County Level Probability of Medical School Admission: Distances and Differences

Robert C. Bowman, M.D.

 

About 97% of US MD Grads for 1991 through 2000 were matched to their county of birth and compared to county population to generate a medical student admissions rate per 100,000 population (admissions per 10,000 population per year of graduates) with a reference point of 1970, the approximate time of birth. Three counties had over 4000 and a total of 7 had over 1900. Admission rates for 1525 counties with at least 5 US MD Grads were compared to county demographics: population per square mile, per capita income, presence of a medical school in the county, and the percentages of those with at least a college degree, with professional or managerial occupation in 1969, with a high school or a college education, with Asian background, or below poverty level.

 

Pearson Correlation Coefficients

Admits per 100,000

College and Above 2000

Professional  Managerial 1970

Medical  School County

HS and Above  2000

Pop Per Sq Mile 1970

Per Capita Income

Admissions

1.000

0.423

0.442

0.345

0.205

0.248

0.194

College Grad %

0.423

1.000

0.799

0.349

0.662

0.155

0.618

Profess + Manage %

0.442

0.799

1.000

0.281

0.467

0.109

0.522

Med School County

0.345

0.349

0.281

1.000

0.126

0.296

0.318

High School Grad %

0.205

0.662

0.467

0.126

1.000

-0.015

0.596

Pop Density 1970

0.248

0.155

0.109

0.296

-0.015

1.000

0.259

Per Capita Inc 1969

0.194

0.618

0.522

0.318

0.596

0.259

1.000

Asian Pop 2000 %

0.172

0.468

0.353

0.299

0.183

0.245

0.420

Poverty 2000 %

0.083

-0.302

-0.075

0.028

-0.704

0.069

-0.575

All correlations other than the shaded cells were significant (p < .05).

 

The relationships between admissions and county income, college graduates, medical school county, Asian population, and population density grow stronger when including 2465 counties with at least 1 admission. Removing the 18 counties that contributed over 1000 admissions each or use of any set of decennial county data (1970 2000) did not vary the relationships. Because these determinations involve secondary data, the correlations are not represented as anything more than relationships to explore in future studies with primary data involving individual student characteristics such as socioeconomics, parents, and scores. Unfortunately access to primary data regarding medical students is limited. There is a great divide between medical education data and physician outcomes. Data collected during medical school does not include physician career and location outcomes. Those with physician outcome data rarely have access to medical student socioeconomics, standardized test scores, and medical school performance. Even the significant contributions of the Jefferson Longitudinal studies are limited to one medical school. Single medical schools admit a similar type of student. Variations are more common across the full range of American medical schools. Secondary data can provide estimates of socioeconomic, geographic, and parent influences. These can be compared to data involving race, ethnicity, socioeconomics, and test scores for consistency.

 

A common theme is reinforced by the secondary studies. Those most likely to gain admission have less social distance and geographic distance when compared to the 70% of admitted medical students who have the highest status origins. Populations most closely associated with the highest levels of income, education, professional degree, urban origins, and proximity to medical school have a higher probability of admission. Those admitted at the highest levels are also the least likely to be found in rural practice, underserved areas, primary care, and family medicine. The different students are also being replaced by those most likely to be found in major medical centers.1 This is confirmed in American Asians that are the greatest concentration of admission probability factors. Asian students of medical school age do have the highest probability of admission.1 The Asian population includes 12 million people or about 4% of the population but Asian US MD Grads have increased to 23%. 2 The full range of probability of admission is also expressed in the highest income counties and those that have the highest and lowest income peoples in the nation, those most exclusive and those most excluded. Within a small area in the cities with the greatest concentrations of medical schools, those with the highest probability of medical school admission and the lowest are born. These areas also have the highest and lowest outcomes in health and education.

 

1.             Bowman RC. Admissions Ratio By Birth Origins in U.S. Medical Students. Admissions Ratio By Birth Origin

2.             Association of American Medical Colleges. Matriculants and Graduates 1993-2004. 2005.

 

The primary purpose of this study is to encourage medical schools and medical associations to probe admissions, student characteristics, and outcomes. To understand important areas such as admissions and physician distribution the nation needs studies involving primary data with direct comparisons involving social distance, standardized test scores, and geographic distance.

 

In national studies, older medical school graduates are more distant and different and are more likely to be found in primary care, psychiatry, family medicine, rural, and underserved careers. Older graduates are often delayed in admission by barriers of income and education. Medical schools with lower MCAT scores are concentrations of the most distant and different students and distribute the most physicians. In studies of older graduates, birth origins, and school MCAT averages, the variations are not always apparent within individual medical schools (most likely due to smaller numbers and lack of student variation), but become apparent across national populations. Without the data that demonstrates that students with higher scores concentrate in subspecialties and major medical centers, it is difficult to change medical school practices and the state and national distributions of education and child development that may well shape career opportunity, admissions, and the distribution of professionals.

 

Admissions Package

 

Physician Workforce Studies

 

For info on the databases, sharing research, or ideas  - rbowman@unmc.edu

 

www.ruralmedicaleducation.org

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