Admissions Ratio By Birth Origin

Admissions Ratios and US Medical Students

Allopathic Admissions in the United States, Gender, Ethnicity, Distribution

Robert C. Bowman, M.D. [email protected] www.ruralmedicaleducation.org

1994 - 2000 Allopathic Graduates	Male Ratio, one out of ___ are allopathic medical students	Female Ratio, one out of ___ are allopathic medical students	Medical Students 1994-2000	% of Medical Students	Ratio Population 18 - 24 to Allopathic Medical Students	Ratio High and Low Alternates	Range or Alternative Measurement	Changes Anticipated	Pop in 2000	% of Population By Group	% 18-24 by census in MIM 2001	number 18 - 24	by add m n f	Male 18-24 by adding 18 - 24 cats in 2000	Female 18-24 by adding 18 - 24 cats in 2000	Male med stud avg 1994-2000	Female med stud avg 1994-2000	Medical Students 1994-2000 (AAMC)	Male Med Students	Female Med Students	% of Allopathic Medical Students, Male Segment	% of Allopathic Medical Students, Female Segment
Asian Indian	17	24	8,136	6.50%	22.6	24.8	Add 10% pop	Fastest Increasing	1700000	0.60%	10.80%	183600	161933	81219	80714	0.58	0.42	8136	4719	3417	3.80%	2.70%
Chinese	46	63	4,882	3.90%	59.7	65.7	Add 10% pop	Increasing	2700000	1.00%	10.80%	291600	257175	128989	128186	0.58	0.42	4882	2832	2050	2.30%	1.60%
All Foreign Born	267	298	7,533	6.00%	279.8	100	Add 10% pop	Increasing past 16%	17562914	6.20%	12.00%	2107550	2107550	1165087	942463	0.58	0.42	7533	4369	3164	3.50%	2.50%
All Asian Students	48	66	20,340	16.20%	63.2	70.1	Add 10% pop	Increasing past 22%	11898828	4.20%	10.80%	1285073	1133431	568485	564946	0.58	0.42	20340	11797	8543	9.40%	6.80%
Vietnamese	61	98	1,424	1.10%	83.6	91.7	Add 10% pop	Increasing	1122528	0.40%	10.60%	118988	106928	53631	53297	0.62	0.38	1424	883	541	0.70%	0.40%
All Urban Born	166	194	109,228	87.00%	138.6	144	80% Urban not 77%	Increasing	162824682	57.90%	9.30%	15142695	19502538	9946294	9556244	0.55	0.45	109228	60075	49153	47.90%	39.20%
US All Student Total	187	220	125,549	100.00%	201.7	180	With Expansion	Increasing	281421906	100.00%	9.00%	25327972	25327972	12917265	12410706	0.55	0.45	125549	69052	56497	55.00%	45.00%
White	192	290	81,973	65.30%	214.1	190 - 230	Declining Yearly	Decreasing	211460626	75.10%	8.30%	17551232	18850900	9590900	9260000	0.61	0.39	81973	50004	31969	39.80%	25.50%
Any Native American	473	534	871	0.70%	501.3	501.3	Any vs All	Stable	4119301	1.50%	10.60%	436646	436646	222689	213956	0.54	0.46	871	470	401	0.40%	0.30%
Only Native American	316	348	871	0.70%	314.7	314.7	Any vs All	Stable	2586000	0.90%	10.60%	274116	287785	148427	139358	0.54	0.46	871	470	401	0.40%	0.30%
All Rural Born	433	302	16,321	13.00%	356.9	310.4	20% Rural not 23%	Decreasing	64727038	23.00%	9.00%	5825433	5825433	2970971	2854462	0.42	0.58	16321	6855	9466	5.50%	7.50%
Black	534	364	8,880	7.10%	422.4	468.8	Add 10% pop	Stable	36419434	12.90%	10.30%	3751202	3834463	1897485	1936978	0.4	0.6	8880	3552	5328	2.80%	4.20%
Mexican American	892	1060	2,887	2.30%	915.1	1006.5	Add 10% pop	Stable	20640711	7.30%	12.80%	2642011	2773415	1519075	1254340	0.59	0.41	2887	1703	1184	1.40%	0.90%
All Hispanic	737	876	5,975	4.80%	756.3	831.3	Add 10% pop	Stable	35305818	12.50%	12.80%	4519145	4743880	2598352	2145528	0.59	0.41	5975	3525	2450	2.80%	2.00%
Low Income Rural	823	572	3,690	2.90%	677.6	600 - 800	Range	Decreasing	27781728	9.90%	9.00%	2500356	2500356	1275181	1225174	0.42	0.58	3690	1550	2140	1.20%	1.70%
Income Quintile and % of Medical Students Admitted By Income Group
Top Quintile Income (60 - 65%)	66	56	75,329	60.00%	67.2	60	Increasing 2% per Year	Increasing	56284381	20.00%	9.00%	5065594	5065594	2786077	2279517	0.56	0.54	75329	42184	40678	33.60%	32.40%
2nd Quintile Income (18 - 22%)	209	193	25,110	20.00%	201.7	164 - 200	Range	Stable	56284381	20.00%	9.00%	5065594	5065594	2786077	2279517	0.53	0.47	25110	13308	11802	10.60%	9.40%
3rd Quintile Income (9 - 13%)	403	343	15,066	12.00%	373.6	310 - 450	Range	Decreasing	56284381	20.00%	10.00%	5628438	5628438	3095641	2532797	0.51	0.49	15066	7684	7382	6.10%	5.90%
4th Quintile Income (6 - 8%)	706	533	10,044	8.00%	616.4	550 - 750	Range	Decreasing	56284381	20.00%	11.00%	6191282	6191282	3405205	2786077	0.48	0.52	10044	4821	5223	3.80%	4.20%
Bottom Quintile Income (1 - 3%)	2751	2642	2,511	2.00%	2689.8	1600 - 4000	Range	Decreasing	56284381	20.00%	12.00%	6754126	6754126	3039357	3714769	0.44	0.56	2511	1105	1406	0.90%	1.10%

For ethnicity, gender, and rurality, the range is 1 in 20 for Asian Indian to 1 in 1000 for female Mexican American students. When considering income alone, the range is 1 in 60 for the top income quartile to 1 in 2700 for those at the lowest 20% income levels and may be as low as 1 in 4000. Many US urban areas have this wide range of admissions probability within the same or adjacent zip code areas.

1994 - 2000 Allopathic Graduates	FP Choice	Rural Choice in FP Graduates	Approximate Money Income Levels 2003	Parent Income Level of Accepted	Parent Income Level of Applicant	MCAT all applicants 1996 (AAMC)	MCAT Accepted 1996 (AAMC)
Asian Indian	2%	15%	$55,000	100000		9.70
Chinese	6%	6%		80000		10.30
All Asian	7%	11%		90000	80000	9.70	10.6
Vietnamese	22%	5%		42500		9.10
All Urban Born	13%	21%		higher
US All Student	18%	24%
White	14%	26%	$48,000	90000	80000	9.50	10.3
Native Am	9%	47%	$33,000	60000	55000	8.10	8.9
All Rural Born	22%	30%		lower
Black	13%	11%	$33,000	55385	50000	6.90	8.4
All Hispanic	12%	12%	$33,000
Mexican Am	19%	13%	$33,000	50000	48000	8.00	9.1
Other Hispanic	7%	11%	$33,000	70000	60000	8.60	9.7

Distribution, Income, MCAT

1994 - 2000 Allopathic Graduates	FP Choice	Rural Choice in FP Graduates	Approximate Money Income Levels 2003	Parent Income Level of Accepted	Parent Income Level of Applicant	MCAT all applicants 1996 (AAMC)	MCAT Accepted 1996 (AAMC)
Asian Indian	2%	15%	$55,000	100000		9.70
Chinese	6%	6%		80000		10.30
All Asian	7%	11%		90000	80000	9.70	10.6
Vietnamese	22%	5%		42500		9.10
All Urban Born	13%	21%		higher
US All Student	18%	24%
White	14%	26%	$48,000	90000	80000	9.50	10.3
Native Am	9%	47%	$33,000	60000	55000	8.10	8.9
All Rural Born	22%	30%		lower
Black	13%	11%	$33,000	55385	50000	6.90	8.4
All Hispanic	12%	12%	$33,000
Mexican Am	19%	13%	$33,000	50000	48000	8.00	9.1
Other Hispanic	7%	11%	$33,000	70000	60000	8.60	9.7

Students from rural and lower income counties have ratios of admission at 1 in 800 or fewer with males at 1 in 1000 or more.
Population density, education, and income levels of the county of birth of medical students predicts well over 50% of the variance in admissions.
From 1997 to the 2001 entering classes in allopathic medical schools, the highest income level students increased at 700 a year while the lowest income quartile decreased at 432 a year.
Asian students have increased from 3% to 22% of allopathic medical school admissions. Regardless of ethnicity, those with the most urban origins, the highest parent education and income levels, and the most college preparation are the least likely to choose family medicine and rural locations. Studies of Asians in the census and in medical students reveals a greater concentration in these key areas. Whites, Blacks, and Mexican Americans with the same characteristics make the same choices.
Students who are white, those who are rural born, and those who are male have declined the most in college and medical school admissions.
In summary, those who are most familiar with, connected to, associated with the US health and education systems are the least likely to consider and be successful in a medical career.

Urban Influence Codes and Admissions Ratios

Distribution of 110638 US Allopathic Med School Students by Urban Influence Code (1993) of County of Birth	1970 Population (approx birth)	US Medical School Grads 1994-2000	Admissions Ratio Per Yr Per 100k By Birth Origin	Board Certified FP
1 metro over 1 million pop	101367458	51895	0.94	13.1%
2 metro less than 1 million	58220559	25595	0.81	17.8%
3 adjacent metro over 10000 pop	2897447	745	0.47	19.6%
4 adjacent less than 10000 pop	1962738	231	0.22	22.9%
5 adjacent small metro > 10000	8371383	2455	0.54	18.3%
6 adjacent small metro < 10000	10317604	1403	0.25	20.5%
7 not adjacent > 10000	8330790	3417	0.75	18.0%
8 not adjacent 2500 - 10000	8528640	1900	0.41	20.5%
9 not adjacent less than 2500	3216612	429	0.24	24.9%
Foreign Born (raised codes 1,2)		17854	Higher	10.6%
Military Birth		847		19.5%
Missing Birth Data		1119		13.3%
Total	203213231	110638	1.00	15.8%
Adjust Code 1 add .7 foreign born	101367458	64393	1.17	13.1%
Adjust Code 2 add .3 foreign born	58220559	30951	0.98	17.8%

The effect of foreign born if included where they were raised in the United States, is to raise admissions ratios for those born and raised in metro counties. See adjusted code 1 and 2. Codes 1, 2, 3, 5, 7 have more education and health resources.

Urban influence codes are not linear in income however, the following table compares urban influence codes by income level:

County types 1,2,3,5 and 7 have more education and income resources (Parker and Ghelfi A county-level measure of urban influence, Rural Development Perspectives Vol 12 2 32-41)

The dilemma of admissions is reflected above.

As county income and college graduation levels in a county increase, the percentage choosing family medicine from students born in such counties decreases.
The intersection of these lines is first generation college access, and not only access but completion. This has to do much with early education and family structure. How states, counties, and nations deal with the early years, in neighborhoods, in families, in schools, in communities, mean a lot in distributing young professionals like teachers, nurses, public servants, and family physicians. Stagnant areas are not going to have many rising up out of poverty, and few young professionals.
Breadth of education and high school graduation and 1st time college attendance figures are crucial measures of the pathway to family medicine and other service-oriented careers, especially teachers and careers in rural areas.

Robert C. Bowman, M.D. 10/04 updated 11/05

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