Schools with Rural and Family Practice Representation in Admission Committees Admit More Who Become Rural Doctors (UNMC, Mercer, Upper Peninsula, Duluth, Marshall, Jefferson, WWAMI, others)
Medical schools in more rural states also graduate more rural doctors
Admission committees face many pressures. Most recognize the importance of getting the right students admitted, but there is little time spent on the actual deliberation of each candidate. Committees often have a full time staff person, but the actual members of the committee are stealing time from other duties to be there. There is also little training for the committee. Perhaps time is too important.
There are various processes that admitting committees use. A more advanced procedure is in use by Kentucky. Priority is given to those likely to become rural doctors first, until the quality is such that candidates would not make it through medical school.
The classic response, it's the poor rural economy Don't believe what many medical leaders believe. Rural Health is the economy, up to 30%. See Economic impact of a rural physician. Programs can choose more rural doctors, therefore medical schools are to blame if they do not adopt peer-reviewed published studies. They must combat the usual trends. Medical School Trends Summary
It is well documented that we can indeed choose the right students (Physician Shortage Area Program by Rabinowitz) See Series on Few Young Professionals. Also articles such as
Boulger JG. Family medicine education and rural health: a response to present and future needs. J Rural Health. 1991;7:105-115.
Brazeau NK, Potts MJ, Hickner JM. The Upper Peninsula Program: a successful model for increasing primary care physicians in rural areas. Fam Med 1990;65;12 Suppl:27-31.
Which Medical School for Rural Practice? - national listing of best ones
Studies have shown that committees can pick students for different outcomes, if more time is devoted to the effort and students are picked for different characteristics such as service orientation (Madison, UNC Chapel Hill Admissions). In this study, the researchers looked at the characteristic of service in the interview and personal statement, and found that students could be selected for eventual primary care. It is also possible to choose more carefully by understanding who is unlikely to choose rural practice and also the characteristics of students, residents, or physicians that stay in rural communities. See also why some states have centralized resources and inadvertently cut off the flow of young professionals of all types to rural areas.
The first choice therefore is getting faculty or others on a committee
that can afford to spend the necessary time to select better.
Some schools such as WWAMI, use rural community leaders to help them with selections, with good success.
Dona Harris, Ph.D., did studies at the University of Utah on MCAT and rural (Family Medicine 21 3 May-June 1989 p 187-90). The higher the scores, the less likely the choice of rural practice.
Clearly selecting for the most intellectual individuals is not a
good thing for rural communities, and perhaps not as
good for the nation's health care.
Other studies at U of KC (J Med Ed vol 56 sept 1981 p 717 726, studies in MN on RPAP students, studies on Jefferson students in PA (Rabinowitz), showed that students that took rural tracks (selected on basis of rural background, desire to return rural and desire to do FP) did poorer on MCAT and GPA when compared with traditional students. Also J Med Ed Vol 51 Jan 1976 p 47-49 (Cullison, Reid, Colwill) showed poorer MCAT in rural background students.
Admission committees must be brave to choose the students
that will go where they are needed to provide service.
This will mean that they will receive much criticism from their colleagues about declining board scores, more remedial students, delayed graduation, less prestige, accreditation concerns, and other inconveniences to faculty time.
It is often very difficult to consider students from rural areas because the scores are so low in some states. It is important to remember that other expenditures are lower in such states for education, public health, and mental health. Smaller schools cannot ignore the needs of the more challenging students and this tends to provide a more uniform product. This impedes the education of some of the more gifted students. A typical rural product might struggle with some college courses. A less than stellar college would be enough to keep such a student out of the running for professional school. Of course a stellar school is also more likely in an urban area where the student might fall prey to an urban or highly specialized spouse. See Centralization.
Admissions in such states must reach out to small colleges
and high schools to encourage the gifted as Missouri,
Nebraska, and Pennsylvania programs do.
One study, (Declining Class Site and the Decline in Graduates Choosing Family Medicine (Fahey, Saches, Bauer) Academic Medicine 67 10 oct 1992 p 680-684) demonstrated an association between decreases in medical school class sizes and declines in the number of graduating students choosing family medicine. It seems that committees select those likely to choose family medicine (and rural practice) near the last after they have selected "the best and brightest". Senior students selecting family practice declined from 2000 per year to 1600 during a decade.
Continued use of GPA, MCAT, academic, and research priorities are likely to cause further declines, especially if we continue to decrease class sizes. Inevitably we will, so it is even more important to select students that are more likely to serve the underserved.
One area to research is to look at admission committees that faced major pressure to increase board scores and see what happens to the students regarding primary care choices and eventual rural practice choice.