Disclaimer: This work does not imply any racial agenda or discrimination. The sad fact is that ethnicity is usually the best measure of income and higher education, with underrepresented minorities, rural, native at the opposite end of the scale from higher income whites and certain other groups.
It is my firm belief that those from lower socioeconomic origins hold the key to service to underserved areas. It is reflected in their choices of primary care (Madison) Service Orientation , and underserved locations (AAMC data). Interest in service is also shared by those interested in rural, volunteer inner city work, and the military (Bowman - AAMC GQ) Characteristics of Rural Interested Students More at Admissions Package
Admissions Ratios and US Medical Students
This seems somewhat of a different topic for a web site devoted to rural medical education. However my research on family medicine residency graduates from 1997 - 2003 seems to show a decrease in the number of family physicians with a native, black, or hispanic background.
Historically those from rural and minority backgrounds have been the ones most likely to choose rural practice, although these were studies at the medical student level, rather than the residency level.
Previous studies by Bowman and Penrod demonstrated that residency programs with a higher percentage of minority physicians, did not graduate as many into rural practice.
The changing ethnic composition of family medicine may also mean that the specialty with the best distribution, may have more difficulty maintaining this distribution, particularly for rural areas. The greatest increases in family medicine residents are in those with asian background. All other is black, native, hispanic, other hispanic, puerto rican, and other, as listed in AMA data.
Click on thumbnail for graphs below
The increases in asian contrast with declines in all other.
The asian group has one of the lowest rural location rates.
| White | Black | Hispanic | Asian | Puerto Rican | Other Hisp | Native American | |||
| Urban1 | 6749 | 788 | 522 | 1863 | 80 | 236 | 32 | 10270 | |
| SmallCity2 | 1073 | 54 | 38 | 111 | 3 | 15 | 9 | 1303 | |
| Town3 | 1038 | 38 | 35 | 109 | 8 | 12 | 9 | 1249 | |
| Rural4 | 484 | 22 | 11 | 55 | 1 | 4 | 10 | 587 | |
| 9344 | 902 | 606 | 2138 | 92 | 267 | 60 | 13409 | total fp docs | |
| 2595 | 114 | 84 | 275 | 12 | 31 | 28 | 3139 | total rural docs | |
| Urban1 | 0.722 | 0.874 | 0.861 | 0.871 | 0.870 | 0.884 | 0.533 | ||
| SmallCity2 | 0.115 | 0.060 | 0.063 | 0.052 | 0.033 | 0.056 | 0.150 | ||
| Town3 | 0.111 | 0.042 | 0.058 | 0.051 | 0.087 | 0.045 | 0.150 | ||
| Rural4 | 0.052 | 0.024 | 0.018 | 0.026 | 0.011 | 0.015 | 0.167 | ||
| Rural % | 0.278 | 0.126 | 0.139 | 0.129 | 0.130 | 0.116 | 0.467 | ||
| Based on non military FP graduates of 1997,1998,1999,2001,2002 | |||||||||
Given the origin of the US asian ethnicity physicians, and the origins in urban areas in other countries, their distribution may be a matter of urban origin.
The white students from rural states and the Native Americans, again more likely to have rural backgrounds, are the ones more likely to choose rural locations.
Hispanic family physicians seem to have similar origins as compared to Asian fp grads. More later
Here is a table representing 2164 recent family medicine residency graduates with Asian ethnicity. The concentration of Asian graduates in some of the most populous areas is demonstrated
Of the 2164, 678 were born in the US, with 137 of these born in California.
Of the 2164, 273 attended medical school in California. Data pending on those attending FP residency in California, but similar results expected.
Of the 2164, 711 are practicing in California.
| BirthCountry | BirthState | MSST | BestState | ||||
| Birth Country | Birth State | MS St | Practice State | ||||
| US | 678 | 0.313 | 137 | CA | 273 | 711 | |
| India | 367 | 0.170 | 47 | HI | 52 | 47 | |
| Vietnam | 261 | 0.121 | 58 | IL | 148 | 209 | |
| Philippines | 205 | 0.095 | 33 | MI | 55 | 168 | |
| Korea | 147 | 0.068 | 26 | NJ | 36 | 110 | |
| Taiwan | 106 | 0.049 | 84 | NY | 143 | 214 | |
| China | 91 | 0.042 | 35 | OH | 86 | 104 | |
| Pakistan | 65 | 0.030 | 24 | PA | 86 | 137 | |
| Hong Kong | 32 | 0.015 | 27 | TX | 174 | 292 | |
| Japan | 32 | 0.015 | 12 | VA | 51 | 73 | |
| Canada | 24 | 0.011 | 15 | MA | 37 | 47 | |
| Iran | 15 | 0.007 | 10 | FL | 42 | 102 | |
| United Kingdom | 8 | 0.004 | 8 | DC | 23 | 10 | |
| other | 133 | 0.061 | |||||
| all w/country | 2164 | ||||||
| blank | 1111 | ||||||
| 3275 | |||||||
| total | 3275 | ||||||
If US medical schools and US family medicine residency programs are unable to admit medical students from white, rural, and underrepresented minority backgrounds, it is likely that maldistribution will increase and access for underserved populations will decrease.
Although some of this might be fallout from Affirmative Action, this diverse group may be impacted by common concerns.
Those from lower socioeconomic origins, especially those with children, may be concerned about the declining prestige and the potential this has on potential finances. In a short period of managed care insecurity, family medicine looked more secure, now the reverse is true.
Those desiring to make a difference may also fear that family medicine and primary care is no longer the place for this.
The impact of affirmative action, with decreases following in medical school admissions since 1997, is in evidence. However the impact is even more marked than anticipated. I have long felt that admissions of minorities as well as those with rural backgrounds were related in more than a few areas. Both share the same declines in education (inner city and rural). Both have challenging situations with small colleges and the need for better preparation and advisors. Both groups of students are a challenge for admissions committees to evaluate, since often the applications have holes or lack polish, when compared to those of students from upper income or more prestigious colleges or urban or white. Underrepresented minority students and rural students tend to be more service-oriented and "make a difference" types in surveys, curriculum taken, and emphasis on primary care.
For a History of Affirmative Action http://www.inmotionmagazine.com/aahist.html see this site.
In construction is a graph regarding changes in medical school admissions in various ethnic groups from1995 - 2001
The impact in states such as California and Texas was even more marked.
Below you will find changes in minority graduates of FP programs. Peak US medical school acceptances for minorities were in 1995, this correlates with med school graduations in 1999 and then graduation from Family Medicine Residency in 2002. The last column is 2003 noted below. The numbers of blacks and hispanice from Caribbean and International medical schools increased in 2003, diminishing the true impact of declines in minority graduations of FP docs.
Impacts on FP graduates originating in California and Texas medical schools were most dramatic, and reflected in eventual declines in FP grads from hispanic origins in Texas medical schools. (Note: UTMB Galveston maintained and increased hispanic admissions, perhaps in part due to a long established series of enrichment programs in the region)
Beyond the affirmative action concerns is which minority students are admitted when the acceptances are more difficult to obtain. In such situations, it is my feeling that admissions committees have tended to prefer the intellectual route of MCAT and GPA rather than a more difficult to defend "well-rounded" student. Such decisions are also more prone to legal action by groups or individuals.
Although there has been some recovery of progress made in improving diversity, I am not sure that this progress will mean much in terms of admitting the minority folks most interested in returning to underserved areas. Even so, they are 2 - 4 times more likely to do so in AAMC and other studies, but newer studies may show that they are less likely to choose primary care and rural and inner city.
Just a comparison with rural background changes over the years to highlight a
common ground for both minorities and rural, deterioration of the nation's
education base. Rural background applications and MCAT takers
remain the same while those accepted decline.
Robert C. Bowman, M.D.
Origin of Asian Female Family Practice Graduates (International medical school sources)
The project will eventually add data regarding location in underserved clinics, and hopefully rural background data on at least a representative sample across the nation.
There are implications for military graduates, some 180 - 200 a year, which share the same characteristics with those medical students most likely to choose rural family practice.
The following is a collection of other items regarding Minorities in Medicine
Backlash against affirmative action Good summary of changes, why minorities have even less interested in professional careers due to family and personal needs, lack of shadowing opps, http://www.acponline.org/journals/news/jan98/backlash.htm
Studies of special admissions groups years later http://jama.ama-assn.org/cgi/content/abstract/278/14/1153
Minorities and Medicine Facts and Figures XII
http://www.aamc.org/publications/factsandfigures.htm
Diversification of US Medical Schools
http://www.inmotionmagazine.com/idaa/sel.html
Medscape: If GPAs and MCAT scores of underrepresented minority students still
lag behind those of whites and Asians, should the issue of affirmative action be
addressed earlier in the education process? Might greater emphasis on improving
academic performance in earlier years allow underrepresented minorities to be
better represented in medical schools even without affirmative action admissions
policies?
Dr. Cohen: The problem is the paucity of academically well-prepared
underrepresented minority students. These problems affect kindergarten to
twelfth grade, and maybe even as early as preschool. We need to devote much more
attention to this if we're going to allow underrepresented minority students to
reach their full potential. But until we address this, we will need tools like
affirmative action programs. Hopefully in the future there will be equal numbers
of well-qualified applicants competing for medical school admission from all
ethnic groups, and then affirmative action will no longer be needed.
from Affirmative Action in Medical School Admissions: A Newsmaker Interview With Jordan J. Cohen, MD Laurie Barclay, MD
AAMC brief at http://www.aamc.org/affirmativeaction
3000by2000 AAMC effort to improve
admissions
"Healthy" Medical School Admissions Without the MCAT FairTest:
The National Center for Fair & Open Testing Nice summary of impact of loss
of affirmative action
http://www.fairtest.org/facts/mcat.html
Minorities in Medicine, COGME XII http://www.cogme.gov/rpt12_2.htm
Impact of Minority Physicians on Health Care http://www.sma.org/smj1998/novsmj98/thurmond.pdf
