Robert C. Bowman, M.D.
About the Birth Origins Database
Birth origins are available in the American Medical Association Masterfile for 97% of the allopathic graduates of medical schools in the United States (US MD Grads). Birth city, state, and nation categories were cleaned and linked to county of birth. Birth state can be compared to medical school to determine students most likely to have instate birth. Data can be compiled by medical school, by state, by medical school types or rankings, by county, or by demographic variables linked to counties. Data can also be compared year to year or over longer time periods.
The distributional careers and locations include all physicians in rural zip codes, (Hart RUCA 1.1) office-based primary care physicians, office-based primary care in underserved locations, and office based family physicians. Underserved locations were defined as zip codes associated with a whole county primary care shortage area, a Community Health Center site, a National Health Service Corps site, or a population with over 20% in poverty. Military zip codes and Major Medical Center zip codes were not considered underserved. Zip codes outside MMC locations were more closely associated with underservice. MMC zip codes had over 75 physicians or were associated with medical schools. The cross section involves physicians as of 2005 locations using Office Max software to select the most likely practice zip code. The methods used are not easily transferred to subsets at the state or regional level due to variation in distributions of population, income, or poverty.
Studies that involve multiple years beyond the most recent graduates reflect equilibrium conditions, not just obligations or first practice locations. The use of office based designations prioritizes the primary care delivery component and minimizes resident, teaching, research, administration, inactive, or hospital based practice activities. Over time those who specialize, return to major medical centers, and transition away from office based care are the ones who leave the primary care workforce.
|
Birth Origins n=203,600 for MD Grads of 1987 – 1999 |
% of Medical Student Totals |
% of 1970Popu-lation Totals |
Office Family Practice |
All Rural Careers |
Office Primary Care |
Under-served Office Primary Care |
Major Medical Center |
|
Totals |
100% |
100% |
11.7% |
11.0% |
30.0% |
9.4% |
70.9% |
|
49.1% |
48% |
10.2% |
8.8% |
28.6% |
7.8% |
73.2% |
|
|
Metro Less Than 1 Million Birth |
23.2% |
29% |
14.0% |
13.6% |
31.9% |
10.3% |
68.4% |
|
NonMetro Organized (larger) |
6.2% |
12% |
17.7% |
23.0% |
35.1% |
13.4% |
62.9% |
|
NonMetro Less Organized |
3.6% |
10% |
22.3% |
26.4% |
38.9% |
15.2% |
58.3% |
|
Foreign Born* |
14.2% |
9.4% |
8.3% |
6.1% |
28.5% |
8.8% |
74.2% |
|
Whole County Shortage Area |
1.3% |
4.6% |
19.3% |
23.9% |
37.0% |
22.4% |
60.2% |
|
Not Born Instate |
59.6% |
|
10.4% |
9.9% |
28.9% |
9.2% |
72.1% |
|
Born Instate |
40.4% |
|
13.4% |
12.6% |
31.7% |
9.7% |
69.2% |
|
Up to 25 yrs at Graduation |
7.3% |
|
7.0% |
6.8% |
25.6% |
7.4% |
75.3% |
|
Age 26 to 29 at Graduation |
70.3% |
|
11.1% |
10.5% |
29.6% |
8.7% |
71.8% |
|
Age 30 and Up at Graduation |
22.4% |
|
14.9% |
14.0% |
32.8% |
11.9% |
66.9% |
|
Birth County Factors |
|
|
|
|
|
|
|
|
1969 Income in 1989 dollars |
|
|
|
|
|
|
|
|
$3000 – 6,999 per capita |
1.5% |
9.8% |
19.7% |
24.5% |
37.1% |
26.8% |
59.2% |
|
$8,000 – 8,999 per capita |
6.0% |
15% |
15.0% |
16.5% |
32.7% |
13.2% |
64.5% |
|
$10,000 – 10,999 per capita |
15.7% |
20% |
12.2% |
10.8% |
30.1% |
7.8% |
70.1% |
|
$12,000 – 12,999 per capita |
10.8% |
8.7% |
11.9% |
8.4% |
30.8% |
7.4% |
73.5% |
|
$14,000 and above per capita |
10.7% |
4.5% |
6.7% |
7.0% |
25.1% |
6.9% |
76.3% |
|
Pop Per Square Mile 1970 |
|
|
|
|
|
|
|
|
Population Density 32 – 64 |
4.6% |
18% |
19.9% |
22.8% |
37.2% |
13.3% |
62.0% |
|
Population Density 125 – 250 |
6.4% |
10% |
15.6% |
17.0% |
32.9% |
10.3% |
67.6% |
|
Population Density 500 – 1000 |
8.9% |
11% |
12.9% |
11.9% |
31.3% |
10.7% |
70.3% |
|
Population Density 2500 – 5000 |
6.8% |
7% |
10.5% |
9.6% |
27.9% |
7.5% |
73.5% |
|
Population Density 10000 up |
12.3% |
11% |
6.1% |
5.8% |
24.8% |
6.4% |
77.2% |
*Reference population is current 19 million who are foreign born
When comparing admissions percentages to population percentages those least likely to be admitted are the most likely to distribute to careers and locations in most need. Older students, instate born students, and students born in counties with medium and low densities of population or income or college graduates are the most likely to distribute. This presents a dilemma for admissions committees, states, public schools, and education systems.
Those most likely to distribute also have middle and lower Medical College Admission Test scores. Their middle and older age is a reflection of the barriers of income and education that they have had to overcome. In states with greater high school graduation rates and broader distribution of education and health resources to middle and lower income areas, physicians are more likely to choose family medicine and to distribute to middle and lower income areas. With increasing concentrations of income, population, and college graduates at a state or county level; the choices of distributional careers by those born in the state or born in the county decline.
The intersection of high school graduation rate increase with college graduation rate decrease as indicated in choice of family medicine is first generation to college. Mexican American, Vietnamese, and rural populations all had over 19% choice of family medicine. (Ethnicity and Gender) Without improving early education and first generation college access, the nation will not be graduating sufficient service oriented professionals such as teachers, nurses, public servants, and family physicians. The needs of the fastest growing populations will not be met. The states that fail to invest will continue to take health and education resources from other states and other nations. They will also continue to have the highest costs of education, prisons, health care, unemployment, and insurance which are also strongly related to poor high school graduation rates and concentrations of income. (Bright Future)
Admissions Characteristics
| Divisions by Medical School by Level of FP Choice | 1987-2000 FP/GP | FP Match 2004 | % Born in County > 1 million | Metro < 1 million | Foreign Born | Rural Born | Older than 29 Years | MCAT | Average NIH Grant Funds |
| All Allopathic Private | 7.1% | 57.7% | 17.2% | 17.3% | 5.5% | 18.7% | 93520600 | ||
| Least FP | 3.6% | 1.9% | 62.5% | 15.0% | 18.1% | 4.1% | 14.8% | 10.9 | 162318284 |
| Next Least FP | 7.4% | 5.6% | 60.3% | 17.2% | 17.7% | 4.7% | 17.2% | 10.5 | 121606535 |
| Next Most FP | 12.5% | 8.0% | 54.3% | 15.1% | 16.2% | 4.8% | 21.4% | 9.6 | 58427197 |
| Most FP | 19.0% | 12.9% | 52.4% | 21.7% | 16.9% | 8.6% | 22.4% | 9.4 | 31730383 |
| All Allopathic Public | 12.1% | 46.1% | 26.8% | 12.8% | 12.5% | 22.8% | 56215553 | ||
| Least FP | 12.0% | 7.7% | 55.1% | 19.0% | 15.8% | 5.6% | 18.1% | 9.8 | 84583798 |
| Next Least FP | 17.5% | 11.0% | 46.8% | 28.8% | 13.5% | 10.4% | 21.3% | 9.5 | 56878605 |
| Next Most FP | 21.2% | 13.2% | 42.0% | 30.0% | 11.3% | 15.8% | 24.9% | 9.6 | 48617780 |
| Most FP | 28.0% | 18.9% | 37.0% | 31.5% | 8.9% | 21.8% | 29.3% | 9.3 | 34748877 |
| All Osteopathic | 47.4% | 22.8% | 12.6% | 12.2% | 38.5% | 10626974 | |||
| Least FP | 27.4% | 13.0%* | 56.0% | 18.5% | 13.7% | 6.0% | 31.0% | 8.4 | 5324347 |
| Most FP | 36.2% | 18.2%* | 40.3% | 26.4% | 11.8% | 17.3% | 44.7% | 8.2 | 15340421 |
| Average Totals US | 15.2% | 11.1% | 51.0% | 20.3% | 14.0% | 10.2% | 23.1% | 62317076 | |
| All 1987 – 2000 Grads | 312217 | 30.5% | 20.4% |
Does not include osteopathic FP physicians choosing osteopathic residency programs.
Outcomes
|
Divisions by Level of FP Choice |
1987-2000 FP/GP |
FP Match 2004 |
Research Grads 87-94 |
MS to State Retain (Not FP) |
MS to State Retain (FP/GP) |
Rural FP/GP |
All Rural Docs |
All Primary Care |
Office-Based Primary Care |
Office PC in Poverty |
|
All Allopathic Private |
|
7.1% |
1.4% |
|
|
1.5% |
6.7% |
37.2% |
27.1% |
3.3% |
|
Least FP |
3.6% |
1.9% |
2.8% |
30.8% |
18.3% |
0.4% |
4.0% |
33.5% |
22.4% |
3.2% |
|
Next Least FP |
7.4% |
5.6% |
1.4% |
25.8% |
21.2% |
0.9% |
5.8% |
35.0% |
25.2% |
3.0% |
|
Next Most FP |
12.5% |
8.0% |
0.9% |
31.3% |
33.9% |
1.6% |
7.0% |
39.5% |
29.5% |
3.9% |
|
Most FP |
19.0% |
12.9% |
0.5% |
31.4% |
34.8% |
3.2% |
10.4% |
41.7% |
32.0% |
3.3% |
|
All Allopathic Public |
|
12.1% |
0.6% |
|
|
4.5% |
12.3% |
42.9% |
33.4% |
4.0% |
|
Least FP |
12.0% |
7.7% |
0.9% |
44.2% |
49.3% |
1.8% |
7.5% |
38.1% |
28.8% |
3.9% |
|
Next Least FP |
17.5% |
11.0% |
0.7% |
47.2% |
56.5% |
3.6% |
12.2% |
42.8% |
33.3% |
4.0% |
|
Next Most FP |
21.2% |
13.2% |
0.5% |
47.6% |
60.3% |
5.1% |
14.0% |
44.2% |
35.2% |
4.0% |
|
Most FP |
28.0% |
18.9% |
0.5% |
41.1% |
53.5% |
7.9% |
17.5% |
48.6% |
38.3% |
4.0% |
|
All Osteopathic |
|
|
0.1% |
|
|
8.3% |
17.7% |
53.5% |
40.8% |
3.2% |
|
Least FP |
27.4% |
13.0%* |
0.1% |
48.9% |
52.4% |
5.1% |
12.2% |
50.2% |
37.4% |
2.5% |
|
Most FP |
36.2% |
18.2%* |
0.1% |
26.7% |
36.7% |
11.1% |
22.2% |
56.2% |
43.6% |
3.7% |
|
Average Totals US |
15.2% |
11.1% |
0.7% |
39.3% |
48.3% |
3.8% |
11.1% |
42.2% |
32.0% |
3.7% |
|
All 1987 – 2000 Grads |
312217 |
|
0.7% |
|
|
3.3% |
10.5% |
45.1% |
31.4% |
3.7% |