Choice of Family Medicine Regression

Robert C. Bowman, M.D.

Choice of family medicine = MCAT + State Inequities + Longitude of Medical School + School Creation post 1966

                                    = School selectivity + state selectivity + longitudinal bias + age bias

Birth origins, medical school admissions, specific emphasis on family medicine, and health policy appear to impact medical student choice of family medicine. MCAT scores of medical schools are related to distributional choices.

·        Schools with higher MCAT scores have more elite students and lower choice of family medicine. This is a result of state education, admissions, and other school factors. A 1 point higher MCAT 3 score average or biological sciences subscore is 3 – 5 percentage points lower choice of family medicine or 5 – 9 fewer family physicians in a typical class. Schools with older students have broader admissions and less exclusive policies.

·        Schools in states with broader income and education distributions present a full range of students of lower income, middle income, rural, and diverse origins. When admissions committees are presented with a wider range of sufficiently prepared medical students, they can select the students who are most likely to distribute. When states concentrate income and education, medical schools are likely to admit more highly urban, out of state, foreign born, and highest income origin types.

·        Medical schools created since the creation of family medicine also have greater choice of family medicine. There are generational aspects of medical school mission, training, and admissions. Schools created since 1966 have 2 – 4 percentage points higher choice of family medicine.

·        Finally the medical students in the eastern part of the United States have lower choice of family medicine. Controlling for rural population, income, age of student, and medical school factors still leave a role for longitude in choice of family medicine, a factor of 1 percentage point more family physicians for each 250 – 300 miles west.

The factors can be combined into a regression equation  such that the Choice of family medicine = MCAT + State Inequities + Longitude of Medical School + School Creation post 1966

This equation explains 65% of the variance. The medical schools selected involved 109 with  normal distributions and the exclusions involved:

·        Merger schools in Pennsylvania, closed schools such as Oral Roberts, osteopathic schools, and the newest schools

·        Early Admission schools in Kansas City and Northeast Ohio

·        Differences in ethnicity, culture, geography, education, inequities, and mission - Historically Black, Puerto Rican, Hawaii, Military, District of Columbia schools

·        In choice of family – Duluth and Mercer and the impacted U of Minnesota

The choice of family medicine included family physicians in the 2005 Masterfile who self-designated office based and family medicine career indicators. This excludes academic and administrative family physicians and is very close to match choices of family medicine. Additional family physicians are added after the match, particularly in allopathic schools that traditionally have not graduated family physicians.

Other factors such as student age and origins and income levels correlated too highly with MCAT and state inequities measurements to include. Substituting mean class age of the school for MCAT results in an equation that explains 50% of the variance. Student age and birth county income levels and birth county population density levels reflect school MCAT scores and likely the student MCAT scores as well.

Because family medicine is central to physician distribution, a failure to focus on student factors, admissions, and state education that can graduate more family physicians is a failure of physician distribution. Actually failures in education and higher costs of living tend to drive all middle income peoples out of major cities. Those moved out or not graduated include all of the basic infrastructure types: teachers, counselors, public servants, nurses, and family physicians. Those that stay have assistance, family connections, own land, or make over $200,000 a year may be able to stay and even profit from living in high concentration areas, but they will pay more in multiple areas.

Driving Difficulty or Distinction

Physician Workforce Studies

Multiplier Impacts Involving Birth Origins, Age, Choice of Family Medicine

Distribution of Physicians - listings of MCAT, distribution of medical schools, research, physician retention levels

Comparing Physician Distribution and the MCAT

NIH Dollars and FP Doctors and Rural Doctors

More definitions and variables at Bowman FP Grad Studies 2004

Choice of Family Practice Update, Reasons for Decline

www.ruralmedicaleducation.org