Robert C. Bowman, M.D.
Those most likely to gain admission to medical school are the least likely to distribute to rural and underserved locations. They are found in primary care or family medicine at the lowest levels. Concentrations of income, education, and population are associated with greater probability of admission. These same concentrations are also present in counties with a medical school. In addition these counties have the highest levels of professionals making children from this counties the most likely to be children of professionals. Those born in counties with a medical school are admitted at the highest levels, but are also the least likely to leave major medical center locations.
|
Birth Origins n=203,600 for US MD Grads of 1987 – 1999 |
% of Medical Student Totals |
% of 1970 Population |
Office Family Practice |
All Rural Careers |
Major Medical Center |
College Degree 1970 % |
|
Totals and Averages for All |
100% |
100% |
11.7% |
11.0% |
70.9% |
|
|
Foreign Born (31 million US citizens and residents in 2000) |
14.2% |
9.4% |
8.3% |
6.1% |
74.2% |
20 – 44% |
|
Core Metro Birth in Area with Over Million Population |
49.1% |
49.9% |
10.2% |
8.8% |
73.2% |
32.3% |
|
With Medical School (64 counties) |
39.2% |
32.4% |
9.6% |
8.2% |
74.0% |
38.3% |
|
No Medical School (247 Counties) |
10.0% |
17.5% |
12.3% |
10.6% |
70.2% |
30.9% |
|
Metropolitan Birth in Area of Less Than 1 Million |
23.2% |
28.6% |
14.0% |
13.6% |
68.4% |
26.0% |
|
With Medical School (53 counties) |
8.5% |
6.9% |
12.5% |
12.5% |
71.2% |
37.7% |
|
No Medical School (472 Counties) |
14.7% |
21.7% |
14.9% |
14.0% |
66.8% |
24.7% |
|
NonMetropolitan County Birth in the United States |
11.8% |
21.5% |
19.4% |
24% |
61.2% |
18.4% |
|
With Medical School (10 counties) |
1.5% |
0.3% |
13.9% |
19.6% |
66.4% |
32.2% |
|
No Medical School (2292 Counties) |
10.3% |
21.2% |
19.6% |
24.3% |
61.0% |
18.3% |
There is a consistent socioeconomic theme regarding physician distribution to the most needed careers and locations. Humble origin students were the least likely to be admitted but were the most likely to distribute. Students were older when delayed by barriers of income and education and distribute well. Medical schools that concentrate younger, higher income, foreign born, and other students with higher Medical College Admission Test scores distribute few physicians. Distribution is increased with admission of any student type not associated with the highest levels of income, education, and proximity to medical schools. Distribution to rural and to underserved areas in the United States is not likely to improve. Those of the highest income levels are replacing distributional student types.
Physician distribution is about the decisions that we make as a nation, especially those made by citizens and residents who are granted the great privilege of a college education. Those who have fought hardest to earn that privilege return the investment with distribution and service at the highest levels. These students and their neighbors and communities depend upon systems of education, health, and public safety that must be maintained. Those who have had few barriers must be reminded that the systems that allow them to maintain and accumulate wealth must be a top priority. These are made strong by local, state, and national investments of time, talents, and taxes. These are best invested in children, families, neighborhoods, and education at the earliest levels.
The concept of proximity to medical schools is a new wrinkle. Secondary data does not include information on parents. Birth in a county with a medical school may well be a proxy for children of professionals or physicians. In a comparison of birth county income with medical school county, admissions levels are slightly higher for those born in medical school counties, while levels of distribution were much lower than expected. Further studies are needed.
Medical experts currently are not willing to study concepts of income, origins, distribution, and MCAT scores citing barriers such as privacy issues, but it is possible that the major concern is what they are likely to find in such research. There is little doubt of the outcomes. The real question is whether medical schools will figure out ways to broaden admissions to be able to address all of the health care needs of the nation, not just a select few.
County Level Probability of Medical School Admission: Distances and Differences