School Admission, Training, Mission and Health Access Contributions

Medical schools are responsible for only two areas related to health access outcomes and these are choices in admission and choices in training. These choices shape primary care contributions. The Medical College Admission Test score is commonly used to rank schools according to exclusive selections, but schools with exclusive selection also tend to have exclusive training and the lowest primary care contributions. The following is a scatterplot of the MCAT averages of schools for 2000 – 2003 matriculants compared to the Standard Primary Care Year per graduate contributions of the schools. Although the matriculant MCAT scores represent different class years, medical schools are consistent in admitting medical students with very nearly the same MCAT and GPA year to year.

Graphic MCAT

Osteopathic, 1970s public schools, and schools with a focus on health access, family medicine, and primary care contribute the most to primary care capacity. Primary care contributions decrease as School MCAT scores increase. States with top concentrations of physicians also shape graduates away from primary care. About 30 – 45% of the physicians in states with top concentrations are found in medical school zip codes. Medical schools also shape primary care to lowest levels in medical school zip codes in these states. Schools that admit more older, rural origin, lower income, and middle income origin medical students admit medical students with more normal scores, graduate more family physicians, and retain more primary care graduates in primary care. The family medicine boost of 29 Standard Primary Care Years per graduate is more and more important with internal medicine contributions declining below 3 SPC years due to record low levels of primary care retention. The SPC years per graduate represented above are actually greater than the actual contributions since tens of thousands of internal medicine graduates have departed primary care for hospital, hospitalist, and subspecialty careers after this data was last collected. The primary care contributions of the schools with increased family medicine proportions remain steady. This is also demonstrated in detailed studies in states such as Nebraska (HPTC) where metropolitan primary care has melted from 144 – 75 primary care physicians per 100,000 while rural primary care based on family physicians has increased from 57 – 63 primary care physicians per 100,000.