Abstract
BACKGROUND: During the long-lasting economic stagnation, the popularity of medical school has dramatically increased among pre-medical students in Japan. This is primarily due to the belief that medicine is generally a recession-proof career. As a result, pre-medical students today who want to enter medical school have to pass a more rigorous entrance examination than that in the 1980s. This paper explores the association between the selectivity of medical school admissions and graduates' later career choices. METHODS: A unique continuous measure of the selectivity of medical school admissions from 1980 to 2017, which is defined as the deviation value of medical schools, was merged with cross-sectional data of 122 990 physicians aged 35 to 55 years. The association between the deviation value of medical schools and various measures of physicians' career choices was explored by logistic and ordinary least square regression models. Graduates from medical schools in which the deviation value was less than 55 were compared with those from more competitive medical schools, after controlling for fixed effects for the medical school attended by binary variables. RESULTS: From 1980 to 2017, the average deviation value increased from 58.3 to 66.3, indicating a large increase in admission selectivity. Empirical results suggest that increasing selectivity of a medical school is associated with graduates having a higher probability of choosing a career in an acute hospital as well as having a lower probability of opening their own clinic and choosing a career in primary health care. Graduating from a highly competitive medical school (i.e., deviation value of more than 65) significantly increases the probability of working at typical acute hospitals such as so-called 7:1 hospitals (OR 1.665 2, 95%CI 1.444 0-1.920 4) and decreases the probability of working at primary care facilities (OR 0.602 6, 95%CI 0.441 2-0.823 0). It is also associated with graduates having a higher probability of becoming medical board certified (OR 1.294 6, 95%CI 1.108 8-1.511 4). CONCLUSION: Overall, this paper concludes that increased selectivity of medical school admissions predicts a higher quality of physicians in their own specialty, but at the same time, it is associated with a lower supply of physicians who go into primary care.