Multiplier Impacts in Distribution

Robert C. Bowman, M.D.

Various types of students have different levels of rural and underserved distribution. A key factor in distribution is choice of family medicine. In the following table the types of distribution by student characteristics are listed, with or without choice of family medicine. 

Total Doctor / Rural Doctor Per Cent

Rural Choices for 203,000 most recent  US MD Grads of 1987 1999 in 2005 equilibrium cross section locations

Rural Career Choices

Multiplier of Birth Core Metro NonFP

With / Without FM

% of Allopathic Physicians

With / Without Family Medicine

Underserved With / Without FM

Major Med Center With / Without FM

14.4/ 8.0%

Foreign Born

5.5%/12.8%

0.74/1.73

5.5%/12.9%

76%/52%

49.3/38.8%

Born Core Metro over 1 million

7.4%/19.6%

1.00/2.65

4.6%/11.5%

76%/48%

55.5/46.4%

Born out of state in any urban area

7.8%/21.1%

1.05/2.85

5.2%/13.1%

75%/48%

34.8/30.7%

Born instate in any urban area

8.2%/20.4%

1.11/2.76

5.5%/11.9%

75%/46%

19.9/22.3%

Older and born in any urban area

10.4%/24.1%

1.41/3.26

6.7%/15.2%

72%/45%

11.7/14.8%

Born in lower income urban area

11.9%/25.9%

1.61/3.50

7.9%/18.9%

72%/42%

22.2/26.6%

Born urban and less than 1 million

11.1%/25.4%

1.50/3.43

6.2%/13.6%

72%/43%

 5.0/ 8.2%

Born out of state in a rural area

14.6%/35.9%

1.97/4.85

7.2%/15.3%

70%/39%

12.0/30%

Born in a rural area

18.7%/44.7%

2.53/6.04

8.4%/16.4%

68%/34%

 8.8/20%

Born in lower income rural area

19.7%/46.0%

2.66/6.22

9.2%/17.8%

66%/31%

 2.8/ 6.6%

Older and born in a rural area

20.4%/43.3%

2.76/5.85

9.4%/18.7%

65%/34%

 6.2/16.1%

Born instate in a rural area

22.2%/49.4%

3.00/6.68

9.5%/17.0%

66%/31%

Top row - 14.4% of all allopathic US MD grads are foreign born and this group is 8% of rural physicians. Foreign born US MD grads choose rural locations at 5.5% for non family physicians and 12.8% for foreign born USMD grad family physicians. This is lower than the 1.0 Core metro birth marker so the multiplier is 0.74 for non FP and 1.73 for family physicians who are foreign born. The same percentages and ratios apply to underserved locations outside of major medical centers. About 76% of nonFP foreign born physicians are found in Major medical centers and only 52% of foreign born US MD family physicians are found in major medical centers with 75 or more physicians at a zip code.

Rows in red indicate the most likely additions during an expansion. Those not in red have been declining in admissions in past decades.

The most numerous medical students are urban born and dominate admissions. For example over 55% were born out of state in an urban area and this group was also nearly half of rural physicians at 46.4%. All urban origin sources of US MD physicians including core metro born, foreign born, and those born in metro areas of less than 1 million are a group comprising 90% of US MD physicians and 70% of US MD rural physicians. Because they are more numerous, they dominate distribution numbers, but not percentages.

There are several implications regarding student factors and distribution:

 

Physician Workforce Studies

www.ruralmedicaleducation.org

 

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