Medical school admissions, specialty selection, and distribution of physicians

This review of the University of Missouri-Columbia medical graduates, with similar data from two other studies, supports the thesis that hometown size and speciality choice are interrelated predictors of the community in which physicians practice. Physicians with nonmetropolitan backgrounds were two to three times as likely to select nonmetropolitan practice as physicians with urban backgrounds. Physicians entering family medicine were almost three times as likely to select nonmetropolitan practice as physicians in other primary-care specialities. Presence of both predictors (nonmetropolitan background and selection of family medicine) resulted in two thirds selecting nonmetropolitan practice. However, selection of family medicine by graduates with urban backgrounds or selection of other specialties by graduates with nonmetropolitan backgrounds did not appreciably increase the likelihood of nonmetropolitan practice. These data have implications for medical school admissions policy and curriculum.