Expansion of medical school positions can improve physician distribution, cost, access, and quality areas
but there must be careful attention to
the methods of expansion.
This study involves a review of the 1970s era medical school expansion, including
the impact on the urban born students who were likely to benefit,
the rural and minority students who did not improve in admissions compared to those of higher income levels, and
the importance of timing medical school expansion during a period of improving primary care choice, as in 1970 – 1978 when primary care percentage doubled from 18% to 41% but nearly quadrupled in actual numbers because of medical school expansion. Distributional Choices and Health Policy
Good - Replication of medical schools, programs, and admissions tracks that admit a broader range of students (rural born, lower income, older, slightly lower MCAT) is a successful way to improve physician distribution during expansion. Such programs admit more of the distributional/humble origin students who have been left behind by allopathic admissions. Changes in Admissions in US Allopathic Schools
Bad – Expansion of the schools graduating the fewest rural physicians, primary care physicians, and office-based primary care physicians for poverty locations would likely fuel increased health care costs and would not improve access to health care. Those admitted would continue to be the students of the highest income levels that are, according to the AAMC Minorities in Medicine Studies, also the least likely to recognize serious health care problems of the nation such as health care access. Birth Origins and Distribution Tables
Ugly - Expansion of medical school positions that results in more students admitted from the highest income origins (urban born, foreign born, Asian, out of state, highest MCAT scores) will increase the graduation of subspecialists and physicians that will crowd into the most urban locations in the nation. See top rows of this table for reduced distribution. This will tend to increase health care costs and worsen quality and access measures. When expansion timing coincides with the lowest levels of primary care choice in decades, there should be no expectation of improvement in physician distribution and health access for rural and underserved peoples.
Best - Even good expansion is limited in graduation of the physicians most needed for rural and underserved communities. Family physicians are the most likely to distribute to rural locations and to urban poverty locations. Attempting to expand medical schools in the hope of more family physicians has been unsuccessful. However, the nation does have the capability to establish and maintain family medicine only medical schools where graduates would 100% become family physicians. This would align admissions completely with the mission of the school. At best only 50% of students choose family medicine despite the most targeted admissions (Duluth, osteopathic).
Also studies of programs such as those involving Accelerated Family Medicine Training Programs demonstrate the value of specific family medicine training.
Cost, Quality, Access, and Physician Workforce Expansion