Ethnicity, Gender, Admissions, and Distribution

Robert C. Bowman, M.D.

1994 - 2000 Class Years Probability of Admission
for those of Medical School Age
  FP Choice Family Medicine Grads 1997 - 2003 Parent Factors    
United States Allopathic Graduates One out of ___ males are medical students One out of ___ females are medical students US Age 18-24 (Census) Medical Students 1994-2000 (AAMC) Male/ Female (AAMC)

 (FP Grads in Masterfile compared to AAMC Class Yrs)

Rural Choice in FP Graduates

Under-served Choice in FP Grads Approximate Money Income Levels 2003 (Census) Parent Income Level of Accepted (AAMC) Parent Income Level of Applicant (AAMC) MCAT all applicants 1996 (AAMC) MCAT Accepted 1996 (AAMC)

Asian Indian

18.8

20.4

159236

8136

0.53

2%

15%

13%

over $55,000

100000   9.70  

Chinese

41.2

44.6

208868

4882

0.53

6%

6%

6%

$55,000

80000   10.30  

All Asian

48.9

53.0

1034000

20340

0.53

7%

11%

6-13%

$55,000

90000 80000 9.70 10.6

Vietnamese

65.7

71.2

97196

1424

0.53

22%

5%

10%

30 - 40k

42500   9.10  

All Urban Born

183.9

176.7

19691600

109228

0.5

13%

21%

10-13%

higher

higher      

US MD Grads

206.9

198.8

25466000

125549

0.5

18%

24%

5.4%

 

       

White

200.6

226.3

17413000

81973

0.54

14%

26%

10-13%

$48,000

90000 80000 9.50 10.3

Native American

270.2

240.6

222000

871

0.48

9%

47%

27-30%

$33,000

60000 55000 8.10 8.9

All Rural Born

462.7

321.9

6218400

16321

0.42

22%

30%

14-20%

 in lower

lower      

Black

589.6

305.0

3593000

8880

0.35

13%

11%

19-22%

$33,000

55385 50000 6.90 8.4

All Hispanic

488.4

597.2

3204000

5975

0.56

12%

12%

14-30%

$33,000

       

MexicanAmerican

967.4

1222.1

3110600

2887

0.57

19%

13%

21-24%

$33,000

50000 48000 8.00 9.1

Other Hispanic

931.7

1139.3

2400000

2346

0.56

7%

11%

14-15%

$33,000

70000 60000 8.60 9.7

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.

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

Family Physicians from Allopathic Schools 1997 2003 Residency Grads

Major Medical Center Zip

Birth in Medical School County or City

Core Metro Born (area over 1 million in 1993)

Birth in a Rural Zip (RUCA)

Non-Metro Born

Allopathic National Data

 

 

 

 

 

Totals for Non FP

71%

70%

40%

8%

8%

Totals for FP

43%

59%

38%

22%

21%

Family Medicine Data for All Types

 

 

 

 

 

All 1997 2003 Grads

34%

59%

44%

22%

21%

White F

35%

58%

43%

24%

21%

White M

30%

54%

34%

28%

28%

Black F

39%

72%

61%

10%

9%

Black M

37%

64%

58%

12%

9%

Mexican American F

40%

59%

65%

9%

6%

Mexican American M

27%

78%

59%

15%

13%

Asian F

43%

78%

70%

8%

7%

Asian M

37%

80%

71%

8%

8%

Puerto Rican F

44%

100%

63%

   

Puerto Rican M

41%

75%

29%

   

Other Hispanic F

46%

67%

65%

13%

12%

Other Hispanic M

33%

70%

59%

9%

11%

Native American F

21%

27%

33%

47%

41%

Native American M

20%

33%

31%

36%

31%

Other F

40%

63%

52%

18%

16%

Other M

34%

59%

35%

25%

26%

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

Divisions by Quartiles/Most or Least FP Choice (n)

Medical School Grads 2004

% Born Urban Inf 1

Foreign Born

Born Urban Inf 3-9

% FP Likely

% Age  30 and older

MCAT 2000 Average

Allo Priv Least FP (11)

112.5

63.1%

14.4%

4.2%

19.3%

14.3%

10.9

Allo Priv Next Least (11)

141.0

60.9%

14.4%

4.7%

21.9%

16.2%

10.5

Allo Priv Next Most (11)

120.1

56.6%

13.1%

4.8%

20.9%

19.6%

9.6

Allo Priv Most FP (8+3)

115.2

51.9%

15.8%

8.7%

30.7%

23.2%

9.4

      Trad. Black (3)

75.4

5382%

4-10 %

714 %

14-38%

21-33

 

 

 

 

 

 

 

 

 

Allo Pub Least FP (20)

139.1

56.0%

13.1%

5.5%

25.3%

17.3%

9.8

Allo Pub Next Least (21)

146.0

46.7%

11.4%

10.5%

40.7%

21.4%

9.5

Allo Pub Next Most (20)

127.0

41.7%

9.9%

16.4%

47.5%

25.6%

9.6

Allo Pub Most FP (20)

92.0

36.9%

7.7%

22.7%

54.1%

29.2%

9.3

 

 

 

 

 

 

 

 

Osteo Least FP (9)

161.3

47.5%

8.3%

4.4%

22.4%

33.6%

8.4

Osteo Most FP (8)

133.0

33.3%

7.3%

13.6%

39.8%

42.9%

8.2

 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.

Allopathic Medical School Family Medicine Graduates

Rural Birth Origins

Rural Practice Location

 

Female

Male

All

Female

Male

All

White

17.7%

20.0%

19.0%

23.7%

28.3%

26.3%

Black

10.8%

9.6%

10.4%

9.9%

11.7%

10.5%

Mexican American

7.0%

10.6%

9.0%

9.3%

14.6%

12.3%

Asian

3.8%

1.9%

2.8%

7.7%

7.5%

7.6%

Other Hispanic

8.1%

4.6%

6.0%

13.2%

8.3%

10.3%

Native American

56.7%

36.4%

44.6%

46.7%

36.4%

40.5%

Unknown/Other

12.5%

14.6%

13.5%

17.0%

24.8%

20.8%

All Graduates

14.9%

17.0%

16.0%

19.7%

24.7%

22.4%

 

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 - 50% choice of rural location; however there were only 118 black family physicians born in rural areas and less than a third of this number for other ethnicities. Admissions from the constraints of rural birth plus lower income level plus diverse origin may represent the greatest challenges to any potential medical student and maybe to a young professional of any type. Such students add great versatility to physician workforce since they can an do choose any specialty and location, especially when choosing family medicine.

It is important to understand that rural practice distribution is limited for all other medical specialties by the availability of patients, facilities, and call coverage issues. Family medicine distribution is essentially the same as the distribution of population.

Locations of Allopathic Medical School Graduates from the 1987 - 2000 Classes

Medical School Graduation Year

US Population 1998

1987 - 2000 FPGP

1987 - 2000 Office Based Primary Care Not FPGP

1987 - 2000 All Physicians Not FPGP

Urban/Urban Focused

77.6%

73.9%

89.7%

89.4%

Large Rural

9.3%

10.5%

5.9%

6.3%

Medium Rural

6.9%

9.7%

2.8%

2.6%

Isolated Rural

6.1%

4.7%

0.8%

0.9%

Data on more recent graduates is not significantly different.

Even for family medicine there is a slight decline in choice of the most isolated rural communities compared to population distribution.  The various medical school types also impact the distribution of family physicians. Again this is a matter of the types of students that they admit. This involves older coding based on 20% poverty levels and not adjusting for zip codes with 75 or more physicians.

Source

Urban FP in Poverty

Rural FP

Rural FP in Poverty

Military

All Poverty

All Rural, Urban Poverty, Military

Total FP

Allopathic Private

876

643

154

275

1030

1783

4196

20.9%

15.3%

3.7%

6.6%

24.5%

42.5%

1

Allopathic Public

2343

3182

763

767

3106

6288

12894

18.2%

24.7%

5.9%

5.9%

24.1%

48.8%

1

Osteopathic Private

329

499

113

188

442

1016

2172

15.1%

23.0%

5.2%

8.7%

20.3%

46.8%

1

Osteopathic Public

96

182

46

42

142

320

689

13.9%

26.4%

6.7%

6.1%

20.6%

46.4%

1

North American International

269

228

62

17

331

513

1240

21.7%

18.4%

5.0%

1.4%

26.7%

41.4%

1

Distant International

405

277

70

21

475

703

1787

22.7%

15.5%

3.9%

1.2%

26.6%

39.3%

1

Total

4318

5011

1208

1310

5526

10623

22978

18.8%

21.8%

5.3%

5.7%

24.0%

46.2%

1

 

There are groups with much better outcomes. Inner city programs graduate 60 70% into urban poverty practices. These programs include concentrations of Black and Mexican American female family physicians born in urban areas. Rural training tracks have 70 90% rural location choice, but tend to have rural training bias, rural birth, and older age. The 150 accelerated family medicine graduates in this group led in total underserved distribution with 55% of graduates in rural locations, 25% in urban poverty locations, and 10% in teaching positions and do not have birth origin or training location bias. Accelerated graduates did have selection based on maturity levels and dedication to family medicine. (Accelerated Family Medicine Training Programs).

 

DISCUSSION

 The students most likely to distribute to the most needed locations as physicians are the least likely to be admitted to medical school. These students have origins in counties and populations with lower income levels, lower population density, and lower MCAT scores. They are the least likely to gain admission to the prestigious colleges and medical schools and specialties.

The changing composition of physicians in the United States predicts worsening distribution to rural and lower income areas of the nation. Students born in lower income counties and populations have the greatest choice of distributional careers but are admitted at lower and lower levels. This means less choice of family medicine, fewer rural physicians, and fewer likely to choose office-based primary care in poverty locations in future years.

The male advantage in rural practice choice is countered by a female advantage in urban poverty location. Female senior students actually have more interest in rural practice but they are less likely to be married or engaged. (Rural interested) Female career choice may be more sensitive to graduate location and spouse issues. The gender differences for rural practice choice are not universal. Females in the most distributional programs in the nation choose rural locations in the same pattern as males, including the Physician Shortage Area Program at Jefferson, the potent combination of Duluth admissions and Rural Physician Associate Program training, and the maturity-based selections and training of the accelerated family medicine residency programs. Unfortunately the accelerated model has been terminated nationwide, Duluth was forced to merge, PSAP has been refused much deserved state lines of funding, and these rural medical education programs have had 30 50% reductions in the number of students signing on in recent years.

Gender comparisons offer important clues regarding physician distribution. In some states where access to education in rural areas lags the most, there are family medicine programs where females are more likely to become rural family physicians. Upon closer examination, the female graduates were born in rural areas and the males were born in urban locations. In these states the males in rural parts of the state access college or medical school poorly. Across the nation rural males and black males are much less likely to gain admission compared to females.

Service-orientation is an important component of primary care choice (Madison Service Orientation)  the expression of service orientation may vary by ethnicity and gender and longitude. Those from eastern inner city poverty locations tend toward internal medicine and pediatrics while those in the Midwest and west tend to choose family medicine. There are few that can escape chronic poverty. Those that do have devoted parents, elite test taking ability, and participate in elite programs. Those with elite scores are treated much the same as those who are privileged and are less likely to choose family medicine. There is a difference for Vietnamese, rural populations, and Mexican Americans. These populations are not enmeshed in extremes of poverty lasting generations. There are more who are the first or second generation in their family to attend college. Those most involved in chronic poverty in the US have low achievement scores, disrupted family structures, low high school graduation levels, and the lowest college participation rates. Chronic poverty also breeds hopelessness and low expectations of professional careers that may kill off important service-oriented careers as teachers, nurses, public servants, and family physicians long before college. Studies indicate major problems with education funding, distribution of education (Funding Gap) and college access (Mortensen) for those in chronic poverty. It is not a surprise that those delayed entry by barriers of education and income are older and tend to choose family medicine, rural practice, and poverty practice.

Medical School Admissions By Income - see what increasing income levels of admitted allopathic students are likely to do to the FP match in just a few years.

A special acknowledgement goes to health professional advisor Dan Marien who died recently.

Association of American Medical Colleges (AAMC) Data Warehouse

AAMC GQ

AAMC Minorities in Medicine

Cooter R, Erdmann JB, Gonnella JS, Callahan CA, Hojat M, Xu G, Evaluation & the Health Professions, Economic Diversity In Medical Education / September 2004 http://ehp.sagepub.com/cgi/reprint/27/3/252

Hart Gary WWAMI Rural-Urban Commuting Areas (For Residential & Commercial/Geographic Zip Codes: Version 1.1)http://www.fammed.washington.edu/wwamirhrc/rucas/descript.html

Hart Gary Use of RUCA codes  Categorization A http://www.fammed.washington.edu/wwamirhrc/rucas/00F02640-005B90E7.-1/use_healthcare.html

Madison, Donald L Medical School Admission and Generalist Physicians A Study of the Class of 1985,  Academic Medicine Vol 69 Number 10 October 1994 p 825 - 831

Martini JM, Veloski JJ, Barzansky B. Medical school and student characteristics that influence choosing a generalist career. JAMA . 1994;272:661 -8          Lower mcat   

McGaghie WC Assessing Readiness for Medical Education Evolution of the MCAT  JAMA September 4, 2002 Vol 288 No 9

McGaghie, W. C. (1990). Qualitative variables in medical school admission. Academic Medicine, 65, 145-149.

Medical Marketing Service I. AMA Physician MasterFile: Medical Marketing Service, Inc; 2000 and 2004, access to 2004 data via Robert Graham Center for collaborative work

Rabinowitz HK, Diamond JJ, Markham FW, Paynter NP, Critical factors for designing programs to increase the supply and retention of rural primary care physicians, JAMA 2001; 286: 1041-1048

Rasmussen CJ  Addressing the Continued Socioeconomic Gap in Higher Education: Insights from Low-Income Students In Australian Universities http://www.ashe.ws/paperdepot/2002Rasmussen-Addrs.pdf 

Seyan K, Greenhalgh T, Dorling D  The standardised admission ratio for measuring widening participation in medical schools: analysis of UK medical school admissions by ethnicity, socioeconomic status, and sex, British Medical Journal 2004;328:1545-1546 (26 June),  http://bmj.bmjjournals.com/cgi/content/full/328/7455/1545  .

 Xu, G, et al. (1997). The relationship between the race/ethnicity of generalist physicians and their care for underserved populations. American Journal of Public Health, 87(5), 817-822

Wheat, JR, Brandon, JE, Carter, LR, Leeper, JD, & Jackson, JR. (2003). Premedical Education: The Contribution of Small Local Colleges. Journal of Rural Health 19(2), 181-189.

Women, Minorities, and Persons with Disabilities in Science and Engineering at http://www.nsf.gov/sbe/srs/nsf99338/frames.htm

Physician Workforce Studies

Gender and Rural Practice

Parent Income and Ethnicity and FP Choice

Variables in the Medical School Database

Gender and Ethnicity in FP Graduates 1997

Distribution Theory

Asian Students in Education and Medical Education

Urban-Rural Location, Per Capita Income, and Choice of Family Medicine

Distribution of Physicians

Medicine, Education, and Social Status

Birth Origin and Ethnicity of Family Medicine Graduates

www.ruralmedicaleducation.org

 

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