Robert C. Bowman, M.D.
Database used 1987 - 1999 graduates of allopathic schools based on the 2005 Masterfile, categorized by medical school and MCAT group
The probability of physician careers changes with type of school.
The probability of physician distribution varies by MCAT and other factors related to education, state investment, etc.
The schools that select the types of students most likely to choose family medicine and that concentrate on a family medicine focus of training, distribute graduates to rural locations, office based primary care in underserved areas, primary care, and family medicine. The schools with more students with higher MCAT scores are the least likely to distribute to careers than can or will distribute.
Students that score poorly on the MCAT will have an uphill battle gaining entry to a school that will allow them a high probability subspecialty choice and have the lowest probability of being able to choose such a career.
The greatest contrasts between careers are Endocrinology vs Family Medicine, adjacent to one another and noted below. Family medicine is one of the largest percentages of physicians but has only 2.2% researchers resulting in one of the lowest ratios for the specialty providing the bulk of primary care across the nation, particularly in rural and underserved areas. Research efforts are specific to disease and medication and not to the delivery of care.
Methods
I broke down the 1987 - 1999 medical school graduates into MCAT groups. I indexed the graduates according to how many per category. Duluth and Mercer earned a separate category for their superior distribution in all categories, as did U Washington, UCLA, Irvine, and Davis for theirs involving underserved primary care.
| Puerto Rico Schools | MCAT 10.6 - 12 | MCAT 10.08 - 10.54 | MCAT 9.76 - 10.05 | MCAT 9.5 - 9.76 | MCAT 9.15 - 9.49 | MCAT 8.6 - 9.15 | Duluth, Mercer | UCLA, Davis, Irvine, U Wash | Traditional Black Schools | UMKC, Uniform,U HI, NEOUCOM | % of researchers 1987 - 1999 | % of allopathic doctors 1987 - 1999 | Ratio | ||||
| Allergy Immunology | AI | 30% | 74% | 99% | 89% | 114% | 110% | 134% | 98% | 76% | 93% | 146% | 815 | 11 | 0.9% | 0.4% | 2.19 |
| Anesthesia | AN | 79% | 78% | 85% | 104% | 109% | 123% | 100% | 38% | 95% | 89% | 105% | 10630 | 18 | 1.4% | 5.2% | 0.27 |
| Pain Management (anesth) | APM | 219% | 71% | 81% | 108% | 105% | 137% | 77% | 0% | 99% | 115% | 54% | 658 | 2 | 0.2% | 0.3% | 0.49 |
| Cardiology | CD | 123% | 132% | 117% | 101% | 94% | 84% | 77% | 50% | 60% | 72% | 76% | 4753 | 41 | 3.3% | 2.3% | 1.40 |
| Child & Adolescent Psychiatry | CHP | 136% | 79% | 94% | 91% | 103% | 113% | 145% | 76% | 44% | 129% | 120% | 2085 | 15 | 1.2% | 1.0% | 1.17 |
| Dermatology | D | 58% | 154% | 109% | 93% | 77% | 81% | 88% | 40% | 118% | 66% | 128% | 3325 | 16 | 1.3% | 1.6% | 0.78 |
| Diagnostic Radiology | DR | 115% | 108% | 97% | 101% | 98% | 107% | 88% | 61% | 75% | 57% | 116% | 7809 | 7 | 0.6% | 3.8% | 0.15 |
| Emergency Medicine | EM | 51% | 80% | 97% | 105% | 115% | 97% | 99% | 52% | 129% | 114% | 124% | 10269 | 11 | 0.9% | 5.0% | 0.17 |
| Endocrinology | END | 195% | 148% | 126% | 95% | 79% | 74% | 69% | 54% | 97% | 68% | 72% | 988 | 36 | 2.9% | 0.5% | 5.92 |
| Family Medicine | FP | 80% | 46% | 79% | 100% | 103% | 121% | 159% | 287% | 151% | 139% | 117% | 26917 | 28 | 2.2% | 13.2% | 0.17 |
| Gastroenterology | GE | 176% | 121% | 109% | 107% | 94% | 87% | 72% | 54% | 67% | 77% | 100% | 2941 | 27 | 2.2% | 1.4% | 1.49 |
| General Preventive Medicine | GPM | 43% | 104% | 114% | 86% | 89% | 85% | 66% | 63% | 91% | 346% | 295% | 848 | 20 | 1.6% | 0.4% | 3.83 |
| General Surgery | GS | 85% | 104% | 94% | 108% | 101% | 95% | 99% | 129% | 86% | 110% | 112% | 8030 | 12 | 1.0% | 3.9% | 0.24 |
| Hematology Oncology | HO | 93% | 147% | 118% | 101% | 85% | 89% | 63% | 52% | 76% | 22% | 72% | 1547 | 25 | 2.0% | 0.8% | 2.62 |
| Hand Surgery | HS | 19% | 178% | 113% | 109% | 76% | 83% | 33% | 86% | 100% | 41% | 70% | 620 | 0 | 0.0% | 0.3% | 0.00 |
| Infectious Disease | ID | 177% | 159% | 120% | 97% | 81% | 76% | 53% | 94% | 69% | 84% | 80% | 1695 | 57 | 4.5% | 0.8% | 5.46 |
| Internal Medicine (general) | IM | 93% | 95% | 108% | 98% | 104% | 97% | 92% | 121% | 110% | 125% | 81% | 24906 | 202 | 16.1% | 12.2% | 1.32 |
| Internal Medicine Geriatrics | IMG | 170% | 105% | 136% | 100% | 76% | 87% | 90% | 42% | 87% | 132% | 100% | 636 | 10 | 0.8% | 0.3% | 2.55 |
| Medicine Pediatrics | MPD | 16% | 52% | 85% | 68% | 122% | 129% | 222% | 73% | 41% | 161% | 78% | 1827 | 3 | 0.2% | 0.9% | 0.27 |
| Neurology | N | 146% | 123% | 114% | 102% | 98% | 95% | 67% | 70% | 51% | 53% | 64% | 2676 | 92 | 7.3% | 1.3% | 5.58 |
| Nephrology | NEP | 173% | 107% | 121% | 93% | 91% | 90% | 92% | 87% | 89% | 93% | 101% | 1532 | 12 | 1.0% | 0.8% | 1.27 |
| Neonatal Perinatal Medicine | NPM | 156% | 96% | 96% | 116% | 97% | 96% | 106% | 157% | 51% | 40% | 122% | 847 | 17 | 1.4% | 0.4% | 3.26 |
| Neurosurgery | NS | 65% | 191% | 105% | 96% | 89% | 72% | 53% | 16% | 85% | 40% | 57% | 1667 | 4 | 0.3% | 0.8% | 0.39 |
| Obstetrics-Gynecology | OBG | 113% | 80% | 102% | 99% | 111% | 102% | 105% | 125% | 89% | 142% | 87% | 13161 | 20 | 1.6% | 6.5% | 0.25 |
| Oncology | ON | 195% | 196% | 100% | 77% | 72% | 91% | 73% | 0% | 78% | 47% | 34% | 710 | 32 | 2.6% | 0.3% | 7.32 |
| Ophthalmology | OPH | 78% | 148% | 106% | 97% | 90% | 91% | 66% | 29% | 84% | 64% | 99% | 5469 | 13 | 1.0% | 2.7% | 0.39 |
| Orthopedic Surgery | ORS | 40% | 132% | 110% | 102% | 90% | 86% | 73% | 63% | 109% | 76% | 125% | 5882 | 2 | 0.2% | 2.9% | 0.06 |
| Orthopedic Sports Medicine | OSM | 40% | 146% | 128% | 105% | 103% | 62% | 50% | 0% | 114% | 11% | 73% | 758 | 0 | 0.0% | 0.4% | 0.00 |
| Otorhinolaryngology | OTO | 50% | 144% | 115% | 102% | 97% | 83% | 65% | 26% | 83% | 19% | 77% | 3113 | 3 | 0.2% | 1.5% | 0.16 |
| Psychiatry | P | 134% | 102% | 103% | 89% | 90% | 105% | 130% | 81% | 93% | 86% | 88% | 7247 | 93 | 7.4% | 3.6% | 2.08 |
| Pulmonary Critical Care | PCC | 82% | 123% | 107% | 111% | 91% | 91% | 72% | 16% | 86% | 25% | 138% | 1695 | 14 | 1.1% | 0.8% | 1.34 |
| Pediatrics | PD | 96% | 103% | 104% | 101% | 100% | 94% | 101% | 76% | 99% | 112% | 84% | 15840 | 67 | 5.3% | 7.8% | 0.69 |
| Pediatric Cardiology | PDC | 52% | 150% | 115% | 92% | 110% | 67% | 63% | 137% | 96% | 14% | 103% | 581 | 8 | 0.6% | 0.3% | 2.24 |
| Physical Medicine | PM | 305% | 59% | 82% | 109% | 108% | 114% | 105% | 10% | 102% | 143% | 84% | 2699 | 10 | 0.8% | 1.3% | 0.60 |
| Plastic Surgery | PS | 59% | 137% | 97% | 109% | 99% | 89% | 74% | 27% | 73% | 60% | 90% | 1942 | 1 | 0.1% | 1.0% | 0.08 |
| Pathology | PTH | 85% | 113% | 95% | 90% | 96% | 110% | 114% | 67% | 80% | 30% | 113% | 2770 | 17 | 1.4% | 1.4% | 1.00 |
| Pulmonary | PUD | 376% | 81% | 100% | 109% | 102% | 102% | 67% | 0% | 97% | 111% | 52% | 607 | 13 | 1.0% | 0.3% | 3.48 |
| Rheumatology | RHU | 286% | 125% | 111% | 94% | 82% | 84% | 92% | 100% | 81% | 21% | 119% | 799 | 22 | 1.8% | 0.4% | 4.47 |
| Neuroradiology | RNR | 74% | 116% | 115% | 108% | 102% | 92% | 61% | 0% | 82% | 80% | 75% | 1055 | 3 | 0.2% | 0.5% | 0.46 |
| Radiation Oncology | RO | 49% | 111% | 111% | 101% | 97% | 93% | 80% | 54% | 126% | 97% | 92% | 1475 | 4 | 0.3% | 0.7% | 0.44 |
| Thoracic Surgery | TS | 48% | 152% | 107% | 104% | 97% | 87% | 61% | 21% | 60% | 81% | 54% | 1242 | 1 | 0.1% | 0.6% | 0.13 |
| Urology | U | 57% | 131% | 113% | 94% | 103% | 98% | 57% | 0% | 92% | 37% | 76% | 2936 | 4 | 0.3% | 1.4% | 0.22 |
| Vascular Interventional Radio | VIR | 58% | 118% | 104% | 101% | 111% | 96% | 67% | 77% | 90% | 41% | 73% | 1030 | 1 | 0.1% | 0.5% | 0.16 |
| Vascular Surgery | VS | 28% | 123% | 121% | 109% | 93% | 90% | 61% | 61% | 75% | 77% | 96% | 868 | 3 | 0.2% | 0.4% | 0.56 |
| Distribution of all Grads | 95% | 98% | 100% | 100% | 101% | 101% | 102% | 104% | 101% | 102% | 98% | ||||||
| Percent of 1987 - 1999 Grads | 1.7% | 14.8% | 16.3% | 16.6% | 18.5% | 17.3% | 7.3% | 0.4% | 3.2% | 1.2% | 2.5% | 203627 | 1254 | 100.0% | 100.0% | 1.00 | |
| Greatest Contrasts | Puerto Rico Schools | MCAT 10.6 - 12 | MCAT 10.08 - 10.54 | MCAT 9.76 - 10.05 | MCAT 9.5 - 9.76 | MCAT 9.15 - 9.49 | MCAT 8.6 - 9.15 | Duluth, Mercer | UCLA, Davis, Irvine, U Wash | Traditional Black Schools | UMKC, Uniform,U HI, NEOUCOM | Docs | Research Docs | % of researchers 1987 - 1999 | % of allopathic doctors 1987 - 1999 | Ratio | |
| Endocrinology | END | 195% | 148% | 126% | 95% | 79% | 74% | 69% | 54% | 97% | 68% | 72% | 988 | 36 | 2.9% | 0.5% | 5.92 |
| Family Medicine | FP | 80% | 46% | 79% | 100% | 103% | 121% | 159% | 287% | 151% | 139% | 117% | 26917 | 28 | 2.2% | 13.2% | 0.17 |
Duluth and Mercer graduated 278% higher FP than their "share" of students, 120% of general IM, 129% of General Surgeons, 157% of neonatal perinatal, 125% of ob-gyn, 137% of pediatric cardiology, 27% of plastic surgery, 40% of dermatology, anesthesia, emergency, radiology. Nice enough for distribution, and even some to please the academic types who pay more attention to numbers. Also Duluth ranked at the top in Native American grads and a variety of lower income and rural types. It is also helpful to realize that about half and sometimes more of Duluth's 60 grads a year have taken the 9 month Rural Physician Associated Program. Duluth Plus RPAP
In my view you could not ask for a more efficient distribution of the most needed physicians, and avoiding the least needed physicians. Duluth's efforts (Duluth 20 Questions) with primary emphasis on admissions by Jim Boulger's example have addressed the most important questions regarding physicians in our time.
The secret should not be a secret to family physicians. You select best by selecting students that are most likely to choose family medicine. You back this up with specific FP training as at Duluth and Mercer from 1987 - 1999 grads. Duluth and Mercer succeeded without favorable distributional health policy before and after 1995 - 1997 graduates. Mercer managed to do so despite a state and region not known for superior distribution. But Mercer has been unable to sustain the distribution either whereas Duluth has, at least pre-merger with U of MN main campus. Look long and hard, after the merger, these numbers will not be able to be studied in a national comparison.
The highest MCAT schools graduated, well, the opposite of the above. They "live" in maldistributed states and cities and have the wealth and income but seem to tolerate serious and gathering problems. They choose based on a standardized system that insures concentrations of education and income, one that has been reinforced by recent court decisions that accelerated admissions of the highest income medical students in the nation, the ones least likely to choose family medicine and distributional careers. Because they see with the perspective of those around them that are most like them, they are not likely to see the problems until far too late.
Concentration of education, health, income, health resources, medical schools, and test taking to the highest levels will eventually lead to systems breakdown.
oops, too late.
Robert C. Bowman, M.D.
Changes in Specialty Choice 1987 - 1999 - there are a number of reasons for career choice beyond the Flaws in the Concept of Controllable Lifestyle