Rurality and Origin-Destination Trajectories of Medical School Application and Matriculation in the United States.

Lan Mu,Donglan Zhang,Janani Rajbhandari-Thapa,Gang Li,Yong Gao,José A. Pagán,Zhuo Chen,Heejung Son,Yusi Liu,Michelle Nuss,Yan Li

doi:10.3390/ijgi10060417

Abstract

Physician shortages are more pronounced in rural than in urban areas. The geography of medical school application and matriculation could provide insights into geographic differences in physician availability. Using data from the Association of American Medical Colleges (AAMC), we conducted geospatial analyses, and developed origin–destination (O–D) trajectories and conceptual graphs to understand the root cause of rural physician shortages. Geographic disparities exist at a significant level in medical school applications in the US. The total number of medical school applications increased by 38% from 2001 to 2015, but the number had decreased by 2% in completely rural counties. Most counties with no medical school applicants were in rural areas (88%). Rurality had a significant negative association with the application rate and explained 15.3% of the variation at the county level. The number of medical school applications in a county was disproportional to the population by rurality. Applicants from completely rural counties (2% of the US population) represented less than 1% of the total medical school applications. Our results can inform recruitment strategies for new medical school students, elucidate location decisions of new medical schools, provide recommendations to close the rural–urban gap in medical school applications, and reduce physician shortages in rural areas.

Highlights

About 15% to 20% of the United States (US) population in rural areas face health inequities, such as worse health care quality and a more severe physician shortage than urban and suburban residents [1]
Our combined dataset included the geographic records of application locations, medical school locations, and Graduate Medical Education (GME)
Tracing back to physicians’ career path origin, we found the medical school application data confirmed that rural areas have significantly fewer applicants in the pipeline to the future workforce

Summary

Introduction

About 15% to 20% of the United States (US) population in rural areas face health inequities, such as worse health care quality and a more severe physician shortage than urban and suburban residents [1]. A recent study commissioned by the Association of American Medical Colleges (AAMC) estimated that the US would face a shortage of between 54,100 and 139,000 physicians by 2033 [2]. Acute in rural compared to urban areas. The primary care physician-to-patient ratio in rural areas was only 39.8 physicians per 100,000 persons, compared to 53.3 physicians per 100,000 persons in urban areas [3]. Unequal geographic distribution of physicians may be worse than the physician shortage itself [5]. The rural physician shortage and the challenge of attracting physicians to practice medicine in rural communities remain a population health challenge

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