Health Access By Medical School Type and Career Choice for 1993 1998 Graduates

Includes 21,470 family physicians and 112,011 graduates not in family practice from the 2005 Masterfile using the Physician Distribution By Concentration Coding   Robert C. Bowman, M.D.

The delays in graduation from 1999 to the 2005 class years allow sufficient time for medical school graduates to complete residency training and a first obligation to be found in a more representative career and location pattern. Note that not all of the international graduates have had sufficient time due to delays in entry to the US and to a residency program.

Super

Major

Marginal Urban

Urban Under-served

Marginal Rural

Rural Under-served

Graduate Not in Family Practice

China Medical School

75.5%

14.0%

6.1%

2.2%

1.1%

0.0%

MCAT 10.5-12 Top Fifth Allopathic US

61.3%

22.9%

9.2%

2.5%

1.5%

0.9%

Other International

64.5%

18.6%

7.9%

3.5%

1.6%

3.1%

India Medical School

54.3%

24.9%

11.7%

3.5%

2.1%

3.1%

Total/Avg Non-FP

50.1%

26.4%

12.2%

3.8%

2.6%

2.5%

MCAT 9.5-10 Middle Fifth Allopathic US

47.3%

28.8%

13.6%

3.4%

2.7%

1.9%

Nigerian Med School

59.6%

16.5%

11.9%

7.0%

1.9%

2.7%

Pakistan

51.8%

24.0%

10.7%

3.3%

3.0%

6.3%

Central America

52.3%

21.3%

9.8%

11.3%

1.6%

3.2%

Caribbean

43.0%

29.4%

17.0%

4.3%

2.7%

2.8%

MCAT 8.5-9.25 Bottom Fifth Allopathic US

40.5%

30.5%

12.8%

5.0%

4.1%

5.3%

Philippines

44.0%

23.3%

11.7%

5.8%

3.9%

10.7%

Historically Black

37.0%

28.2%

17.5%

8.4%

2.1%

3.6%

Osteopathic

30.1%

33.4%

19.6%

4.3%

5.7%

4.2%

Family Practice Graduates Below

China Medical School

42.1%

42.1%

5.3%

5.3%

5.3%

0.0%

Nigerian Med School

50.8%

23.8%

12.7%

6.3%

1.6%

4.8%

Other International

46.4%

24.7%

14.7%

4.8%

3.4%

4.4%

Pakistan

40.5%

29.5%

14.2%

5.8%

3.2%

5.3%

India

39.4%

29.8%

18.1%

5.5%

4.4%

2.7%

Philippines

33.8%

34.4%

15.6%

4.4%

6.3%

5.0%

MCAT 10.5-12 Top Fifth Allopathic US

26.1%

27.6%

22.0%

8.4%

7.7%

5.3%

Central America

29.3%

23.9%

13.4%

21.4%

1.4%

9.8%

Caribbean

24.0%

27.8%

24.0%

7.8%

7.2%

7.0%

Total/Avg for FP

21.4%

27.1%

23.8%

6.6%

9.6%

8.2%

MCAT 9.5-10 Middle Fifth Allopathic US

20.9%

27.2%

24.9%

5.6%

10.9%

7.5%

Historically Black

20.0%

24.7%

22.2%

15.6%

5.5%

7.3%

Osteopathic

15.5%

28.8%

28.0%

5.7%

9.6%

9.6%

MCAT 8.5-9.25 Bottom Fifth Allopathic US

14.1%

25.1%

23.4%

7.5%

14.7%

13.3%

When the family practice component is removed, it is possible to determine more of the impact of selection and training. Medical schools with exclusive most urban and highest income and highest scoring graduates have the lowest contributions to populations in most need of health care.

A shift away from most needed health access is certainly indicated in the past decade with lower percentages of family medicine graduates in all of the school types resulting in a shift to the non-family practice career choices that are found in top concentrations.

The international graduates listed as graduates of their home nation school from 1993 1998 also are still in obligation effects due to delays in entry to the US and in finding a residency position. This obligation effect is demonstrated by higher percentages in rural underserved compared to marginal rural locations. In a normal distribution this should be about the same percentage for both locations. The much higher rural underserved rates are found in the internal medicine graduates of these schools. Most of these are no longer in rural underserved locations as they have already completed their 3 year obligations. Also the decline of the J-1 Visa (bypass, fewer, use by medical schools) indicates that fewer will remain in primary care and serve in underserved areas.

Physician Distribution By Concentration Coding

Health Care: Dividing the Nation     Basic Health Access: Bringing a Divided Nation Back Together

www.basichealthaccess.org

www.physicianworkforcestudies.org

www.ruralmedicaleducation.org