Robert C. Bowman, M.D.
All 6 of the osteopathic public schools started out lower than the national
FPGP average for the first 3 classes before rising to the top levels of FPGP
choice and distribution in later years.
All 5 of the private osteopathic schools started with national average (2) or
greater (3) levels of FPGP choice compared to national averages and have
generally maintained this level.
22 of the allopathic public schools began at greater than the national average
and generally have stayed above the average
10 allopathic public schools began at the average U Connecticut, U Nevada,
NEOUCOM, South Alabama, SUNY Stony Brook, U Mass, U Missouri KC, Eastern VA,
Texas A & M and have remained at the average with some exceptions
2 allopathic public schools (UC San Diego and Arizona) began below the national average
4 of the allopathic private schools started below average - Mt. Sinai, Rush, U
Central del Caribe, Brown - stayed lower
1 or Dartmouth began at the average
4 or Ponce, Morehouse, Mayo, Oral Roberts all began above average - generally
have continued in this
Hypotheses that would be interesting to explore beyond the numbers
- the type of medical school impacts the first years of FPGP choice
- the timing of medical school creation may impact the choice of family
medicine, rural, and underserved
- the first years of a medical school may not fully reflect the eventual
outcomes for FM, rural, or underserved in some types of schools but may reflect
the future outcomes in others
Method - Masterfile using class years and FPGP choice divided by total graduates
of the class year for each school
Results - The table lists the average FPGP choice for the nation as of 2004 data from
the Masterfile by class year. This gives some baseline of comparison for the
FPGP choice and trends for use in examining individual schools. National
averages for the school for the first 3 years (disregarding distortions from low
numbers) are compared to national average for the nation during this same time
period.
Allopathic Private | msid | ST | Start Compared to National FPGP | 3yr avg for school |
Mt. Sinai | 3547 | NY | low | 3.0% |
Rush | 1601 | IL | low | 8.3% |
U Central del Caribe | 4203 | PR | low | 10.1% |
Brown | 4301 | RI | low | 12.3% |
Dartmouth | 3201 | NH | avg | 12.5% |
Ponce | 4202 | PR | high | 18.0% |
Morehouse | 1221 | GA | high | 21.3% |
Mayo | 2608 | MN | high | 23.8% |
Oral Roberts | 3905 | OK | high | 43.5% |
Allopathic Public | ||||
UC San Diego | 518 | CA | low | 3.3% |
Arizona | 301 | AZ | low | 5.3% |
Penn State | 4114 | PA | avg | 11.6% |
U Connecticut | 802 | CT | avg | 12.0% |
U Nevada | 3101 | NV | avg | 12.3% |
NEOUCOM | 3844 | OH | avg | 13.1% |
South Alabama | 106 | AL | avg | 13.2% |
SUNY Stony Brook | 3548 | NY | avg | 13.2% |
U Mass | 2416 | MA | avg | 14.1% |
U Missouri KC | 2846 | MO | avg | 15.5% |
Eastern VA | 5107 | VA | avg | 16.0% |
Texas A & M | 4816 | TX | avg | 16.0% |
U of NM | 3401 | NM | high | 8.4% |
UC Davis | 519 | CA | high | 13.2% |
UT San Antonio | 4813 | TX | high | 14.6% |
U South FL | 1104 | FL | high | 16.4% |
Hawaii | 1401 | HI | high | 16.9% |
Marshall | 5502 | WV | high | 17.3% |
LSU Shreveport | 2106 | LA | high | 19.4% |
UT Houston | 4814 | TX | high | 19.9% |
Uniform Services | 2312 | MD | high | 20.3% |
Med Coll Ohio | 3843 | OH | high | 20.4% |
UMDNJ RWJ | 3306 | NJ | high | 22.2% |
East TN St | 4720 | TN | high | 22.4% |
U S Dakota | 4601 | SD | high | 22.4% |
Brody E Carolina | 3608 | NC | high | 22.4% |
Texas Tech | 4815 | TX | high | 22.5% |
U N Dakota | 3701 | ND | high | 23.5% |
Mich St Allo | 2512 | MI | high | 23.7% |
U S Carolina | 4504 | SC | high | 23.9% |
U MN Duluth | 2607 | MN | high | 30.0% |
Wright State | 3845 | OH | high | 35.3% |
Southern Illinois | 1645 | IL | high | 35.5% |
Mercer | 1222 | GA | high | 37.2% |
Osteopathic Private | ||||
Lake Erie Osteo | 4178 | PA | avg | 14.9% |
Nova SE Osteo | 1175 | FL | avg | 15.3% |
NY Osteo | 3575 | NY | high | 14.2% |
Western Osteo | 576 | CA | high | 19.9% |
U New Eng Osteo | 2275 | ME | high | 21.9% |
Osteopathic Public | ||||
Mich St Osteo | 2576 | MI | low | 2.5% |
Ok St U Osteo | 3979 | OK | low | 5.9% |
UMDNJ Osteo | 3375 | NJ | low | 6.3% |
U N Tx Osteo | 4878 | TX | low | 6.5% |
Ohio U Osteo | 3875 | OH | low | 7.1% |
WV Osteo | 5575 | WV | low | 9.2% |
Hypotheses that would be interesting to explore beyond the numbers
WV Osteopathic - now the leader in the world in % US rural docs,
Oral Roberts is an interesting study from a number of aspects. There is a beginning and an ending for ORU grads. Also the impact of this beginning and ending can be compared to U of Oklahoma and the Ok State osteo. Shifting of student types in states such as Oklahoma and Pennsylvania are indicators of the potential impact of health professional advisors and school efforts to attract certain types of students, thus shaping future outcomes. ORU FM production for 1982 began with 2 for FM then in subsequent years 6, 11, 8, 11, 16 (during a low period for FM choice in 1987 class), 7, 7, then 8 in the final class. for percentage of FPGP choice the class started with 25.0% in 1982 then 48.0% 57.6% 45.0% 41.0% 46.3% 24.2% 27.0% 36.8%
When a school is in known
difficulty, it may also be less likely to attract the distributional types of
students, the ones who have fought current systems all of their previous lives
and might not want to fight the system for the rest of their lives. - more on
this later as the case may be made better with black or Hispanic students.
The first year grads of FSU are not likely to represent what they will continue
to become, although as I have stated before, the state of Florida has a very
great difficulty in advancing the rural, black, Hispanic, different, and diverse
types of students that they most need from the lower and middle income brackets
to higher education and medical school.
However given the level of state funding for FSU, the pressures are enormous to
produce geriatric, rural, and minority distributions to fit the expressed
mission. FM choice is a common denominator for care of the elderly, rural, and
underserved.
The case for students not feeling confident in health policy or a medical school
is made by the choices of Historically Black medical school students and
students from medical schools with higher levels of black and Hispanic students.
Choice of family medicine has fallen at the highest levels from the peak 1995 -
1997 choice to the current choice in these schools. The west coast
distributional schools are a category I created for UCLA, Davis, Irvine, and the
U of Washington. These are schools that have had much greater choice of FM and
distribution to underserved areas than expected given the students and
locations. They also tend to have older students who also have greater
distribution. Diversity in the student body is high. The West Coast
Distributional schools also shared the significant decline of Historically Black
colleges, I suspect that the combination of students who went with FP when it
was hot and those who went with FP because it was stable and supported, helped
peak FM choice in these school types because of their student blends. When FM
support declined and FM was no longer respected and FM was no longer a top hire,
these students made other decisions. This is tragic as we and the nation lost a
lot of the most distributional types of students and family physicians, and a
lot of potential teaching physicians as well. Distributional Medical Schools:
A Matter of Distributional Students and Careers for graphic comparing peak
FM choice to recent FM choice
Alternative Hypotheses
Also there are differences in LCME and osteopathic beginnings, and this may be
reflected in the admissions and curriculum. More preparation could potentially
help osteopathic medical schools produce a higher FPGP number sooner.
Interactions between the accrediting folks and the school could be important
areas of study. also will new osteopathic schools have the later rise of FPGP at
a time with declining FP choice and declining primary care policy and increasing
osteopathic status.
Conclusions
There are interesting differences in type of school and type of beginning for student career choices. School support levels and accreditation support may vary. The environment of the nation may impact student choice. Student types may vary in the first few years of admissions. Variation in student choice involves class years also.
Certain student types may also need more reassurance, from the school for certain types of schools, or from the nation to choose certain types of specialties. Students may also think that they need more support or know that they need more support, and this may not be around in the early years of a school or the school may not address this area with students in the early years until they realize the importance of support areas for certain types of students.
Do schools implement missions, or do their own thing? After controlling for school type (osteopathic public) - Do initial class years actually reflect the true mission of the school?
Robert C. Bowman, M.D.
[email protected]
Distributional Medical Schools: A Matter of Distributional Students and Careers
Distributional Medical Schools: The Lost Lesson of Specific Forms of Government Support
Five Periods of Health Policy and Physician Career Choice