By Shana F. Sandberg, PhD, Research Writer, Association of American Medical Colleges Center for Workforce Studies
The December issue of Academic Medicine features a collection of articles on training the future health care workforce. Anticipating future workforce needs, in 2006 the Association of American Medical Colleges (AAMC) called for a 30% increase in enrollment at U.S. MD-granting medical schools over the next decade.
Medical schools have responded. This fall, a record number of students applied to and enrolled in medical schools across the country. And, according to the results of the most recent AAMC Medical School Enrollment Survey, the nation’s medical schools are on track to reach the goal of a 30% increase by 2017.
This expansion in medical school enrollment is the direct result of two related, but separate, responses. The first is that many existing medical schools increased the size of their incoming classes. The second is that several new medical schools have applied for accreditation and opened their doors.
Despite the fact that both of these efforts were motivated, at least in part, by growing concern about physician workforce shortages, little is known about whether and how enrolling more students in medical school will help address particular workforce priorities such as provider diversity, care for underserved populations, and sufficient numbers working in shortage fields including primary care and academic faculty.
In order to address this question, Shipman, Jones, Erikson, and I designed a study using data from the American Medical Association (AMA) Physician Masterfile and the AAMC. In writing the paper, we sought to answer two research questions about what effects expansion thus far might have on the future workforce:
(1) Do the schools that have expanded the most differ from other schools in ways that could influence the composition and career choices of the future physician workforce?
(2) Have the characteristics and interests of recent students who enrolled in medical school shifted in ways that suggest the workforce will be more diverse, more likely to practice in underserved areas, or more likely to practice in needed specialties such as primary care—and what impact have new schools had on this?
We found that the schools that had expanded the most between 2001 and 2011 had historically produced a greater proportion of students who went on to work in rural areas, other underserved areas, and in primary care, than had the schools that expanded the least. In fact, when schools were divided into four groups based on amount of growth, there was a linear relationship between amount growth and the percentage of past students who went on to practice in each of these areas. However, these schools were less likely to have produced full-time faculty than schools that had not expanded.
In order to answer the second question, we compared students enrolling in medical school in the three years immediately prior to the most recent expansion (1999-2001) to students who had recently enrolled at the the time of the study (2009-2011). We found that the percentage of enrolling students who were female and the percentage from particular underrepresented minority groups (black, Native American, and Hispanic) both increased at existing schools between the two periods. At the new schools, students from these minority groups was even higher, making up more than a quarter of the incoming classes (27.9%).
Median parental income also decreased somewhat among students entering the existing schools between the two time periods, and was even lower among students enrolling in the new schools. While this suggests more economic diversity among more recent medical school enrollees, it is important to keep in mind that even among matriculants to new schools, median parental income was still $100,000—almost double median household incomes in the United States.
The percentage of students from a rural background decreased at existing schools between the two time periods (from 6.7% to 4.2%), and was even lower among entering students at the new schools (2.9%). New schools only enrolled an average of one rural student per school, per year.
In terms of career interest, plans to practice in an underserved area, to work primarily with minorities, and to work in a large city or suburb all increased among students enrolling at existing schools post-expansion. Plans to work primarily with minorities was higher still among students enrolling at new schools. The percentage of students interested in a primary care specialty rose slightly at existing schools, but not at new schools.
On the whole, while there has been some change in the characteristics and interests of students enrolling in medical school post-expansion, the magnitude of many of these differences is small, especially at the existing schools (for example, black, Native American, and Hispanic students as a group increased at existing schools only 1.6 percentage points, from 14.1 to 15.7). While these gains are important, states and local communities may benefit from more attention to workforce needs at the nation’s medical schools.
In a perspective piece in the same issue of Academic Medicine, Mahon, Henderson, and Kirch argue that transforming the admission process has great potential to alter the composition of our health care workforce. The techniques they describe—including holistic review and multiple mini-interviews—help shift the focus in admissions away from purely academic credentials to include interpersonal and intrapersonal competencies that will be necessary to meet the needs of the health system of tomorrow.
Both medical schools and the communities they are built to serve will benefit from increased attention to the way that expansion can be targeted to specific workforce needs.