Health Access By Medical School Type and Career Choice for 1993 – 1998 Graduates
Includes 21,470 family physicians and 112,011 graduates not in family practice from the 2005 Masterfile using the Physician Distribution By Concentration Coding Robert C. Bowman, M.D.
The delays in graduation from 1999 to the 2005 class years allow sufficient time for medical school graduates to complete residency training and a first obligation to be found in a more representative career and location pattern. Note that not all of the international graduates have had sufficient time due to delays in entry to the US and to a residency program.
|
Super |
Major |
Marginal Urban |
Urban Under-served |
Marginal Rural |
Rural Under-served | |
|
Graduate Not in Family Practice |
||||||
|
China Medical School |
75.5% |
14.0% |
6.1% |
2.2% |
1.1% |
0.0% |
|
MCAT 10.5-12 Top Fifth Allopathic US |
61.3% |
22.9% |
9.2% |
2.5% |
1.5% |
0.9% |
|
Other International |
64.5% |
18.6% |
7.9% |
3.5% |
1.6% |
3.1% |
|
India Medical School |
54.3% |
24.9% |
11.7% |
3.5% |
2.1% |
3.1% |
|
Total/Avg Non-FP |
50.1% |
26.4% |
12.2% |
3.8% |
2.6% |
2.5% |
|
MCAT 9.5-10 Middle Fifth Allopathic US |
47.3% |
28.8% |
13.6% |
3.4% |
2.7% |
1.9% |
|
Nigerian Med School |
59.6% |
16.5% |
11.9% |
7.0% |
1.9% |
2.7% |
|
Pakistan |
51.8% |
24.0% |
10.7% |
3.3% |
3.0% |
6.3% |
|
Central America |
52.3% |
21.3% |
9.8% |
11.3% |
1.6% |
3.2% |
|
Caribbean |
43.0% |
29.4% |
17.0% |
4.3% |
2.7% |
2.8% |
|
MCAT 8.5-9.25 Bottom Fifth Allopathic US |
40.5% |
30.5% |
12.8% |
5.0% |
4.1% |
5.3% |
|
Philippines |
44.0% |
23.3% |
11.7% |
5.8% |
3.9% |
10.7% |
|
Historically Black |
37.0% |
28.2% |
17.5% |
8.4% |
2.1% |
3.6% |
|
Osteopathic |
30.1% |
33.4% |
19.6% |
4.3% |
5.7% |
4.2% |
|
Family Practice Graduates Below |
||||||
|
China Medical School |
42.1% |
42.1% |
5.3% |
5.3% |
5.3% |
0.0% |
|
Nigerian Med School |
50.8% |
23.8% |
12.7% |
6.3% |
1.6% |
4.8% |
|
Other International |
46.4% |
24.7% |
14.7% |
4.8% |
3.4% |
4.4% |
|
Pakistan |
40.5% |
29.5% |
14.2% |
5.8% |
3.2% |
5.3% |
|
India |
39.4% |
29.8% |
18.1% |
5.5% |
4.4% |
2.7% |
|
Philippines |
33.8% |
34.4% |
15.6% |
4.4% |
6.3% |
5.0% |
|
MCAT 10.5-12 Top Fifth Allopathic US |
26.1% |
27.6% |
22.0% |
8.4% |
7.7% |
5.3% |
|
Central America |
29.3% |
23.9% |
13.4% |
21.4% |
1.4% |
9.8% |
|
Caribbean |
24.0% |
27.8% |
24.0% |
7.8% |
7.2% |
7.0% |
|
Total/Avg for FP |
21.4% |
27.1% |
23.8% |
6.6% |
9.6% |
8.2% |
|
MCAT 9.5-10 Middle Fifth Allopathic US |
20.9% |
27.2% |
24.9% |
5.6% |
10.9% |
7.5% |
|
Historically Black |
20.0% |
24.7% |
22.2% |
15.6% |
5.5% |
7.3% |
|
Osteopathic |
15.5% |
28.8% |
28.0% |
5.7% |
9.6% |
9.6% |
|
MCAT 8.5-9.25 Bottom Fifth Allopathic US |
14.1% |
25.1% |
23.4% |
7.5% |
14.7% |
13.3% |
When the family practice component is removed, it is possible to determine more of the impact of selection and training. Medical schools with exclusive most urban and highest income and highest scoring graduates have the lowest contributions to populations in most need of health care.
A shift away from most needed health access is certainly indicated in the past decade with lower percentages of family medicine graduates in all of the school types resulting in a shift to the non-family practice career choices that are found in top concentrations.
The international graduates listed as graduates of their home nation school from 1993 – 1998 also are still in obligation effects due to delays in entry to the US and in finding a residency position. This obligation effect is demonstrated by higher percentages in rural underserved compared to marginal rural locations. In a normal distribution this should be about the same percentage for both locations. The much higher rural underserved rates are found in the internal medicine graduates of these schools. Most of these are no longer in rural underserved locations as they have already completed their 3 year obligations. Also the decline of the J-1 Visa (bypass, fewer, use by medical schools) indicates that fewer will remain in primary care and serve in underserved areas.
Physician Distribution By Concentration Coding
Health Care: Dividing the Nation Basic Health Access: Bringing a Divided Nation Back Together
www.physicianworkforcestudies.org