Probability of admission tables

Robert C. Bowman, M.D.

Many consider that changes in medical school admissions toward more urban students as a matter of demographic changes. This is not true. Rural born students have less probability of admission and this gap is widening.

The author compared data on birth origins of medical students to census data from the county of origin. The ratios below represent the number of medical students born in that county per 100000 live births in the same county.

Three periods of time were compared. 1942 census data was matched to 1965 - 1976 grads, the pre-expansion era just prior to the doubling of the US medical students graduating per year from 8000 to 16000. Data from 1955 and 1966 was matched to later years.

Ratios for US medical students by birth origins, Allopathic and Osteopathic, not international.

There were decreases in the ratio of admission in the time era corresponding to medical school expansion from 8000 to 16000 students per year. There have been continued increases in urban born admissions.

These ratios remove demographics from consideration as an explanation.

Comparing the Probabilities of Admission

census data was collected differently for the 1940s compared to the 1950s, some allowances are needed in this.

Before expansion, urban born students had 1.63 times the probability of admission compared to rural, increasing to 4.45 times the probability during expansion, and slightly decreasing to 3.88 post expansion

Balancing preparation and admissions is important. If the Metro to NonMetro ratios are out of proportion, it may be that the state is not investing child development, early education, and opportunity in rural areas of a state. A rapid expansion beyond the rural capacity may greatly increase urban born, highest income, or foreign born admissions without doing much to rural born. This would shift the balance in favor of children of professionals instead of children of lower and middle income populations.

Cost, Quality, Access, and Physician Workforce Expansion

The medical students born in urban influence code 1, counties of over 1 million population, involve 61% of all medical students admitted to US medical schools from 1994 - 2000. Only 49% of the US population is in urban influence code 1. This 11% gap between medical student composition and US population has widened from a 5 % differential to 12 % in the past 30 years.

By RUCA coding 87% of medical students come from urban and urban-focused locations while only 76% of the US population was in urban locations during this time period, again an 11% gap.

Top Sites for Data

Review at Hart and Risley, Meaningful Differences in the Everyday Lives of American Children detailed studies of 42 families linked to education and child development literature. After age 8, interventions are far more costly and less effective.

PreKindergarten http://nieer.org/yearbook/pdf/yearbook.pdf  2005 data on dwindling American efforts

The United States spends 0.5% of GDP on age 0 – 6 child development compared to Denmark at 2% GDP (Starting Strong II, OECD). Not starting well means more costs and inefficiency in many ways

The Funding Gap 2004 Carey - state and local financing of education

Jay Greene, High School Graduation Rates in the United States - not a pretty picture

Carnevale and Rose in Kahlenberg, Left Behind, New Century Foundation, page 9 74% of top income quartile students attend top 146 colleges compared to 3% for lowest income quartile

Changes in Admissions in Allopathic Medical Schools

Admissions Ratios, Changing Admissions, and Physician Distribution

Kennedy and Crisis: A Long Term Blueprint for Conduction the Nation

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