Robert C. Bowman, M.D.
Choice of family medicine is consistent by birth origins and by age. Medical school choice of family medicine is also consistent over time periods, suggesting consistency in selections and student composition. There is variation by magnitude, but this seems to be shaped more by health policies such as health reform, managed care, and the creation of Medicare and Medicaid.
The period of time from 1987 to 1999 was a period of time with relatively little change in medical school sources of US physicians with the exception of steady increases in Osteopathic Private schools and Caribbean contributions. Allopathic Private contributions regarding family physicians continue to decline. About 1 - 2 schools a year are likely to be added to the list of schools graduating no family physicians in the match.
The schools not created since the creation of family medicine, those in the most eastern locations, those with the most exclusive selections, and those located in states with the most divisions between high and low income populations graduate the fewest family physicians. (Choice of Family Medicine Regression) These schools have few older, middle income, lower income, or different students, in background or geographic origin. (Birth Origins and FP Choice)
Office Family Medicine and Family Medicine/General Practice Choice By Medical School
|
|
1987 |
1989 |
1991 |
1993 |
1995 |
1997 |
1999 |
2001 |
|
Allopathic Private Office FP |
6.8% |
6.0% |
5.8% |
6.4% |
9.4% |
10.5% |
8.2% |
5.1% |
|
Allopathic Private FP and GP |
8.1% |
7.1% |
6.8% |
7.6% |
11.0% |
11.7% |
9.7% |
7.7% |
|
Allopathic Public Office FP |
12.3% |
11.5% |
11.7% |
14.2% |
16.0% |
17.6% |
14.5% |
8.3% |
|
Allopathic Public FP and GP |
14.5% |
13.1% |
13.6% |
16.3% |
18.5% |
19.4% |
16.4% |
13.0% |
|
Osteopathic Private Office FP |
27.9% |
24.4% |
23.5% |
27.5% |
24.4% |
27.2% |
20.8% |
17.4% |
|
Osteopathic Private FP and GP |
39.2% |
32.7% |
32.5% |
35.4% |
34.6% |
30.2% |
23.8% |
25.2% |
|
Osteopathic Public Office FP |
26.0% |
27.5% |
18.0% |
26.0% |
24.2% |
25.9% |
18.8% |
16.8% |
|
Osteopathic Public FP and GP |
39.0% |
38.3% |
31.4% |
35.1% |
34.9% |
37.3% |
24.4% |
25.0% |
|
North American Office FP |
11.4% |
9.8% |
11.2% |
9.3% |
11.2% |
7.5% |
6.0% |
1.5% |
|
North American FP and GP |
17.5% |
16.9% |
17.1% |
18.4% |
17.0% |
15.3% |
16.9% |
19.8% |
|
Distant International Office FP |
4.9% |
4.2% |
3.2% |
3.0% |
2.6% |
2.7% |
1.7% |
0.3% |
|
Distant International FP and GP |
7.3% |
6.4% |
6.3% |
6.4% |
8.7% |
9.9% |
11.6% |
10.5% |
|
Caribbean Office FP |
16.0% |
15.3% |
14.4% |
14.2% |
16.0% |
14.9% |
9.8% |
7.4% |
|
Caribbean FP and GP |
18.7% |
17.0% |
18.5% |
16.3% |
19.8% |
20.5% |
18.7% |
23.1% |
|
All Office FP |
10.5% |
9.5% |
9.1% |
10.8% |
12.6% |
14.1% |
11.4% |
7.4% |
|
All FP and GP |
13.4% |
11.9% |
11.7% |
13.6% |
16.2% |
17.1% |
14.8% |
13.3% |
The 2001 graduate year is reliable for allopathic graduates although 1999 is the limit for practice locations for 2005 Masterfile data. The 1997 class year is reliable for the other graduates in career choice ratios.
The FP and GP distribution is roughly the same for both. The GP designations are often a result of incomplete data transfer regarding osteopathic family physicians and others who are not allopathic United States graduates.
The consistency of the student types admitted are related to a consistent choice of family medicine. The other factor is the impact of health policy most apparent in the 1995 and 1997 class years. (distribution and policy)
Because medical student choice is consistent over time, it is possible to make some level of prediction of family medicine choice and physician distribution as soon as the medical school admissions committee makes its decision, years before physicians have chosen specialty or practice location. The other major factor that can modify choice up or down is health policy.