Medical Schools and Rural Graduation Rates 

Updated 2005 rural ranking of medical schools in the world with US physician graduates at

Ranking Medical Schools and FP Residency Programs

Dependent variables used from WAMI study by Rosenblatt and Hart

Additional variables added by Robert C. Bowman, M.D. using data from multiple sources.

Previous studies at WAMI by Rosenblatt et all were published in JAMA. This study noted the importance of rurality, public medical schools, NIH funding (negative correlation), and rural mission. All were factors related to the graduation of rural physicians. See abstract of study at Which Medical Schools Produce Rural Physicians?

Methods:

I used WAMI study data for the dependent variable, the percent graduating into rural practice. See data at Medical Schools Ranked By Rural Graduation Rate. Also I added the % of underrepresented minorities from each school as reported by the AAMC in 1997, I added the latest NIH Grant Amounts for Medical Schools 2001, and also FP data from programs, and state demographic characteristics.

Caution - this data is from different years by convenience so the research is preliminary, also the rural mission or person is arbitrary and subject to bias since it was my designation based on work done a few years ago 

Disclaimer - be aware that the data sources vary by a few years. In general these variables do not change much over time. The original WAMI study did not have values for Mercer, Morehouse, Uniformed Services, Charles Drew, U of Puerto Rico, and osteopathic schools. 

Interpretation and Discussion     - be sure to understand cautions above regarding the data elements, their timing, and the assumption that the rural graduation rate has not changed:

1. The main factor that contributes to the successful rural graduation rate for a medical school is global and environmental, the rurality of the state. The percentage of the state population that is rural is indeed likely to determine the political pressures placed on the medical school to make or maintain changes likely to satisfy the rural needs of the state.

2. The commitment of the school (and government) toward the specialty most likely to graduate rural physicians, Family Medicine, is also significant. Since the match rate is so dependent on admissions of the right students, this is also a key element.

3. Leadership is the final factor in efforts to graduate more rural physicians. Former rural physicians in key positions can have great impact, especially if they participate in the selection of medical students that are more likely to choose rural practice. This has been found to be significant at the medical school level, department chair level, and at the residency program level. When the program director was the rural contact person for the residency, the program was far more likely to graduate rural physicians. When rural docs have had a key role in admissions (Nebraska, Mercer, WAMI, others), the impact has been enormous. Predoc directors with rural orientation or background have also accomplished much. Admissions efforts could be improved by involving rural doctors, rural community members, or physicians who have been in shortage areas such as NHSC physicians.  

4. Class size can be important to educational quality and the mission of the school. It may also be difficult to attract a larger number of medical students who share an interest in a smaller area such as rural practice. Also larger medical schools may just not focus on rural needs.

5. MCAT scores should not be a major focus of medical school admissions other than to help establish a baseline for academic readiness. Beyond this, MCAT and GPA should take a back seat to communication skills, versatility, experience, maturity, ability to make a contribution to medicine, leadership, and interest in serving the underserved areas of the state or nation.

When studies do show that there are variables that are significant, the hope is that the researcher can find something that can be changed. For example the rurality of the state is a constant. Other changes that might impact rural graduation rates might have undesirable consequences. Decreasing the admission of underrepresented minorities may not result in more rural doctors. This would have other consequences that would be bad for the nation. It would certainly mean less doctors for underserved areas, where 40% of underrepresented minorities choose to locate (as opposed to 10% of all medical students). Getting physicians to rural areas with minority populations remains a most difficult challenge and new approaches are needed Community Driven Approach

The one factor that could have long term impact is a change in the rural mission or person variable. Of course changing a mission statement means little without enacting a strategy or plan.

Having a rural person also means little without other kinds of investments. Of all the factors this is the variable most easily modified to graduate more rural physicians. In my studies of family medicine residency programs, having a program director who was the rural contact was associated with graduating more rural physicians. Apparently a rural person, in order to accomplish change, must be in charge of curriculum, programs, or admissions. Admissions research demonstrates that selecting students with rural background and Family Medicine interest does result in more rural physicians. Having a rural faculty or dean working with admissions makes eminent sense.

This mission/person variable is easily the one that is most least valid. The rural mission or person variable was an arbitrary choice based on past surveys of program directors, familiarity with the medical schools, and activity at rural medical education events, but even without this variable, the variance explained was still over 70%.

Time to end the debate and get on with changes that will result in more rural doctors, such as impact on admissions committees and their choice of candidates that will choose rural practice.

One could examine this model further by looking at total GME dollars to the institution and likely get more interesting results than by using a proxy such as the number of residents adjusted by the size of the medical school class. This would probably not impact the findings. 

Also it would be interesting to see if medical school minority efforts mirror the % of the state population that is minority.

See also Family Medicine Residency Programs and the Graduation of Rural Family Physicians

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Robert C. Bowman, M.D,

UNMC Department of Family Medicine Director of Rural Health Education and Research

983075 Nebraska Medical Center

Omaha, NE 68198-3075

(402) 559-8873 or fax at -8118

Email: [email protected]

http://www.unmc.edu/Community/ruralmeded/

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Ranking Medical Schools and FP Residency Programs