Robert C. Bowman, M.D.
Distributions of Origins and Physicians
For better or for worse many Americans relate to higher education and medical education by what is seen in various rankings. Although the rankings are often associated with quality in the mind of the public, the relationship between quality and MCAT scores is missing in action. What is increasingly clear is that the medical schools that have the most exclusive selections are the ones that distribute physicians at the lowest levels.
Summary of Findings
Distributional medical schools admit distributional types of students and graduate more family physicians, rural physicians, and physicians for underserved locations. Schools and students with higher MCAT scores have more exclusive origins and locations for the first 30 years of life and are the least likely to choose family medicine or be found in rural or underserved locations or primary care careers.
Only those born in rural areas and those found in family medicine have rural distributions above national averages. Only those born in underserved areas and those found in family medicine have underserved distributions above national averages.
Changes in Admissions include fewer rural, lower income, and middle income origin. Changes in training mean less preparation for complex primary care careers. Fewer US MD Grads are choosing family medicine, a result of lack of support for the permanent primary care choice, lack of support for health care in lower and middle income areas, and lack of support by major medical centers. Major Medical Centers hire 50% of the nation’s family physicians, over 65% of all other forms of primary care in the nation, and over 75% of all physicians outside of family medicine. When major medical centers see less benefit from hiring primary care physicians due to lower reimbursement and rising costs and better reimbursement for ER and hospital care, medical students will not be influenced positively toward primary care and family medicine. Five Periods of Health Policy and Physician Career Choice
Physician Career and Location Choice by Types of Medical Schools
|
|
FPGP |
Rural |
MMC |
Urban Under-served |
Rural Under-served |
Office Primary Care |
Women's Health |
|
Puerto Rico Schools |
12.1% |
3.5% |
68.1% |
8.1% |
1.0% |
21.7% |
16.9% |
|
Traditional Black Schools |
18.7% |
9.3% |
69.6% |
7.8% |
3.2% |
37.8% |
26.6% |
|
UCLA,Davis,Irvine,UWash |
20.0% |
8.9% |
77.8% |
4.0% |
2.4% |
37.9% |
25.4% |
|
MCAT 10.6 – 12 |
6.2% |
5.4% |
85.4% |
2.2% |
1.0% |
22.6% |
10.7% |
|
MCAT 10.08 - 10.54 |
10.5% |
8.6% |
80.3% |
2.3% |
1.3% |
28.6% |
16.4% |
|
MCAT 9.76 - 10.05 |
13.4% |
10.5% |
76.8% |
2.6% |
1.8% |
29.7% |
19.1% |
|
MCAT 9.5 - 9.76 |
13.8% |
11.2% |
75.6% |
3.0% |
2.2% |
31.4% |
20.3% |
|
MCAT 9.15 - 9.49 |
16.2% |
14.6% |
73.2% |
4.0% |
3.7% |
32.4% |
22.1% |
|
MCAT 8.6 - 9.15 |
21.3% |
19.4% |
69.7% |
3.8% |
4.9% |
37.9% |
27.3% |
|
Duluth, Mercer |
38.1% |
35.1% |
52.8% |
5.2% |
9.2% |
55.7% |
45.8% |
|
Osteopathic Upper MCAT |
29.7% |
13.8% |
66.3% |
3.5% |
2.5% |
38.8% |
33.5% |
|
Osteopathic Lower MCAT |
37.6% |
23.3% |
57.8% |
3.9% |
6.4% |
43.6% |
40.8% |
|
All US Medical Schools |
15.5% |
11.7% |
75.5% |
3.2% |
2.5% |
31.2% |
21.0% |
If the nation desires to influence distribution, then changes in admissions, preferences for certain types of schools, preferences for family medicine, rural, and underserved training, and health policies that support the physicians who do choose family medicine, rural, and underserved locations.
Birth Origins and Type of Medical School
|
|
MS County |
Foreign Born |
Instate Born |
Older Than 29 |
Younger Than 26 |
Top Quartile |
Bottom Quartile |
|
Puerto Rico Schools |
75.4% |
7.9% |
71.9% |
11.1% |
18.3% |
5.8% |
0.8% |
|
Traditional Black Schools |
71.9% |
23.2% |
13.1% |
26.3% |
6.6% |
26.2% |
13.1% |
|
UCLA,Davis,Irvine,UWash |
71.2% |
21.9% |
43.6% |
28.8% |
7.0% |
40.8% |
5.9% |
|
MCAT 10.6 - 12 |
76.4% |
16.2% |
28.2% |
17.7% |
9.1% |
35.4% |
8.3% |
|
MCAT 10.08 - 10.54 |
75.3% |
14.6% |
36.5% |
21.3% |
5.3% |
34.5% |
8.0% |
|
MCAT 9.76 - 10.05 |
68.4% |
13.6% |
41.5% |
22.6% |
7.9% |
26.6% |
10.3% |
|
MCAT 9.5 - 9.76 |
69.5% |
14.4% |
40.4% |
23.2% |
5.4% |
29.4% |
10.5% |
|
MCAT 9.15 - 9.49 |
61.3% |
12.6% |
47.2% |
24.3% |
5.5% |
17.5% |
19.8% |
|
MCAT 8.6 - 9.15 |
52.3% |
8.7% |
51.8% |
25.9% |
4.0% |
12.8% |
29.5% |
|
Duluth, Mercer |
42.2% |
4.7% |
60.2% |
31.9% |
2.0% |
10.6% |
35.4% |
|
Osteopathic Upper MCAT |
70.3% |
8.6% |
33.6% |
30.0% |
2.4% |
19.4% |
5.1% |
|
Osteopathic Lower MCAT |
59.0% |
7.3% |
17.3% |
44.7% |
1.3% |
12.6% |
11.6% |
|
All US Medical Schools |
68.3% |
13.4% |
38.8% |
24.0% |
6.7% |
25.8% |
12.3% |
Birth Origins Compared to Desired Career and Location Choice
|
|
MS County |
Foreign Born |
Instate Born |
Older Than 29 |
Younger Than 26 |
Top Income Quartile |
Bottom Income Quartile |
|
Rural (11% average) |
9.2% |
8.5% |
12.8% |
14.9% |
8.3% |
8.3% |
21.2% |
|
Underserved (5.4% avg) |
5.0% |
6.8% |
5.8% |
7.7% |
5.9% |
4.1% |
9.7% |
|
FPGP (was 15% for all US medical schools) |
12.3% |
9.7% |
16.4% |
20.9% |
7.7% |
12.4% |
21.4% |
Bottom quartile reflects a dominant rural birth origin as well.
The medical schools that distribute physicians have lower income, rural, and older medical students and graduate more family physicians. The schools with highest income, highest scoring, most urban, most born in counties with medical schools did not distribute physicians or graduate into family medicine or primary care.
The class compositions are compared to practice outcomes.
Origins of 1987 – 1999 Graduates of United States Medical Schools Classified By MCAT and School Types
Practice Outcomes for 1987 – 1999 Graduates of United States Medical Schools
|
Types of Medical Schools: MCAT and Different |
Retain in Same State |
Research Career (1987-90 Grads Only) |
Subspecialty Internal Med |
Off IM / by total IM Res Grads |
Total Grads 1987 - 1999 |
Non Metro Born |
Rural % Pop 1992 State Location |
|
Historically Black |
16.8% |
0.8% |
34.5% |
54.2% |
2427 |
7.2% |
22.8% |
|
West Distributional |
62.8% |
1.2% |
37.6% |
55.6% |
6589 |
3.6% |
7.8% |
|
MCAT 10.6 - 12.03 |
34.8% |
3.6% |
53.7% |
38.5% |
30231 |
5.7% |
16.4% |
|
MCAT 10.08 - 10.54 |
35.4% |
2.0% |
48.1% |
44.5% |
33286 |
7.6% |
20.3% |
|
MCAT 9.76 - 10.05 |
37.9% |
0.9% |
47.3% |
44.7% |
33868 |
9.2% |
17.9% |
|
MCAT 9.5 - 9.76 |
38.0% |
0.7% |
44.5% |
47.7% |
37701 |
9.0% |
21.4% |
|
MCAT 9.15 – 9.49 |
47.8% |
0.7% |
45.4% |
47.5% |
35296 |
13.9% |
31.5% |
|
MCAT 8.6 - 9.15 |
49.2% |
0.6% |
46.2% |
46.8% |
14948 |
21.1% |
42.9% |
|
Duluth, Mercer |
64.7% |
0.6% |
28.9% |
64.2% |
766 |
31.9% |
25.5% |
|
Osteopath Hi MCAT |
48.8% |
0.2% |
40.2% |
50.2% |
9796 |
5.8% |
25.3% |
|
Osteopath Lo MCAT |
32.5% |
0.2% |
30.3% |
57.5% |
12740 |
16.2% |
26.3% |
|
Total |
40.3% |
1.2% |
46.4% |
45.6% |
226163 |
10.0% |
24.4% |
West Coast Distributional schools are UCLA, Irvine, Davis, and the U of Washington. These and the Duluth and Mercer schools were singled out as different with a focus on distributional types of students and even better distribution than expected. The schools with lower MCAT had greater retention instate. Higher scoring students do tend to leave their medical school state for other locations and do not return. Researchers have one of the lowest levels of retention with less than 19% found within 60 miles of their medical school. The Office IM / total IM residency graduates (IM or an IM subspecialty choice) were also more likely to be retained in IM generalist practice when they were older, humble origin, or graduated from a distributional medical school. Rural practice location is more likely in rural states, distributional medical schools, and schools graduating more family physicians. Underserved distribution is more likely in states with higher poverty, distributional medical schools, and schools graduating more family physicians.
Physician Distribution in the United States