Ethnicity, Gender, Admissions, and Distribution

Robert C. Bowman, M.D.

Admissions varies with densities of income, education, and professional occupation of parent; proximity to medical school, and additional barriers. Population density, education, and income levels of the county of birth of medical students predict well over 50% of the variance in admissions. These socioeconomic measures also influence test scores such as SAT/ACT and MCAT. Higher socioeconomics means low choice of distributional careers and poor retention for practice in the state where students attended medical school. Family medicine is a more likely choice in all but the top 30% in status and in allopathic public schools, FPs are 44% more likely to be retained in their state for practice (1987 - 2000 medical school graduates compared to 2005 locations in the Masterfile). Data on ethnicity was not shared other than in family medicine but family physicians are a reliable two times as likely to be found in rural or in underserved areas compared to the same types of medical students across similar demographic origins or medical schools.

• Students from rural and lower income counties have ratios of admission at 1 in 800 or fewer with males at 1 in 1000 or more.
• Population density, education, and income levels of the county of birth of medical students predicts well over 50% of the variance in admissions.
• From 1997 to the 2001 entering classes in allopathic medical schools, the highest income level students increased at 700 a year while the lowest income quartile decreased at 432 a year.
• For the 2004 entering class, 3000 more came from parents making over $100,000, 1500 fewer had lower income origins and 1500 fewer had middle income origins.
• Asian students have increased from 3% to 23% of allopathic medical school admissions. Regardless of ethnicity, those with the most urban origins, the highest parent education and income levels, and the most college preparation are the least likely to choose family medicine and rural locations. Studies of Asians in the census and in medical students reveals a greater concentration in these key areas. White, Black, and Mexican American students with the same characteristics make the same choices.
• Students who are white, those who are rural born, and those who are male have declined the most in college and medical school admissions.

Origins and Distribution of Family Practice Graduates of 1997 - 2003

Origins help determine career choice and practice location. Those with major medical center origins such as birth in a city or a county with a medical school are most likely to end up in major medical centers. Those born in urban areas tend to return and those born in rural areas have greater rural distribution. Distribution levels are greatly facilitated by family medicine choice. Facilitating Physician Distribution

Those with origins beyond major medical centers return to practices away from major medical centers. Rural origins improve rural location. White and Native graduates have the only significant percentages of rural origins.

Underserved is determined by zip code locations and can also be categorized by rural or urban. Underserved coding included:

1. zip codes with over 20% of the population in poverty or the lowest 6% (less than $35,000) by county income,

2. zip codes with a CHC or NHSC site or both

3. zip code in a whole county shortage area for primary care

Equal proportions of designated and not designated sites were involved and both had the same number of people in poverty, physicians, and ratios of people, poverty, and physicians. The zip code determinations were smoothed for consistency with adjacent zip codes (this only involved 128 physicians out of 200,000). Zip codes with NHSC or CHC zip code categories as the sole determinant were rejected

1. if the zip code was military

2. if the zip code had over 75 physicians or a medical school (major medical center definition)

3. if poverty levels were less than 13% at the zip code (moved to major medical center or served location).

Other locations were military, international, urban served, rural served, urban major medical center, and rural major medical center

Major Medical Centers

ABSTRACT

Background:  Certain types of students are more likely to distribute to careers and locations in great need. Student ethnicity, gender, income, and age are considered regarding medical school admissions, choice of specialty, and practice characteristics.

Methods:  This study compared medical students graduating from 1994 - 2000 to census data to generate ratios of admission by ethnicity and gender. The medical students were also compared by choice of career and location, age distribution, and various birth origin characteristics.

Results:  The average medical student was admitted at a ratio of 1 medical student out of 200 total citizens or residents in the United States age 18 to 24 years old. Asian Indian citizens or residents were admitted at the highest ratio of 1 out of 20, Native Americans 1 out of 280, rural born 1 out of 360, black female 1 out of 300, black male 1 out of 600, lower income rural born 1 out of 760, Mexican American male 1 in 1000, and Mexican American female 1 in 1300. Rural born, Vietnamese, Mexican American, and low income origin students were most likely to choose family medicine, rural locations, and office-based primary care in poverty locations.

Discussion:  Admissions levels and physician distribution varied across population density, income level, education level, age, and MCAT scores. Those of lower socioeconomic level had the lowest levels of admissions but greater choice of distributional careers.  

Background

The composition of medical students in the United States has been changing in recent decades. There has been a slow decline in white students, males, rural born students, and those born in the same state as their medical school. Each of these groups is more likely to choose family medicine and rural practice. The most dramatic increases involve students with parent income levels of over $100,000 which increased 74% or from 3765 to 6560 between the 1997 and 2001 matriculating classes. This was a period dominated by news headlines noting the reversals of affirmative action. Visits to universities by affirmative action reversal activists were followed by threats of lawsuit or actual lawsuits.

Asian students have increased to 3500 out of the 16000 matriculants or 22%. Asian students represent a group with the highest levels of parent income, education, professional degree, (MIM) and urban origin (census, Bowman birth) Asian and urban born students represent the youngest medical students. (Bowman birth) The nation has also entered a new era with parity in gender composition. Studies have noted that females do not choose rural practice as often as males. (ellsworth)

Medical students who are born in counties with lower levels of income, education, and population density (Bowman birth) are more likely to choose family medicine. Students from lower income origins are more likely to choose family medicine (Cooter, Bowman birth) and they also have higher attrition rates (Cooter). Senior students interested in rural practice have the greatest family medicine choice at 68% and they tend to be older, married, from rural high schools, and have greatest levels of interest in serving the underserved at 60% levels. Rural interested seniors are not likely to be Asian, Black, or Hispanic. (bowman rural interested) Those are most different in ethnicity and income are also more likely to have plans to serve the underserved at 40% compared to 10% for average sutdents. (AAMC MIM)

 Comparing gender, ethnicity, and career choices can give important information about future workforce.

 Methods

The data sources that were compared included the number of medical students from the seven years of classes of 1994 – 2000 by ethnicity and gender (AAMC MIM, AAMC warehouse), seven years of U.S. citizens and residents by ethnicity and metro/nonmetro location who were age 18 – 24 years (Census 1990), parent income levels (AAMC MIM), income by ethnicity (Census 2000), family medicine graduates by gender and ethnicity, and graduate practice locations (Masterfile, Robert Graham Center). The Masterfile has ethnicity data on 14686 of 18230 or 80.5% of family physicians who attended U.S. allopathic medical schools. Rural practice location was determined by Rural Urban Commuting Area coding using the practice zip code selected by OfficeMax software. Poverty designation included a zip code that was associated with the National Health Service Corps designation, a Community or Migrant Health Center, or a population with over 20% in poverty.

Results

 Those most likely to gain admission have higher income levels, higher MCAT scores, and the most urban origins. 

Table of Allopathic US Medical Student Admissions by ethnicity, income, rural vs urban

 Vietnamese students are an exception. Despite the lowest parent income and education levels, Vietnamese students are admitted at levels greater than average and equal to Asians of much higher income levels. Vietnamese make choices of family medicine at higher levels consistent with other lower income level students.

Choice of rural location and rural poverty location is related to rural origins. When  comparing the percentage of rural born students from a school to the percentage of graduates choosing rural locations, there is a 0.86 to 0.92 positive correlation for typical medical schools.

Medical Schools By Choice of Family Medicine for 1987 – 2000 Graduating Classes

 Studies of birth origins by county also confirm a linear relationship between county of birth income levels and choice of family medicine (Birth Origins and FP Choice).

 Ethnicity appears to play a role in rural practice location for family medicine graduates. Rural birth origins are a major reason but older graduates also choose rural locations.

White family physicians are basically the only ethnicity with significant rural origin numbers and provide rural family physicians in the highest numbers. Native American family physicians choose rural practice in the highest percentage, but less than 10 per year go on to choose family medicine. Native males from rural areas may have admission ratios as low or lower than rural white males and black males.

Regardless of ethnicity, family physicians born in rural areas have approximately the same 40 - 5