Managed Care Comparison Table

Robert C. Bowman, M.D.                Impacts on Allopathic Medical Students

Newer at Five Periods of Health Policy and Physician Career Choice or Changes in Specialty Choice 1987 - 1999

Students from allopathic medical schools were impacted differently by health policy favorable to primary care. The nation had a sudden change if health policy and a sudden change in choice of primary care and family medicine in a short time. Students had far different career choices during the 1995 - 1997 graduating classes than the past 20 or more years. Those most likely to change career choice appear to be those who had a vested interest in staying connected to current locations. Those born instate and those born in the same county as their medical school and those locating nearest their FP residency after graduation had the greatest increase in choice of family medicine (65 - 75%), a choice at the time that allowed the most ability to determine future career location. Those born in medical school counties that did not attend a local medical school did not have higher choice of family medicine than the national average.

Unfortunately the impact was not sustained and the nation may actually have the worst primary care health policy, and primary care physician location in rural and poverty areas in the nations post Medicare era.

The common theme behind the changes involve socioeconomics. Those of lower income origins were less likely to change. Urban, higher MCAT, younger are all markers for higher income levels of students. Older, rural born, and those born in lower income counties represent more humble origins.

Codes 1,2,3,5,7 have greater education levels and more colleges and doctors and health facilities

MCAT Correlations - see other correlations of urban, income, research, and specialty choice, also similar considerations in SAT and ACT

Birth Origins and FP Choice

Managed Care and Choice of FP

Those staying within 60 miles of their medical school "changed places" during managed care with fewer subspecialists staying close and more FPs staying close. This is supportive in of the hypothesis that the most urban born students chose a return to birth origins and the urban lifestyle of living over choice of specialty during the impact of the health care reform/managed care era. Other data in support involves no overall change in continued urban practice choices of allopathic physicians despite managed care. However there were more rural family physician graduates of 1995 - 1998 and less rural physicians of other types in 2004 practice locations.

Complex table comparing urban/foreign, MCAT, age, and in vs out state

FP Unlikely is born in counties of over 1 million or outside of the 50 states

Generally instate, younger, high MCAT, and FP Unlikely had less percent change with managed care

Normal instate have higher choice of FP and the other three have lower choice of FP

The instate, urban born students were the ones who changed choice to FP and PC, a likely response to maintain urban practice location upon graduation