Robert C. Bowman, M.D.
Certain types of medical students are more likely to choose rural and underserved locations after graduation. Distributional students include medical students who are older than 29 years at graduation, those born in rural areas, those born in the same state as their medical school, and those of lower income levels. Family medicine is the specialty with the best distribution to rural and low income areas of the nation (Mold Graham Center, also Bowman). When students with distributional characteristics chose family medicine, distribution is facilitated.
The following involve data on locations. These are equilibrium conditions, not first practice locations. Birth data regarding geographic and socioeconomic origins are compared to distribution and choice of family medicine.
|
Factors |
Geographic Birth Origins |
Age at Medical School Graduation |
1969 Birth County Per Capita Income |
|||||
|
Location Percentages |
Foreign Born |
Urban Born |
Rural Born |
Less than 26 |
Usual Age |
Older than 29 |
High Income |
Low Income |
|
Rural Locations
|
|
|
|
|
|
|
|
|
|
Not Primary Care |
4.5% |
7.0% |
16% |
4.7% |
7.1% |
9.9% |
5.4% |
13.8% |
|
Office Internal Medicine |
4.7% |
8.1% |
23% |
6.4% |
8.4% |
11.0% |
6.2% |
18.8% |
|
Office Family Medicine |
11.3% |
20% |
43% |
17.6% |
23% |
26.0% |
16.9% |
37.8% |
|
Underserved Location
|
|
|
|
|
|
|
|
|
|
Not Primary Care |
4.0% |
3.8% |
6.5% |
3.0% |
3.8% |
5.4% |
3.0% |
6.9% |
|
Office Internal Medicine |
5.6% |
4.8% |
10.5% |
4.2% |
5.2% |
6.6% |
3.7% |
10.1% |
|
Office Family Medicine |
11.7% |
11.4% |
15.0% |
10.2% |
11% |
14.9% |
10.5% |
18.7% |
Shaded cells exceeded the average national distributions of 5.4% underserved and 11% rural.
Rural distribution for rural born Native American family physicians is over 45%.
Family medicine distribution is beyond birth origins impacts, an effect not seen in other specialties. Even for 100% rural born family medicine residency graduates, a maximum would be 43% rural location. Rural distribution for accelerated family medicine residency programs and rural graduate training programs range from 50 – 95% depending on program type and location. Other primary care choices involve rural location at 8% for urban born and 18 - 22% for rural born residency graduates. This is no different than the usual physicians and the rates are less than half of family physician rates, meaning no facilitation of distribution.
Underserved distribution for Black or Mexican American family physicians is 20 – 25%. This increases to a 30 - 35% level for those graduating from inner city family medicine residency programs and is even higher for Native American family physicians. Distribution for generalist internal medicine parallels birth origins.
Table of Distribution for Allopathic US Graduates
|
Characteristic |
Distribution Tendency |
% of Allo Med Students |
All Internal Medicine Specialties |
Office-Based Internal Medicine |
Distribution With FM Choice |
Accelerated FM Grads n=150 |
|
Older than 29 |
Rural |
21.3% |
10.2% |
12.0% |
28.2% |
47.9% |
|
Younger than 30 |
|
78.7% |
6.7% |
8.7% |
24.4% |
53.2% |
|
Rural born |
Rural |
10.3% |
17.9% |
22.7% |
45.8% |
56.8% |
|
Urban born |
|
89.7% |
6.4% |
8.1% |
21.1% |
48.0% |
|
Instate born |
Rural |
40.2% |
8.8% |
11.2% |
28.2% |
53.2% |
|
Out of State Born |
|
59.8% |
6.5% |
8.3% |
23.0% |
47.9% |
|
Average Rural Location |
|
10.4% |
7.4% |
9.5% |
25.5% |
50% |
|
White Male |
Rural |
35.3% |
|
|
30.7% |
56.3% |
|
White Female |
|
30.0% |
|
|
25.6% |
54.0% |
|
Native American |
Rural |
0.7% |
|
|
40.5% |
NA |
The distributional students also share other characteristics involving barriers of income, maldistribution of education resources, inadequate college funding support, and lower ratios of medical school admission.
Changes in Admissions in Allopathic Medical Schools - lower income, middle income, and rural origin medical students are losing out to those least likely to distribute and choose family medicine.
Accelerated Family Medicine Training Programs
Family Medicine Central: National Comparisons of Workforce
Poverty Locations and Physicians
Family Medicine Physician Distribution by gender and ethnicity for 1997 - 2003 graduates nationwide