State Researcher Comparisons

Birth Origins, Researcher Location, Retention, Researcher Development, Physician Workforce

Robert C. Bowman, M.D.

As a researcher, I certainly do not have problems with investing in research or researchers. However the nation, states, and medical schools should be aware of the impacts that they are having and also what the current policies do. This study involves 1971 – 1994 graduates of US medical schools including the birth states and practice states of the researchers. Key considerations are the efficiency of research dollars. Spending money on students who are unlikely to use the skills to full time use is not efficient. Also research is a huge economic benefit to the schools, cities, states, and nations involved.
Although there are research contributions for those who finish Medical Scientist Training Programs, in the Missouri program 95% continued on to residency programs. The fact of the matter is that most of those recruited to MSTP programs are the types that are most likely to choose subspecialty and urban careers and can make far more income. They also have the ability to hire, fire, and train their own assistants, a situation much more limited when working in the medical school environment. It takes a dedicated researcher to survive medical school training, research training, medical school employment, and medical school policies. In the current health policy environment with no limitations on subspecialists and severe limitations in several careers, the nation will find it hard to graduate researchers, psychiatrists, family physicians, office based primary care physicians, particularly for rural and poverty areas.

Researcher Development
By comparing zip codes from medical school to practice location, less than 20% of researchers remain within 60 miles of the medical school, state, and program that developed them. There are even fewer in the same medical school but this is difficult to calculate by zip code comparisons and distances. There are variations as noted in the states below. For a simple comparison of those born in a state and retained in a state among researchers, California retains the most at 34%, Massachusetts at 27%, PA at 25%, MI 17%, OH 15%, NY 12%, IL 11% In all of these states the home state had the advantage except in Illinois where the greatest number ended up in California at 77 with 56 in IL out of 497 born in the state of Illinois. California is the largest source of researchers for Washington State at 41 of 250. Considerations of ethnicity and the most urban birth origins may also be valuable in the determination of practice location for researchers. Asian family physicians concentrated in California also with only 100 born there but over 700 Asian FPs located in California for the 1997 – 2003 graduates. Researchers were the most likely to be 1000 miles away among numerous physician careers examined. Those who do benefit from a prestigious medical school, scholarships, research training, and federal funding and do well can pretty much name their location. Medical schools that have moved up in NIH rankings, no easy task, have recruited well and can be seen in the winner’s brackets below.

Losers in the Research Competition
The following list birth state and the state of current practice in 2005 along with the percentage comparison lost or gained comparing birth location to research location. Note that the official state or school determined residency of the student is not used in this comparison, these are birth origins data from the Masterfile which are 97% complete for US allopathic graduates.
 

Other nations and smaller states lose. Many of these invest significant portions in per capita education expenses.

By the numbers and the millions that go with the numbers, Maryland and California are the clear winners. The best interpretation involves the entire pipeline for researchers from birth to education to migration to different states for school and education and college to admission and to eventual choice of career and location.

The impact of injecting billions into direct research as in the stem cell project will only tip the playing field much further west. The overall impact of state competition in research dollars can only limit funding for education, underserved populations, basic health needs, and infrastructure. The nation needs researchers, but it also needs researchers involved in workforce studies, health care quality, translational research, and other key areas beyond basic science and drug studies. Hopefully some of the new investments in MD researchers will match some of these areas of need.

By the way, Maryland and California research sites have maximal growth, traffic congestion, housing cost, parking, security, risk of disaster, and other factors to consider. All of these cost precious time in extra fees, commuting time, and other stresses not conducive to research productivity. Maybe one day there will be a study that demonstrates that the pay of pure researchers (or family physicians, or psychiatrists or general pediatricians or internists or medical school faculty) is incapable of allowing them to live within 90 minutes commuting time of these medical schools.

A rural FP friend of mine just sent me an email. One morning on a camping trip near their rural Canadian home, she and her husband saw a bright light in the distance. "We thought that it was a train but didn't think that we were close to a railroad track. Until we found our glasses, we were a little concerned." The train was Venus just above the horizon. Now why is this not a location for physician researchers? Might involve a very different type of research. Quotes From Dale Dewar, MD

Robert C. Bowman, M.D. rbowman@unmc.edu

Research in Rural Medical Education

Research Feeder Programs

Research By the Ages

Physician Workforce Studies

www.ruralmedicaleducation.org