Admissions Ratios and US Medical Students

The competition for US medical school positions is global, limited only by English language proficiency and the ability to finance a prestigious US college and do well in college and MCAT testing.

Robert C. Bowman, M.D. [email protected]  www.ruralmedicaleducation.org

Allopathic Admissions in the United States, Gender, Ethnicity, Distribution

Using Logarithms for both the broad spread of income and of admissions ratios, the relationship clearly is linear between income and admissions.

Admissions Income Quartiles for graph and more details

The same linear relationship is seen between income and physician distribution or admissions and physician distribution for family medicine, rural locations, and office-based primary care in poverty locations.

Back to Admissions

For ethnicity, gender, and rurality, the range is 1 in 20 for Asian Indian to 1 in 1000 for female Mexican American students. When considering income alone, the range is 1 in 60 for the top income quartile to 1 in 2700 for those at the lowest 20% income levels and may be as low as 1 in 4000. Many US urban areas have this wide range of admissions probability within the same or adjacent zip code areas.

Admissions varies with income, population density, and parent education level. Population density, education, and income levels of the county of birth of medical students predict well over 50% of the variance in admissions. These socioeconomic measures also influence test scores such as SAT/ACT and MCAT. Higher socioeconomics means low choice of distributional careers and poor retention for practice in the state where students attended medical school. Family medicine is a more likely choice in lower socioeconomic students and in allopathic public schools, FPs are 44% more likely to be retained in their state for practice (1987 - 2000 medical school graduates compared to 2005 locations in the Masterfile)

• Students from rural and lower income counties (urban influence 6,8,9 in 1993) have ratios of admission at 1 in 780 and males born in such locations have admissions at 1 in 1000.
• Income levels of students have dramatically increased. When comparing 1997 matriculants to those of 2001 entering classes in allopathic medical schools, those with parents making over $100,000 increased 77% with fewer admitted from the lowest income origins.
• Asian students have increased from 3% to 22% of allopathic medical school admissions. Regardless of ethnicity, those with the most urban origins, the highest parent education and income levels, and the most college preparation are the least likely to choose family medicine and rural locations. Studies of Asians in the census and in medical students reveals a greater concentration in these key areas. Whites, Blacks, and Mexican Americans with the same characteristics make the same choices.
• Students who are white, those who are rural born, and those who are male have declined the most in college and medical school admissions.
• In summary, those who are most familiar with, connected to, associated with the US health and education systems are the least likely to consider and be successful in a medical career.

The actual number of 18 - 24 year olds used in the table involves census values, however these are known to lag behind for groups with rapid increases. The groups with the most rapid increases are Indian-Pakistani, Vietnamese, and Mexican American.

States vary greatly in the growth of various populations, the students admitted, income levels, and education levels.  Medical school admissions would be expected to vary greatly as well.

There is also a variation to consider regarding east-west location or longitude. Family medicine is a much more common choice by all students in students who have more western locations. Students in the east tend toward general internal medicine, and general pediatrics. Mexican American and Vietnamese populations have choice of family medicine at nearly the same rates as rural populations. They also have a more western location. Black and Cuban and Puerto Rican populations have eastern locations and lower choice of family medicine. Whether this is medical education bias, lack of exposure to family medicine during upbringing, or the impact of poverty is unknown. Family medicine is a low choice for populations with skewed income and education distributions with more in poverty and more elite in income and education. Those higher income do not choose FP. Those lower income mostly cannot access college or medical school at all. Those that do have elite test taking skills in urban areas are shuttled to special schools and programs. This may socialize such students away from distributional choices and toward subspecialities and elite medical schools.

For a detailed description of the impact of birth origins on choice of specialty and location, see Birth Origins Articles

Distribution, Income, MCAT

Older students have 2 - 5 point higher FP and Rural choice (2 for rural born, 5 for urban born)
Male students have similar 2-  5 point increases over females in rural choice unless specific admissions or different training Accelerated
About half of US allopathic Asian students are foreign born, and half born in US (census, fp studies) Asian Students in Education and Medical Education

Birth Origins and Distribution Tables are an updated version of those below

The effect of Foreign born if included where they were raised in the United States, is to raise admissions ratios for those born and raised in metro counties. See adjusted code 1 and 2. Codes 1, 2, 3, 5, 7 have more education and health resources.

Ethnicity and the Steps Toward Family Medicine

*Note: Most Asian ethnicity FP residency graduates were from international schools

Ranges used because of incomplete ethnicity data

Traditional underrepresented minorities have had declining FP choice in recent years even as number have increased

AAMC MIM is AAMC 2001 Minorities in Medicine report

Birth Origins Articles

Medicine, Education, and Social Status

Parent Income and Ethnicity and FP Choice

County Birth Origins, Incomes, Choice of FP

Probability of admission tables - the impact of expansion did not improve rural origin or minority admissions

Admissions Ratio By Birth Origin

Physician Workforce Studies

Side Effects of Selecting for Family Medicine

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