The leaders that we choose for the nation must be aware of the wide range of populations and their specific needs for care. The physicians that we are selecting are increasingly less likely to choose careers of service to the underserved.

More importantly, they are less likely to understand the critical issues involved in health access.

URM is an older term for Black, Mexican American, Native American, and Puerto Rican medical students within the 50 states and these populations have about half the income of White and Asian populations when considering those applying to medical school. In 2003 the income distributions for all in the US indicated money income of $55,000 for Asian, $48,000 for White, and about $33,000 for the others indicated.

See also Service Orientation  and Rural Interested Senior Medical Students 1995 for common ground in awareness, socioeconomics, empathy, and potential for better physician quality by closer shared ties with patients.

According to AAMC data reported in Minorities in Medicine XI reports (from the 1996 Matriculating Student Questionnaire)

Statement and percentage strongly agreeing

Low Income URM


High Income URM Low Income NonURM

All NonURM

High Income NonURM

Access to care is still a problem



73% 60



Everyone is entitled to adequate care






Physicians can influence health promotion disease prevention






Physicians are obligated to care for the poor







The numbers on access to care are income-related with lower income level students more likely to recognize the problems and nonURM the least likely of all to recognize the problem. These are the White and Asian students that represent the groups most likely to be admitted and to some degree the URMs of higher income as well. Birth origin studies indicate that the physicians born in the lowest income counties were also the most likely to choose careers involving the care of the underserved, rural and urban. Rural Interested Senior Medical Students have the highest level of service orientation and share the lower income origins of many inner city URM students. Empathy, awareness, service orientation, and other characteristics may well be related to origins outside of the elite students that capture 70% of medical school positions, just like they capture 74% of the top 146 college positions (Carnevale and Rose)


Other Data


The window of opportunity for URM students to consider a career in medicine may close early.

Those admitted in the lowest probability areas (Admissions Ratios, Changing Admissions, and Physician Distribution) must decide early. Also in the AAMC GQ data for 1995 Rural Interested Senior Medical Students this group also had decided on a final career at twice the level of the 13,500 seniors. Within the white group below is a rural interested group with different characteristics.


Rural interested students decided earlier in a pattern different than white students shown above.


For some, the door closed even earlier, related to income and family structure. Income and access to college drive medical school admissions.


Source of Income URM % Reporting NonURM % Reporting
Both Parents $60,000 58.20% $80,000 68.20%
Father Only $45,500 13.70% $100,000 23.10%
Mother Only $25,000 26.70% $30,000 7.90%
Overall Median $62,605   $75,000  


The route for lower income students is challenging, particularly when considering the entire pipeline to an underserved primary care practice. For success it takes dedicated parents; a reasonable community environment; local and state governments willing to invest in schools, education, and college funding; governments willing to invest in public medical school positions and funding for medical students; and governments and groups of Americans with broad representation willing to invest in health care and willing to troubleshoot areas of health access and problem areas such as overhead, paperwork, liability, and the organization of health care.


An increased focus on elite college graduations, gifted children, and admissions of the highest income level students increasingly born in other nations are likely to produce leaders for the United States who are both

  1. Less likely to serve the underserved

  2. Less aware of the challenges faced by the underserved, and the nation that they will attempt to advise regarding national solutions for the underserved.  Education

Those most likely to be aware of the massive health problems in our nation as children, during their education, during college, in medical school, and afterwards are more likely to choose family medicine and distributional careers. Another unfortunate consequence of upbringing in lower and middle income levels is Service Orientation. This also means that few will attempt additional leadership responsibilities. This again leaves leadership in the hands of those who are less aware. There are Leadership Factors that can help with awareness. For some of us, the choice to become a good father and to overcome obstacles of education has helped to understand many of the above factors.


Physician Workforce Studies
Physician Distribution in the United States

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