Medical students who were born in the same state as their medical school are born instate. This is different from the instate determinations made by medical school admissions committees and by state regulations.
Students born in the same state as their medical school are more likely to be found in practice instate in future years. The odds ratios for instate location for birth in a state compared to those found practicing in a state reveal that those born in a state are over 9 times more likely to be found instate in practice.
Instate birth is a stronger factor in larger states and those more isolated. Smaller states, those with many larger neighbors, and those without public medical schools have less instate birth influence.
Instate born medical students are often the most dependable source of rural physicians for many states. Instate Born and Rural Practice
|
Odds Ratios Using 5 Different Logistic Regressions |
Retention in the Same State as Medical School |
Retention in Practice in Same State as Birth |
|
Family Medicine |
1.544 |
1.449 |
|
Instate Born |
2.819 |
9.634 |
|
Bottom Income |
1.196 |
1.244 |
|
Older than 29 at medical school graduration |
1.123 |
1.033 |
|
Younger than 26 at graduation |
.964 |
0.782 |
|
Medical School County/City Birth |
0.971 |
1.021* |
| Top 20 MCAT Medical School | 0.935 | 0.960 |
| Internal Medicine Residency Graduate | 0.893 | 1.056 |
*Not significant at .01
Not many birth origin and career factors influence retention, however instate birth is a huge factor. Also family physicians are more likely to stay. If individual data was available, the impact of higher standardized test scores could be examined. Every indication points out that those with higher test scores are the most likely to leave a state.
Some students seek opportunity, which is not a bad thing, but it leads out of state. For example researchers are only found within 60 miles of their medical school 19% of the time.
Other students seek opportunities to serve. It also appears that those most likely to serve urban underserved populations or rural underserved populations share origin characteristics with these populations. Attempting to place urban origin students in rural locations is often a temporary situation. Matching up types of students with their preferred locations may be the best way to improve long term retention.
Instate Medical Students and FP Choice
Changes in Admissions in Allopathic Medical Schools