There are major questions whether the US education system is capable of
preparing enough qualified applicants.
70% of those admitted are from the top 30% income in the US, were born and
raised in major medical center locations, and will remain in such locations
for practice. Foreign born students are rapidly replacing US born medical
students, even in the top socioeconomic groups. this is yet one more
confirmation of serious problems with US education.

The lower 70% in income and education background in the US are completely
dependent upon local and state efforts. the Federal share is less than 10%.
Higher education is at a 25 year low in investment. The efforts are too
little, too late, and poorly invested. Much of the education funding should
be stacked earlier and should involve child development. Those that improve
by age 8 might put some competition on the rich and jump start them back
into better preparation.

The United States has yet to take any of these steps which will take some
time. The Asian and foreign born components going to US allopathic schools
will continue to increase. In the past 25 years Asian Indian up from 1% to
7%, Asian from 3 % to 23%, foreign born (half Asian born) up from 4% to
16%. This does not include the continued flood of physicians from medical
schools all over the world. About 22 to 23 thousand enter the US workforce
each year and 16000 are US allopathic grads.

Any medical school, even the elite ones, could admit and graduate at
different type of physician as noted by the Jefferson PSAP program. Any
state can take a different plan for education and admissions such as an
admissions track, a distributional medical school such as Duluth or Mercer,
or a statewide effort to partner between education, higher education, and
medical education.

These are choices not made.

The United States could also redistribute physicians by health policy as in
1965 - 1978 and the 1990s, but chooses not to do so. This means moving
health funding from major medical centers to rural, low income, and middle
income populations with broader health care coverage involved. This rewards
those who locate outside of major medical centers.

Decreases in the distributional types of students, decreasing choice of
family medicine and distributional careers stimulated by health policy (or
lack of it) will mean fewer physicians in all but the major medical center
areas. Current expansions, with the few exceptions of the targeted
distributional efforts (Wisconsin, UC Davis) will increase the numbers in
major medical centers and will not improve health access, economics, or
facilities outside of major medical centers in the nation where over 70% of
physicians already practice.

Robert C. Bowman, M.D.
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