such as the Medical College Admission Test (MCAT), were combinedly utilised in the US, whereas Japanese medical schools relied on the national college entrance exam supplemented by institution-specific exams. Additionally, US schools universally require letters of recommendation, whereas recommendation letters were limited to specific institutes in Japan. The US employed a holistic assessment, whereas Japan designated specific weights for each selection tool.

Educational programs and training approaches

The analysis of educational programs and training approaches in the US and Japanese medical schools is summarized in Table 3. They demonstrated convergence in their structured educational strategies and core program objectives to promote students’ interests in community healthcare in each region. Medical schools in both countries had diverse programs from community medicine lectures to early clinical exposure and longitudinal integrated clerkship programs.

Table 3.

Comparative overview of educational programs

Criterion	United States	Japan
Structural characteristics	Mostly practice-based with experiences in community settings
	Serving students within the same learning phase (e.g. years 1 and 2, or years 3 or 4)	Engaging a broader range of groups across year levels (e.g. years 1 to 4 or 1 to 6)
Curriculum objectives and contents	Objectives including developing knowledge (patient care, social determinants of community health and role of rural physicians), skills (data analysis and developing evidence-based care plans), and attitude (interprofessional collaborations); activities including didactic lectures about regional healthcare, clinical experiences in communities with inpatients and outpatients, and community projects, mentoring and shadowing
	Developing practical competencies (e.g. history taking, differential diagnosis, relationship-building with patients); contents reflecting the racial and cultural diversity of patient groups	Understanding systemic issues of regional healthcare (e.g. insurance, administration, comprehensive care models); contents reflecting an ageing society
Program operations	Attending physicians and interprofessional care teams, patients and placement coordinators involved in education
	Various types of operation units depending on program types	Operated by community medicine departments regardless of program types

Structural characteristics

Most of the educational programs in both countries were practice-based highlighting authentic clinical experiences in community settings. The periods of practice-based programs were mainly longer in the US, where short-term programs were delivered for less than 1 month during academic breaks, and longer programs spanned over 6 months as longitudinal integrated clerkships. Remarkably, some medical schools in Japan offered programs for regional quota students, which were similar to pathway programs found in several US medical schools. Those programs were common in that they provided long-term education to a cohort of students who are interested in and pursue careers in rural health.

The programs in both countries were diverse in terms of participants, from pre-clinical students provided with early community exposure to upper-year students in clerkships. Notably, the US programs tended to serve students within the same learning phase (e.g. years 1 and 2, or years 3 and 4), whereas Japanese programs engaged a broader range of groups across year levels (e.g. years 1 to 4, or 1 to 6). The latter included examples that focused on promoting peer mentoring and mutual interactions among students at various learning stages.

Curriculum objectives and contents

Regarding program objectives and content for addressing rural physician shortages, programs in both countries aimed to strengthen rural health-related medical knowledge, skills and attitudes. Common objectives included understanding the social determinants of health, developing evidence-based care plans, analysing regional health data and recognising the role of rural physicians and the importance of interprofessional collaboration. However, the US emphasised more practical competencies, such as history taking, differential diagnosis, test interpretation, and relationship-building with patients, whereas Japanese programs focused more on understanding systemic issues in regional healthcare, including insurance, administration, comprehensive care models, and various organisations. Further, contextual differences in the healthcare society of each country were reflected in educational content. Cultural humility and advocacy were only being addressed in the US, whereas the welfare of aging populations, palliative care and home healthcare were only highlighted in Japan.

In terms of educational activities, both Japan and the US provided didactic lectures on regional healthcare, authentic clinical experiences in communities with inpatients and outpatients, as well as community projects, research and volunteering opportunities. Both countries exhibit mentoring or shadowing from rural physician preceptors and career development activities. However, simulations for geriatric or obstetric care, as well as role-playing for interprofessional education, were unique to Japanese medical schools.

Program operations

US medical schools had more diverse organisational structures for operating programs than Japan. Family Medicine or rural health departments in the US typically manage lecture- and practice-based programs. In contrast, offices dedicated to rural education, workforce development or medical education often manage hybrid programs. Conversely, Community Medicine departments, regardless of their types, operated most programs in Japan. Despite these differences, the human resources involved in programs were common in both countries: attending physicians, interprofessional care teams, patients and coordinators for student placement in communities.

Outcomes

Regarding the effectiveness of these recruiting and training strategies, targeted tracks in the US have demonstrated significant success in workforce alignment. It is reported that the pipeline and track-based programs in the US, such as TRUST in University of Washington, showed a higher likelihood of matching into family medicine and other high-need primary care specialties compared to general track students [14]. Similarly, longitudinal programs in University of California, Davis or University of Minnesota have been successful in producing physicians in primary care or rural practice [15, 16].

In Japan, the nationally coordinated regional quota system and specialized institutions like Jichi Medical University have yielded high quantitative outcomes in physician supply. Research indicates that the regional quota system has significantly contributed to increasing the number of physicians in underserved areas through its mandatory service component [18]. Jichi Medical University’s home-prefecture recruiting scheme has maintained a high long-term retention rate of graduates in their respective regions even after their obligatory service periods [17]. However, the post-graduation trajectories of physicians trained under these programs are not uniformly positive. Studies of regional quota students have reported declining motivation to work in underserved areas during medical school [19], raising concerns about the long-term sustainability of the quota system’s effects. Furthermore, negative aspects of the regional quota system—including constraints on career autonomy and reports of professional dissatisfaction—have been documented [20].

Discussion

Main findings

This comparative study revealed both convergent trends and contextual variations between the US and Japan in their student admission policies and education programs to address regional physician disparities. Both countries shared strategies of recruiting students with regional backgrounds and training them to maintain their interests in rural or community healthcare. Yet their specific approaches were divergent according to their own contexts surrounding medical education and healthcare system.

The bottom-up admission policy of the US, in which each medical school identifies its pipelines autonomously, was a key contrasting point from Japan with a top-down quota system. The differential system structure led to distinct characteristics of support and obligations for the selected students. Japanese quota system requires service commitment in underserved areas after graduation in exchange for tuition coverage during medical school, which is based on regulatory, incentive-based approach. In contrast, academic and educational support provided to rural-origin students in US pipeline systems rather seem to follow intrinsic motivation-based approach. This probably be essentially rooted in different models of medical school entry: the US follows a graduate-entry model whereas Japan follows an undergraduate-entry model. In Japan, students enter medical school directly from high school, typically at age 18–19, while US medical school entry requires a bachelor’s degree, meaning students typically enter at age 22–25 or older. This difference in age and maturity at entry has important implications for how each country’s admission and training strategies function, as age at entry and prior life experiences, including previous education or work, are known to be associated with greater certainty and motivation regarding career choices [30]. Consequently, the US students entering as graduate-level adults may have more clearly formed career intentions and a stronger sense of commitment to rural practice. Japanese students, entering at an earlier stage of personal and professional development, may require the structured financial incentives and mandatory service obligations that the Japanese system relies upon.

Despite these distinctive structures for admission, similarities between specific selection criteria and tools provide empirical evidence for implementing targeted admission to address physician disparities. Both countries emphasize readily available metrics that are often related to academic abilities. Assessing pre-admission academic abilities, which strongly predicts academic performance during medical school, remains critical, on the one hand, as cognitive competencies are actually foundational to rural practice [31]. On the other hand, this is grounded in their positions of meritocracy and academic excellence in the issue of access to medical school, which might hinder matriculation of students with various backgrounds [32]. The current targeted selection of both countries turned out to be still advantageous for students with high socioeconomic backgrounds, although they have incorporated selection criteria or tools other than academic achievements [32, 33]. This demonstrates that prioritizing attributes such as the interests of applicants in underserved communities and ethical responsibilities is integral to solving physician workforce issues, as such factors at matriculation are revealed to predict their rural practice post-graduation [9], but the realistic decision on policy might depend on social ideology of the country or resources available for education.

In terms of training, the educational significance of early clinical exposure is reaffirmed in that both Japan and the US are providing clinical experiences in communities to pre-clinical students. Considering that offering students in the clerkship stage with clinical experiences in rural settings is effective in fostering their development as rural physicians, coupling early exposure with continuing education during the clinical years can surely promote their career intentions [12]. Realistic decisions on adopting early exposure to communities might vary across the contexts in length or timing of the program.

Our findings underscore that recruitment and training are inextricably linked to each other. Educational continuity should be ensured by selecting students who are most likely to retain in their regions and providing them longitudinally with authentic educational experiences in communities. Although pipeline-based approach in the US and quota-based approach in Japan differ in their fundamental structures, both countries attempt to provide peculiar educational elements to the selected students through targeted admission. Learning communities or tailored pathway curriculum in the US or longitudinal interactional activities within quota system in Japan are exemplary attempts for such continuity.

The distinct maturity levels and backgrounds of students in each country, as noted earlier, inevitably lead to different outcomes for these training strategies. While both countries have proven effective in retaining regional physicians, challenges remain regarding the sustainability of these strategies integrated with the students’ life stages. The quota-based Japanese system has concerns regarding the stability of students’ intrinsic motivation. The initial willingness of practice in underserved areas may decrease during medical school or mandatory service period, which implies providing a long-term motivation and professional satisfaction is essential [19, 34, 35]. Cultivating a sense of belonging among communities or students with the same interests in regional healthcare or might be useful [35, 36]. For the US, where the system relies more on the intrinsic motivation of entrants, the focus should be placed on removing extrinsic barriers, such as educational debt or the lack of support for their families.

Implications and recommendations for policy borrowing in different countries

The similarities and differences found in this study do not merely serve as institutional descriptions but demonstrate to us how policy can further be ‘glocalized’ within the process of being adopted, implemented, and re-contextualized in various contexts [37]. The four-stage educational policy borrowing model suggested by Phillips and Ochs provides us a framework to discuss insights and several success factors for countries when adopting strategies of the US and Japanese medical schools [28].

Cross-national attraction and decision

Countries facing a similar challenge in their regional physician workforce might have cross-national attractions for borrowing strategies of the US and Japanese medical schools. Despite both countries share some strategic focuses on selecting and training students, what defines realistic decision-making might vary depending on the contexts in each borrowing country, such as degree of centralization of medical education system, medical school entry system, guiding philosophy of physician workforce production, economic situations, and culture. For example, countries with centralized system in medical education or healthcare management may find Japanese approaches more readily adaptable, while those with decentralized systems may benefit from borrowing strategies from the US.

Implementation

The speed and conditions of implementing adopted strategies depend on involvement of stakeholders and institutional contexts. Decentralized system might enable flexible implementation of new elements, whereas the centralized system might trigger delayed but internally consistent procedure. National coordination mechanisms to guide student selection or training placements with comprehensive workforce tracking systems might ease the situations in those centralized countries. Robust institute-level leadership and consistent commitment with clear mission to community health within collaborations with regional governments may encourage sustainable implementation. Further, significant actors of medical education in the micro-level, such as patients, physicians and interprofessional care teams in communities, and faculty and staff, should play integral roles in designing region and institution-specific support system for the selected students and operating programs systematically as planned.

Internalization

Successful and sustainable policy embedding requires re-contextualization in each healthcare society, beyond mere being duplication. This might include alignment of student selection methods with accreditation standards of each country or mission and educational goals of each institute. The differences discovered in curriculum contents of the education programs in the US and Japan, reflecting significant issues of each healthcare society, also delineate the examples of re-contextualization. Further, the reliability of selection and effectiveness of educational programs should be longitudinally monitored in new contexts.

Limitations and further research suggestions

This study extends the literature by analysing the process of policy adoption within a comparative research framework and a policy borrowing model that are unique to medical education to address the global challenge of regional disparities in physician workforce. Nevertheless, this study has several limitations. Data collection relied primarily on official documents and institutional websites, which may not fully capture the actual implementation in each medical school. Further studies could incorporate more qualitative data from interviews with faculty, students, and policymakers to reflect subtle realities and contexts. In addition, this study focused on analysing two high-income countries with relatively highly qualified medical education systems, which may limit the generalizability of conclusions to some low- and middle-income countries. Expanding the comparative scope beyond North America and East Asia to include more diverse countries would also enrich the global applicability of our findings.

Conclusions

This study compared pioneering admission policies and educational programs of the medical schools in the US and Japan to address the persistent global challenge of physician maldistribution across regions. Targeted recruiting strategies of the medical schools to select prospective physicians for future regional workforce vary according to the degree of centralization of medical education system in each country. This structural contrast drives the differences particularly in the characteristics of obligatory requirements and support for the selected students, but key selection methods still share similarities. Educational programs to promote students’ willingness in regional healthcare commonly focus on providing them with practice-based experiences within supportive educational environment in which community members actively engage. 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 internalize them to ensure selection and training are integrated with each other.

Authors’ contributions

S Park and EB Yang made a substantial contribution to the concept and design of the study, and supervised the study. S Park collected and analysed the data, and was a major contributor in writing the manuscript. S Park and EB Yang substantially revised the manuscript and approved the final manuscript.

Funding

This research did not receive any specific grant from funding agencies and has not been previously published elsewhere.

Data availability

The datasets used and analysed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This study does not involve human participants or personal data. Data were collected exclusively from publicly available sources, including institutional resources, national reports, and peer-reviewed literature. Therefore, under the Bioethics and Safety Act of the Republic of Korea, the requirements for ethics approval and consent to participate are not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.