Robert C. Bowman, M.D.
Physicians are taught in a number of ways. When I was teaching medical students to read EKGs it seemed easy to get the top level 5 out of 5 ratings within the first few blocks of medical students. Of course I was depending upon a number of previous professors who had taught physiology and more.
Pattern recognition got me through Calculus I and II, but Calculus III forced me to go back to my teacher and confess I was doing pattern recognition rather than using comprehension, and so I did much of Calculus I, II, and III in a single semester, thanks to his good graces.
Recognizing patterns of distribution also involves understanding the basics of who distributes, medical school influences, and health policy influences.
Bear with me on a complicated graphic resembling and EKG in some ways, involving 1987 - 1999 US MD Grads in 2005 Masterfile careers and locations. Hopefully you can take the pattern in your medical school and compare the various types of students admitted to get a good idea about where you can improve distribution.
Underserved areas are outside of Major Medical Centers and involve high poverty zip codes and those with designations. This is secondary data so the association is with zip code only, not an actual underserved practice.
For the income determinations, birth county income levels in 1969 were used. The percentage of medical students from Lowest Quartile, Middle Quartiles, Highest Quartile, and Foreign Born % was used. About 20% of the osteopathic birth county data is missing, otherwise the levels are over 95%. Other comparison groups include rural born and students older than 29 years at graduation. The outcomes measures are rural location, two different FP Match years, and underserved location outside of Major Medical Centers. The MMC link helps understand distributions, definitions, and numbers. Averages for all US Grads are shown.
The left side includes medical schools that graduate the most physicians for underserved areas of the nation outside of major medical centers. (for those inside major medical centers see Physicians in Poverty Discussion: Major Medical Center Locations) Those distributing physicians to underserved areas admit medical students from the lowest income counties and the lowest income populations. They have lower MCAT score averages. They also admit more older students, more rural born students, and fewer high income and fewer foreign born students. They graduate more family physicians and more rural physicians as well.
Historically Black medical schools have a concentration of inner city origin students that are born in higher income counties, but the birth county income does not reflect their actual income levels. Howard admits a high percentage of foreign born graduates consistent with the DC area and east coast inner city residents and these students have a wide variety of backgrounds. Few rural origin students are black (or Hispanic or Asian); otherwise rural born also translates to more underserved location. It is important to note that rural counties overlap with lower income counties and Asian and foreign born populations concentrate in top income and medical school counties.
Osteopathic medical schools distribute well with older graduates and greater choice of family medicine to drive distribution. Osteopathic Public Medical Schools have been particularly effective and lead all categories of distribution.
Schools that distribute admit a broad range in age, MCAT, income origins, and geographic origins. The students in the most distributional schools all have greater levels of distribution, even those with higher status origins.Distributional Medical Schools
Schools that do not distribute have a narrow range of origins. They have the lowest levels of choice of distribution and family medicine across the origins that they do admit.
The health policy effect can be seen in the FP Match figures of 1997 (Gold lines above) compared to FP Match 2005 (yellow lines above). At either end of the socioeconomic and distributional "spectra," the students do not vary much with health policy or with origins. They are relatively fixed in place and likely have made most career decisions before considering health policy.
The major effect or the difference in distance between the yellow and gold lines involves the majority of schools and students.
There are also enhanced effects that may be attributable to health policy in the west coast schools and in the Historically Black schools. Both have significant levels of minority graduates who may be sensitive to perceived government support for primary care and family medicine. Students are all too aware that family medicine choice is permanent (Retention Within the Specialty of Family Medicine) as compared to other forms where they can choose to subspecialize. Generalist pediatrics may also be a career choice made before medical school and resistant to health policy as evidenced by a consistent 70% remaining generalists.
Please note that the 2005 Osteopathic family medicine figures shown above are only the allopathic match figures. Actual osteopathic total family medicine figures take a few years to compile from osteopathic and allopathic sources. Generally health policy has less impact on osteopathic schools just like other distributional medical schools.
The humble origin medical students are the most likely to distribute to underserved areas. Medical schools with admissions of more lower income and rural born and older students distribute more to underserved areas. Health policy can influence increased choice of family medicine, the specialty choice that doubles distribution. (Family Medicine Physician Distribution) This impact is greatest outside of those who have decided on careers earlier, including the most elite, older, rural born, the least distributional and the most distributional. The United States has had Five Periods of Health Policy and Physician Career Choice.
Comparing Medical Students By Class Year
Comparing Physician Distribution and the MCAT
Ethnicity Gender and Rural Practice Choice