D. Zhang is assistant professor, Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia; ORCID: https://orcid.org/0000-0001-5225-4721 .
G. Li is a PhD student, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China, and Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia; ORCID: https://orcid.org/0000-0002-6513-2907 .
Acad Med. 2021 Jun 1;96(6):885-893. doi: 10.1097/ACM.0000000000004033.
Socioeconomic and geographic determinants of medical school application and matriculation may help explain the unequal distribution of physicians in the United States. This study describes trends in MD-granting medical school application and matriculation rates and explores the relationship between county median family income, proximity to a medical school, and medical school application and matriculation rates.
Data were obtained from the Association of American Medical Colleges, including the age, gender, and Federal Information Processing Standards code for county of legal residence for each applicant and matriculant to U.S. MD-granting medical schools from 2001 through 2015. The application and matriculation rates in each county were calculated using the number of applicants and matriculants per 100,000 residents. Counties were classified into 4 groups according to the county median family income (high-income, middle-income, middle-low-income, low-income). The authors performed chi-square tests to assess trends across the study period and the association of county median family income with application and matriculation rates.
There were 581,833 applicants and 262,730 (45.2%) matriculants to MD-granting medical schools between 2001 and 2015. The application rates per 100,000 residents during 2001-2005, 2006-2010, and 2011-2015 were 57.2, 62.7, and 69.0, respectively, and the corresponding matriculation rates were 27.5, 28.1, and 29.8. The ratios of the application rate in high-income counties to that in low-income counties during the 3 time periods were 1.9, 2.4, and 2.8, respectively.
The application and matriculation rates to MD-granting medical schools increased steadily from 2001 to 2015. Yet, applicants and matriculants disproportionately came from high-income counties. The differences in the application and matriculation rates between low-income and high-income counties grew during this period. Exploring these differences can lead to better understanding of the factors that drive geographic differences in physician access and the associated health disparities across the United States.
医学院校申请和入学的社会经济和地理决定因素可能有助于解释美国医生分布不均的现象。本研究描述了 MD 授予医学院校申请和入学率的趋势，并探讨了县中位数家庭收入、靠近医学院校与医学院校申请和入学率之间的关系。
数据来自美国医学院协会，包括 2001 年至 2015 年期间每位申请和入学的美国 MD 授予医学院的申请人和入学的年龄、性别和联邦信息处理标准代码，以及每个县的申请人和入学人数除以每 10 万居民的人数。根据县中位数家庭收入（高收入、中等收入、中低收入、低收入）将各县分为 4 组。作者进行了卡方检验，以评估研究期间的趋势以及县中位数家庭收入与申请和入学率的关系。
2001 年至 2015 年期间，共有 581833 名申请人和 262730 名（45.2%）申请人入读 MD 授予医学院。2001-2005 年、2006-2010 年和 2011-2015 年期间，每 10 万居民的申请率分别为 57.2、62.7 和 69.0，相应的入学率分别为 27.5、28.1 和 29.8。在这 3 个时期，高收入县的申请率与低收入县的申请率之比分别为 1.9、2.4 和 2.8。
2001 年至 2015 年，MD 授予医学院的申请和入学率稳步上升。然而，申请人和入学人数不成比例地来自高收入县。在此期间，低收入县和高收入县的申请和入学率之间的差异不断扩大。探讨这些差异可以更好地理解导致医生获得途径的地理差异以及美国各地相关健康差距的因素。
