Family Medicine Choice:
Initial Class Years of New Medical Schools

Robert C. Bowman, M.D.

Findings

All 6 of the osteopathic public schools started out lower than the national FPGP average for the first 3 classes before rising to the top levels of FPGP choice and distribution in later years.

All 5 of the private osteopathic schools started with national average (2) or greater (3) levels of FPGP choice compared to national averages and have generally maintained this level.

22 of the allopathic public schools began at greater than the national average and generally have stayed above the average

10 allopathic public schools began at the average U Connecticut, U Nevada, NEOUCOM, South Alabama, SUNY Stony Brook, U Mass, U Missouri KC, Eastern VA, Texas A & M and have remained at the average with some exceptions

2 allopathic public schools (UC San Diego and Arizona) began below the national average

4 of the allopathic private schools started below average - Mt. Sinai, Rush, U Central del Caribe, Brown - stayed lower
1 or Dartmouth began at the average
4 or Ponce, Morehouse, Mayo, Oral Roberts all began above average - generally have continued in this

Hypotheses that would be interesting to explore beyond the numbers
- the type of medical school impacts the first years of FPGP choice
- the timing of medical school creation may impact the choice of family medicine, rural, and underserved
- the first years of a medical school may not fully reflect the eventual outcomes for FM, rural, or underserved in some types of schools but may reflect the future outcomes in others

Method - Masterfile using class years and FPGP choice divided by total graduates of the class year for each school

Results - The table lists the average FPGP choice for the nation as of 2004 data from the Masterfile by class year. This gives some baseline of comparison for the FPGP choice and trends for use in examining individual schools. National averages for the school for the first 3 years (disregarding distortions from low numbers) are compared to national average for the nation during this same time period.

Allopathic Private msid ST Start Compared to National FPGP 3yr avg for school
Mt. Sinai 3547 NY low 3.0%
Rush 1601 IL low 8.3%
U Central del Caribe 4203 PR low 10.1%
Brown 4301 RI low 12.3%
Dartmouth 3201 NH avg 12.5%
Ponce 4202 PR high 18.0%
Morehouse 1221 GA high 21.3%
Mayo 2608 MN high 23.8%
Oral Roberts 3905 OK high 43.5%
Allopathic Public        
UC San Diego 518 CA low 3.3%
Arizona 301 AZ low 5.3%
Penn State 4114 PA avg 11.6%
U Connecticut 802 CT avg 12.0%
U Nevada 3101 NV avg 12.3%
NEOUCOM 3844 OH avg 13.1%
South Alabama 106 AL avg 13.2%
SUNY Stony Brook 3548 NY avg 13.2%
U Mass 2416 MA avg 14.1%
U Missouri KC 2846 MO avg 15.5%
Eastern VA 5107 VA avg 16.0%
Texas A & M 4816 TX avg 16.0%
U of NM 3401 NM high 8.4%
UC Davis 519 CA high 13.2%
UT San Antonio 4813 TX high 14.6%
U South FL 1104 FL high 16.4%
Hawaii 1401 HI high 16.9%
Marshall 5502 WV high 17.3%
LSU Shreveport 2106 LA high 19.4%
UT Houston 4814 TX high 19.9%
Uniform Services 2312 MD high 20.3%
Med Coll Ohio 3843 OH high 20.4%
UMDNJ RWJ 3306 NJ high 22.2%
East TN St 4720 TN high 22.4%
U S Dakota 4601 SD high 22.4%
Brody E Carolina 3608 NC high 22.4%
Texas Tech 4815 TX high 22.5%
U N Dakota 3701 ND high 23.5%
Mich St Allo 2512 MI high 23.7%
U S Carolina 4504 SC high 23.9%
U MN Duluth 2607 MN high 30.0%
Wright State 3845 OH high 35.3%
Southern Illinois 1645 IL high 35.5%
Mercer 1222 GA high 37.2%
Osteopathic Private        
Lake Erie Osteo 4178 PA avg 14.9%
Nova SE Osteo 1175 FL avg 15.3%
NY Osteo 3575 NY high 14.2%
Western Osteo 576 CA high 19.9%
U New Eng Osteo 2275 ME high 21.9%
Osteopathic Public        
Mich St Osteo 2576 MI low 2.5%
Ok St U Osteo 3979 OK low 5.9%
UMDNJ Osteo 3375 NJ low 6.3%
U N Tx Osteo 4878 TX low 6.5%
Ohio U Osteo 3875 OH low 7.1%
WV Osteo 5575 WV low 9.2%

Hypotheses that would be interesting to explore beyond the numbers

 

Special Interest Schools

WV Osteopathic  - now the leader in the world in % US rural docs,

Oral Roberts is an interesting study from a number of aspects. There is a beginning and an ending for ORU grads. Also the impact of this beginning and ending can be compared to U of Oklahoma and the Ok State osteo. Shifting of student types in states such as Oklahoma and Pennsylvania are indicators of the potential impact of health professional advisors and school efforts to attract certain types of students, thus shaping future outcomes.  ORU FM production for 1982 began with 2 for FM then in subsequent years 6, 11, 8, 11, 16 (during a low period for FM choice in 1987 class), 7, 7, then 8 in the final class. for percentage of FPGP choice the class started with 25.0% in 1982 then 48.0% 57.6% 45.0% 41.0% 46.3% 24.2% 27.0% 36.8%

When a school is in known difficulty, it may also be less likely to attract the distributional types of students, the ones who have fought current systems all of their previous lives and might not want to fight the system for the rest of their lives. - more on this later as the case may be made better with black or Hispanic students.

The first year grads of FSU are not likely to represent what they will continue to become, although as I have stated before, the state of Florida has a very great difficulty in advancing the rural, black, Hispanic, different, and diverse types of students that they most need from the lower and middle income brackets to higher education and medical school. However given the level of state funding for FSU, the pressures are enormous to produce geriatric, rural, and minority distributions to fit the expressed mission. FM choice is a common denominator for care of the elderly, rural, and underserved.
 

Regarding the Impact of Various School and National Support Levels on Certain Types of Students


The case for students not feeling confident in health policy or a medical school is made by the choices of Historically Black medical school students and students from medical schools with higher levels of black and Hispanic students. Choice of family medicine has fallen at the highest levels from the peak 1995 - 1997 choice to the current choice in these schools. The west coast distributional schools are a category I created for UCLA, Davis, Irvine, and the U of Washington. These are schools that have had much greater choice of FM and distribution to underserved areas than expected given the students and locations. They also tend to have older students who also have greater distribution. Diversity in the student body is high. The West Coast Distributional schools also shared the significant decline of Historically Black colleges, I suspect that the combination of students who went with FP when it was hot and those who went with FP because it was stable and supported, helped peak FM choice in these school types because of their student blends. When FM support declined and FM was no longer respected and FM was no longer a top hire, these students made other decisions. This is tragic as we and the nation lost a lot of the most distributional types of students and family physicians, and a lot of potential teaching physicians as well. Distributional Medical Schools: A Matter of Distributional Students and Careers for graphic comparing peak FM choice to recent FM choice

Alternative Hypotheses

Also there are differences in LCME and osteopathic beginnings, and this may be reflected in the admissions and curriculum. More preparation could potentially help osteopathic medical schools produce a higher FPGP number sooner. Interactions between the accrediting folks and the school could be important areas of study. also will new osteopathic schools have the later rise of FPGP at a time with declining FP choice and declining primary care policy and increasing osteopathic status.
 

Conclusions

There are interesting differences in type of school and type of beginning for student career choices. School support levels and accreditation support may vary. The environment of the nation may impact student choice. Student types may vary in the first few years of admissions. Variation in student choice involves class years also.

Certain student types may also need more reassurance, from the school for certain types of schools, or from the nation to choose certain types of specialties. Students may also think that they need more support or know that they need more support, and this may not be around in the early years of a school or the school may not address this area with students in the early years until they realize the importance of support areas for certain types of students.

Do schools implement missions, or do their own thing? After controlling for school type (osteopathic public) - Do initial class years actually reflect the true mission of the school?


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

Distributional Medical Schools: A Matter of Distributional Students and Careers

Distributional Medical Schools: The Lost Lesson of Specific Forms of Government Support

Five Periods of Health Policy and Physician Career Choice

Physician Workforce Studies

www.ruralmedicaleducation.org

 

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