Physician Careers By School Type

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. (Note from 2009 - sadly Mercer's decline from 32% FM to 7% indicate changes in admission, training, career choice, and career and location outcomes not favorable to most needed health access)

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.

Exclusivity Tables for Specialties - Who is more likely to gain admission and is least likely to serve where most needed?

Changes in Specialty Choice 1987 - 1999 - there are a number of reasons for career choice beyond the Flaws in the Concept of Controllable Lifestyle

Atlas of Basic Health Access  

www.basichealthaccess.org

www.physicianworkforcestudies.org

www.ruralmedicaleducation.org

 

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