Just did a review of Indiana medical school graduates. Across the nation
and in most states, the older graduates are likely to choose family
medicine, rural locations, and underserved locations. In the states with
better distributions of income and education the impact of age and
physician distribution is lessened.
Indiana fits this pattern with better distributions of education (increased
HS grad to professionals) and income (Gini, income quintiles) and not much
difference in physician career choice with older age.
Minnesota and Nebraska fit this pattern, but the inner city parts of Omaha
and Twin Cities are clearly decades behind in infrastructure.
I suspect that studies that examine the statistics in some ways magnify the
differences. Overall it appears that almost all areas of these Midwestern
states can prepare kids well enough to do well, except for the
concentrations of poverty in the inner city areas (and some reservation
areas).
Trashing on the entire state may do a disservice to a real focus on the
areas that need infrastructure.
Age at medical school entry or graduation represents delays due to barriers
of income and education.
Across the nation the youngest students are those of the most urban
origins, Asian, foreign born, and highest income. They have had few if any
barriers to top education, college (74% in the top income quartile for the
top 146 colleges), and professional schools. They also have the lowest
levels of distribution to family medicine, primary care, underserved
locations, high poverty locations, or rural locations.
Older medical school graduates are a mix of those from middle and lower
income counties and populations such as rural born, Black, Mexican
American, Native American, and others who are different and diverse. They
are a universal donor for physician distribution. They also have the
advantage of a much closer match with the growing diversity of US
populations. Because they are different, however, they are more difficult
to evaluate and have different MCAT scores. In recent years older graduates
have been improving in admissions mainly in historically black medical
schools and the medical schools admitting more Hispanic and Black students
(UT San Antonio, UT Galveston, UC Davis, UCLA, UC Irvine, U Washington).
This is a likely effect of legal actions in the United States.
Current expansions of medical schools in the United States should result in
more older admissions as in the previous expansion, but these are likely to
be higher income urban origin older students just like in the previous
expansion. Expansions in the past also missed the chance to admit more
minorities and rural origin students. Only a slow steady expansion coupled
with previous improvements in education and college access will maximize
the graduation of physicians that are a better match for the US population
in socioeconomics, geography, and other dimensions of distribution.
Older admissions tracks are a good idea to capture a better quality
physician with previous experience in health care or behavioral areas or
teaching or management. Few have such admission tracks.
Robert C. Bowman, M.D.
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