Abstract Background Rural physician shortages persist globally, with professional isolation a major barrier. Traditional incentives have limited effects on long-term retention. Aim To describe the decentralized, academically integrated training model at Shimane University General Medicine Center (SGMC) and evaluate recruitment and retention outcomes. Setting Shimane Prefecture, a rural, aging region in Japan. Participants Forty-two General Practice residents (2018–2025). Program Description SGMC implemented a prefecture-wide “Neural GP Network” community of practice and a “Virtual Office” using Slack and Zoom. Residents completed longitudinal rural placements in local care teams. Program Evaluation Annual recruitment averaged 15.8% of specialty trainees, significantly exceeding the national average (2.6%; P < 0.001). As of January 2026, 88.1% (37/42) remained in the prefectural network, exceeding estimates for rural Japan (~ 50%). The Virtual Office generated 26,787 messages and 6803 files (Feb 2024–Jan 2025). Since 2021, affiliates published 58 English-language papers. Discussion Over 8 years, this hybrid model integrating digital networking with longitudinal training was associated with strong workforce stability, representing a promising approach to strengthen rural primary care.
Sakaguchi et al. (Mon,) studied this question.