Medical School Admissions By Income: Pipeline Issues in Medical Education

Robert C. Bowman, M.D.

Where do we lose the physicians most likely to serve the underserved and what do income changes mean for the specialties that serve the underserved like family medicine?    

• The losses are steady and progressive from birth until admissions.
• There are major changes in who gets the best start in education as early as age 3 - 5 as determined by those who read to their children and those who do not
• Those who get the best start have the best achievement test scores and are the most likely to finish what they start: high school, college, professional school. Without a good start, there will be great inefficiencies and many that drop out of high school, college, etc. (California, District of Columbia)
• Bright Future states have the best completion rates, choice of family medicine, retention of graduates in the state of training, and distribution to underserved areas. Bright future states support education, health care coverage, and a better future.

Matters of Perspective- comparisons of medical schools by types of students admitted by income, and how distribution and choice of FP disappears with increasing income, MCAT, and younger age - medical school leaders view distribution differently, especially those trained at schools with few distributional student types.

Jim Boulger of Duluth first presented this pipeline concept from high school to college to application to admission at Rural Medical Educator meetings

The nation had 3,792,800 that were or should have been seniors in high school. This figure involved the Age 20 - 24 numbers in the 2000 Census divided by the 5 years involved from 20 - 24. The graduation and college data is from Postsecondary Education. The data is matched up to actual class averages. The Family Medicine choices are based on income level as per Cooter's Jefferson Longitudinal Studies and my Birth Origins and FP Choice studies.

Graduation data from www.postsecondaryeducation.org

Maps of Graduation indicate state variations in high school and college data.

Unless the nation reverses course and admits more lower income, whites, males, older students or others likely to choose family medicine, the nation will have increasing difficulty with health care access, particularly in rural and poverty locations.

Maldistribution Cured

Physician Workforce Studies

Physician Distribution in the United States

State By State Education Status

States Graduating More Family Physicians

Most Rural FP Grads

Underserved - Overview and Models

www.ruralmedicaleducation.org