States Graduating More Family Physicians
Robert C. Bowman, M.D.
Comparing the 50 states there are key associations between
education policy, health policy, family medicine, and physician distribution.
These tend to relate along socioeconomic lines.
Increased family physicians are associated with
·
Breadth of education investment, broad education measures such as
high school graduation, and broader medical school admissions of rural born,
older, and lower income students
·
Broad health care coverage for children and poor people and lower
health care costs for a state
·
Decreased concentrations of income, education, and people.
Students from lower income levels and less educated families were more likely to
become family physicians and were more likely to return and serve those of less
income and education, increased numbers of those in a state with high school
compared to college education, lower population density origin for students who
will become family physicians and more rural locations for family physician
graduates
States and medical schools graduating more family
physicians had broad medical school admissions and broader education and health
investments and were less dependent upon other states or nations for the
physicians, family physicians, medical students, and other resources needed in
their state.
States and medical schools graduating fewer family
physicians tended to specialize and focus on narrow areas as evidenced by a with
a higher college graduation rate compared to high school graduation, graduation
of more physician researchers, narrow investments in education, and poor
distribution of education and health resources. These states and medical schools
were more dependent on other states or nations for the physicians, family
physicians, medical students (foreign born), and other resources needed in their
state.
The birth states graduating more family physicians
- Had a higher percentage of state funding for education
compared to local funding (+.351),
- Had a priority focus on breadth of education with
better high school graduation rates (+0.394), higher ratios of high school
graduation to college graduation (+0.613), lower college graduation rates
(-0.423), and graduation of fewer physician researchers from 1987-1994.
(-0.323)
- Had a better distribution of education resources with
had better grades on education resource equity (+0.264), a better
distribution of funding to poor as compared to rich school districts
(+.321),
- Had a different approach regarding some of the
troubling issues facing the nation in health care with much lower health
care costs (-0.465), lower average malpractice liability claim for
1999-2001(-0.468), and had a lower abortion rate overall (-0.539), but a
higher abortion rate for teens (+0.483).
- Had greater challenges to overcome in funding,
geography, and education with lower median family income (-0.474), higher
poverty rate, lower property values, lower levels of college graduates
(-0.423), a higher percentage of population in rural areas (+0.721), and
lower grades on teacher quality (-0.394)
- Had a higher ratio of high school graduation rate
divided by state personal income level (+0.681) and a lower percentage of
state education funding devoted to salaries (-0.299) which may reflect an
efficiency of education or more of an effort by people and communities
beyond state funding levels,
- Had a lower grade regarding standards of education
(-0.584)
- Had the highest percentage of state public medical
school graduates retained in a state for practice in 2004 (+0.381).
- States graduating more family physicians were more
likely to have increased the number of medical students gaining admission to
medical school in recent years even though states graduating fewer family
physicians had greater or much greater population growth rates. This may
reflect education or it may be that states losing ground had medical schools
that admitted relatively more foreign born medical students, now up to 16%
for allopathic medical schools and over 40% in schools in CA, NY, and DC.
Methods and Sources
The source materials of the study include
- state level data on education from NCES National
Center for Education Statistics
www.nces.ed.gov , Education Weekly, Post Secondary Education, and
Funding Gap 2004
- the American Medical Association Masterfile 2004
- family medicine databases 2004 and liability data 2003
from the Robert Graham Center
- AAMC Minorities in Medicine Reports
- AAMC Graduation Questionnaire Reports
State per capita Ed Spending 00-02, State Share of
Education Compared to Local, State Education Distribution to High and Low Income
Districts (Funding
Gap 2004)
Allopathic Public FM Match 2004 (Family Medicine +
estimates from states without own public school)
FM Choice by those Born in a State (AMA Masterfile 2004)
Health Care Costs (Baicker
and Chandra)
High School Graduation Rate 1986 (Education Weekly)
The methods include simple correlations, all significant at
the .01 level or above.
State By State Education
Status
Physician
Workforce Studies
Family Medicine
Central: National Comparisons of Workforce
Birth Origins Articles
Birth Origins and
FP Choice
www.ruralmedicaleducation.org