Robert C. Bowman, M.D.
Asian ethnicity students are the fastest growing body of US allopathic medical students. Asian Indian students are the fastest growing group within US Asian medical students. About 1 in 17 Asian Indians of medical student age (age 18-24 census data) is an allopathic medical student. The characteristics of Asian medical students can help understand medical school admissions probabilities.
America is growing ever more diverse at an increasing rate. The United States is attracting some of the wealthiest and most educated from across the planet. The United States is also attracting some of the least educated and poorest from its nearest neighbors. What is actually most amazing is that the populations with the highest rates of growth from both immigration and fertility are those at either end of the socioeconomic spectrum. Fertility rates are highest in Asian Indian (74.5 per 1000) and South American groups (58 – 60 per 1000) with the same or greater status compared to whites contrasted with those with broader distributions of income such as Vietnamese (71.8 per 1000), Mexican (82.8 per 1000) and Guatamalan (92.1 per 1000) White and most other populations have rates of 45 - 55 per 1000. The immigration “problems” of the United States involve poor economics in a few nearby nations. Strengthening education and economics in Mexico and Central America would seem to make more sense than currently proposed policies, especially those costing billions without addressing the differentials in economics. Taking dentists, doctors, and educated people from Mexico and Central America would seem to make the least sense of all. What makes the most sense is addressing our own weaknesses in child development and early education and in distribution of resources, and working to meet our own needs as well as those of neighbors and all who plan to retain civilized society. see The American Community - Asians: 2004 The American Community - Hispanics: 2004
The United States appears to be headed a different direction. Populations disadvantaged for decades or centuries remain limited and new populations are being added into the type of poverty that has the least reason to exist: child poverty.
The lack of data compiled by social class often means that the data is presented by race or ethnicity, when the actual changes involve changes in status, not race or ethnicity. Colleges and medical schools rarely want the public to know how exclusive that they have become, how status is related to standardized test scores, how testing is important to the finances of the associations, or other sensitive areas.
Education References, Distributions, Inequities, Child Development
Admissions is related to higher income, greater family education (college and professional), urban origins, and proximity to medical schools. MCAT scores are also related to the same factors. Physician distribution and choice of family medicine and rural practice has an inverse relationship with the above. In Asian students there was significant decline in USMLE 1 compared to MCAT while whites had increased USMLE 1 compared to MCAT. (Veloski reference) This may be a likely pattern not just for Asian students, but for all with the characteristics of Asian students, particularly highest income, urban origin, and children of professional parents. Medical schools are admitting more and more medical students with dual professional parents, regardless of race or ethnicity.
Asian Indian medical student had 2.2% choice of family medicine, the lowest in the nation for any group. This is now likely to be closer to 1% now. Vietnamese, at the opposite in income and education, have 15 - 20% choice of family medicine. First generation to college is a particularly powerful indicator for family medicine and most other service-oriented careers (nurses, teachers, public servants, counselors). Broad distributions of income are better sources of family physicians. Distribution by Income Levels
Rural location choice is greatest for those born in rural areas, Native American, then white, then Black and Hispanic, and then Asian. Again this has to do with the rural vs urban origins of each ethnicity ranging from 40 - 50% for Natives to 30% for whites to 10% for Black and Hispanic to 3% for Asian medical students. Asian family physicians have only 6% rural choice, but also are born, raised, and trained in states such as California and 25% are found in California (next is Texas with 9%). 6% rural location in a state with 3 - 4 % rural population is twice the level. As with other ethnic groups, choice of family medicine increases rural choice by 50 - 150%.
Admissions Ratios and US Medical Students
To understand the range of impacts involved, it is useful to understand some basic information. Even among Asian groups there are divisions which really have more to do with income levels and access to education than any stereotype. Perhaps there have been no more dramatic differences than during WWII.
During my search to match each US physician to a birth city and state, I found 7 born in Rivers, AZ. Others were born in Amache and Heart Mountain. I had difficulty identifying a town that no longer exists. Finally I was able to piece together what I think is the origins of these physicians. Here is a picture of that town Over 1000 from this town served in the US military and 23 died in WWII in service to the US. This was no small internment camp since the high school graduated 97 in 1944. Most had origins in the Los Angeles area prior to the war. It appears that they returned home after the war, at least regarding the physicians, since nearly all graduated from California medical schools. The Japanese American community finally received an official apology from President Reagan and 22 from WWII finally received Congressional Medal of Honor Awards from President Clinton. This was too late for many who left the United States in the years following WWII.
Understanding why Asians are so concentrated in certain parts of the nation means understanding influences over the decades. Many returned to "Chinatowns" because of problems with discrimination. They developed an interdependent society in such locations. New immigrants and family members came to the same locations. These locations were the largest cities and had close proximity to medical schools and colleges. (Zhou Min and Rebecca Y. Kim) Other groups have established tight social structures such as Jewish peoples and Mormons. They have had similar concentration and success.
To understand the magnitude of the differences in medical education, I suggest a Download of Facts and Figures XII in Portable Document Format (PDF). (174 pages - 997.8 KB) from the Association of American Medical Colleges and also the 2005 report
Kenneth Ludmerer in Time to Heal and others have noted some not so stellar past history in medical education. Some, if not many medical schools, at various times in US history have practiced "quotas." For example there were only a handful of medical schools that actively fought quotas of Jewish physicians 60 or more years ago. There have also been discrimination patterns in the past against Asian ethnicity students. Lower income Asians and others performing at a high level may still have great difficulty in admissions, particularly in states with fewer medical school positions. The differences between admission or not for whites and Asians is very small in GPA and MCAT. see Minorities in Medicine Applicants Accepted and Rejected
Using the 2001 version of AAMC Minorities in Medicine, the following table is created from the AAMC data using 18 - 24 year olds (7 years of age group) and 1994 - 2000 graduates (7 years of allopathic graduates) and some of my birth origin data. For more on choice of FP, ethnicity, income, and admissions see Medicine, Education, and Social Status
Admissions Ratios and US Medical Students Allopathic US Medical Student Admissions by ethnicity, income, rural vs urban Asian students are admitted in the highest ratios and have the highest income levels in many areas. Note that the lowest income origin groups, blacks and rurals, have the lowest admission ratios and the lowest income origins. These two also share a common trait of fewer progressing in just about any form of higher education and greater impacts on males.
About 96% of US Asians live in 1993 urban influence codes 1 and 2 or the metropolitan counties of the nation.
US Asians live in the areas that are considered "most desirable," at least for those who desire concentrations. Given past coastal, urban, and Pacific Ocean proximity for many, this is not surprising.
US Asians are about half born in the US and half born in other countries. Of those born in other countries, 45% live in 3 cities, Los Angeles, New York, and San Francisco. http://www.census.gov/prod/2002pubs/cenbr01-3.pdf
This graphic is very similar to one I prepared on Asian parent income distribution from AAMC data.
Quite different than other income distributions Broad Distributions of Parent Income vs Higher Income Distribution
Parent Income and Ethnicity and FP Choice
In the following table, those born in various urban influence codes, those born in other countries (Asian group), and those born in Puerto Rico, Guam, Virgin Islands, Marianas, etc. are shown Admissions Ratio By Birth Origin
|n =||% of US allo||Choice of FP for Residency Grads 97-03||Compare to Gold Standard|
|Born in counties of over 1 million and US allopathic private medical schools||20625||18.7%||9.1%||-64.5%|
|Born over 1 million and public||30892||28.0%||16.1%||-37.5%|
|Born urban < 1 million and Private||6623||6.0%||11.9%||-53.6%|
|Born urban < 1 million and Public||19033||17.2%||19.6%||-23.9%|
|NonMetro birth and Allo Private||2023||1.8%||15.7%||-39.1%|
|NonMetro birth and Allo Public||8484||7.7%||25.7%||0.0%|
|Born PR, GU, VI, CZ, MH, AS Private||1062||1.0%||8.9%||-65.3%|
|Born PR, GU, VI, CZ, MH, AS Public||960||0.9%||9.8%||-62.0%|
|Core Urban US Born/Raised (Born or raised in counties of over 1 million)||72207||65.4%|
|Metro US Born/Raised||97863||88.7%|
The lowest choice of FP yet identified is Indian-Pakistani origin US allopathic medical students at 2.2% choice of FP. This is the fastest rising group of Asian medical students and Asian students are the fastest rising group admitted to US allopathic schools. Parent Income and Ethnicity and FP Choice Indian medical students are likely to have the highest income levels and their parents have the most education and professional degrees, followed closely by the Chinese. In contrast is the Vietnamese segment, with the lowest parent income level and the highest choice of family medicine although Vietnamese are changing rapidly.
Vietnamese in America http://www.oah.org/pubs/magazine/asianamerican/do.html
Physician Workforce Studies
Education - concentrated listing of bibliographies on child development, early education, and distributions of education