Robert C. Bowman, M.D.
Choice of family medicine is less in the South and East and better in the Midwest and West. This impacts choice of family medicine in Black, Cuban, or Puerto Rican populations as compared to Mexican American or Vietnamese. Populations concentrated in the east and attending medical schools with little or no family medicine emphasis from the highest income and education origins have family medicine choice at 1%. Opposite characteristics can mean 50% FP choice. Longitude and medical school creation after 1965 are factor specific to medical schools. Choice of Family Medicine Regression
There is regional variation in choice of family medicine across the nation. Those born, attending medical school (especially private allopathic schools), and practicing in the East and South are less likely to be family physicians compared to those in the Midwest and West. Census divisions were used to categorize the locations.
|
|
Office Family Practice |
All Rural Physicians |
Office General Primary Care |
Office PC Underserved |
||||
|
Birth State |
Private |
Public |
Private |
Public |
Private |
Public |
Private |
Public |
|
Northeastern |
5.9% |
10.2% |
6.4% |
9.4% |
23.8% |
28.9% |
5.3% |
6.1% |
|
Southern |
9.0% |
14.5% |
10.4% |
16.6% |
27.0% |
32.9% |
7.7% |
9.9% |
|
Midwestern |
9.6% |
17.0% |
8.7% |
15.2% |
27.7% |
34.2% |
7.1% |
7.1% |
|
Western |
10.2% |
16.5% |
8.1% |
12.3% |
28.9% |
34.8% |
7.0% |
9.0% |
|
Outside US |
5.9% |
10.1% |
5.1% |
6.9% |
25.9% |
30.7% |
6.8% |
7.6% |
|
All |
7.9% |
14.5% |
7.9% |
13.9% |
26.1% |
32.6% |
6.4% |
8.0% |
|
Medical School |
|
|
|
|
|
|
|
|
|
Northeastern |
5.9% |
8.7% |
5.9% |
8.3% |
24.3% |
27.7% |
5.8% |
5.8% |
|
Southern |
7.9% |
13.3% |
9.3% |
14.8% |
25.8% |
31.4% |
6.9% |
8.9% |
|
Midwestern |
9.3% |
17.0% |
8.4% |
14.6% |
28.1% |
34.5% |
7.0% |
7.1% |
|
Western |
12.8% |
16.4% |
8.1% |
10.8% |
31.1% |
36.4% |
7.9% |
9.5% |
|
All |
7.6% |
14.0% |
7.5% |
13.1% |
26.0% |
32.4% |
6.5% |
7.9% |
|
Practice State |
|
|
|
|
|
|
|
|
|
Northeastern |
5.1% |
8.4% |
5.1% |
8.0% |
23.7% |
27.6% |
5.7% |
5.6% |
|
Southern |
7.4% |
13.1% |
9.6% |
14.5% |
24.3% |
31.2% |
6.1% |
9.0% |
|
Midwestern |
9.0% |
17.7% |
8.9% |
15.8% |
26.4% |
35.0% |
7.2% |
7.0% |
|
Western |
9.3% |
14.7% |
5.5% |
8.6% |
30.0% |
34.8% |
7.3% |
8.6% |
|
All |
7.4% |
13.9% |
7.0% |
12.6% |
25.9% |
32.3% |
6.5% |
7.9% |
When considering Mexican American populations with 19% choice of family medicine, these are populations in the middle and western parts of the nation. Vietnamese are also 20% or more in choice of family medicine with western locations. Puerto Rican, Other Hispanic, and Black populations tend to have lower choice of family medicine reflecting eastern location and medical schools. This also tends to suppress family medicine choice in graphics. Vietnamese and Mexican American populations have better choice of family medicine than if their respective populations were distributed nationally.
This can also mean differences among types of schools. Schools such as Howard have lower choice of family medicine that reflect eastern location, DC location, higher income levels, and more foreign born students. Meharry and Morehouse have increased choice of family medicine with opposite factors.
It is important to remember that the medical schools that admit older, rural born, and lower income origin students admit fewer of the most urban and foreign born students and graduate more distributional physicians. (Consistent Family Medicine Choice By Medical School) However there is a role for regional and school type influences. Schools such as Duluth and Mercer have even demonstrated levels of distributional careers above that predicted from the students admitted or the location of training.
Although there are rural-urban differences in the regions, there are also differences in the distribution of income and education that do not relate to region, longitude, and rurality.
It appears that places that concentrate income and education to the exclusion of those of middle and lower status are not likely to graduate family physicians, primary care physicians, rural physicians, or office based primary care for underserved locations. The loss of a broader rural born, older, lower income, and instate born students is difficult to overcome.
Where education, admissions, medical education, and health policy support is all broad, distribution is likely to be significantly better.
Distribution of Physicians - Table of Medical schools and distribution
Choice of Family Medicine: Past, Present, Future