Academic Medicine Study Finds Medical School Expansion Alone Won’t Solve Health Care Access Challenges

FOR IMMEDIATE RELEASE: Tuesday, October 29, 2013 

Leslie Champlin 
Senior Public Relations Strategist 
American Academy of Family Physicians 
(800) 274-2237, Ext. 5224 

LEAWOOD, Kan. — Expanding medical school enrollment without sufficient, well-targeted growth in primary care residency training positions will do little to ensure that all Americans have access to primary medical care, according to research by the Robert Graham Center for Policy Studies in Family Medicine and Primary Care. In fact, an uncoordinated medical school expansion could worsen the imbalance of specialties and maldistribution of physicians. 

Those were among the findings in "State Patterns in Medical School Expansion 2000-2010: Variation, Discord, and Policy Priorities(," published in an early release of the December issue of Academic Medicine. 

University of Massachusetts Medical School researcher Ben Adler and his colleagues Wendy Biggs, MD, University of Kansas Medical Center family medicine residency program director, and Andrew Bazemore, MD, MPH, director of the Graham Center, recommended that states adopt legislation or policies that improve both the number of medical students choosing primary care and the retention of those students after they complete their residency training. 

Adler and his coauthors measured growth in each state's population and medical school enrollment to determine states' success in building a primary care physician workforce. They found that, overall, median state population growth was 7.4 percent while median medical school enrollment growth was 14.7 percent. They then determined the rate at which graduates return to the states where they graduated from medical school to practice primary care. Retention rates varied from 10 percent in New Hampshire to 67 percent in Wyoming. (Residents from Wyoming trained at University of Washington through a cooperative education agreement among the states of Washington, Wyoming, Alaska, Montana and Idaho.) 

"Although the 22.9 percent increase in total U.S. medical school enrollment from 2000 to 2010 will increase supply of physicians, as the Council on Graduate Medical Education suggested, an increase in supply 'will not in and of itself address issues of maldistribution of physicians,'" the researchers write. 

The data "indicate that uncoordinated expansion of medical school enrollment may not solve the problem of getting providers into areas where they are most needed," said Adler of the findings. "We found that some expansion occurred in states with recent population growth, short supply of primary care physicians and a track record of keeping graduates in state to provide care. At the same time, much of the medical school expansion occurred in states that didn’t have the same need for it. Other states in greater need did not see the increases one might have expected." 

The researchers made several recommendations to address the issue: 

  • local and regional health care needs, such as population growth, access to care and the geographic distribution of physicians, should inform medical school expansion efforts;
  • coordinated efforts among neighboring states, such as the WWAMI model at the University of Washington School of Medicine, should be pursued where appropriate, given the high costs of medical education;
  • policies encouraging careers in primary care are needed at the preadmission, admission and curriculum levels in medical schools. Admissions committees should prioritize admission of students with known intentions and characteristics associated with choosing primary care;
  • new medical schools' intentions to increase the supply of physicians in primary care should be assessed by measuring graduates' practice five years after graduation; and
  • the manner in which medical school expansion occurred after warning of provider shortages may foretell the course of future Graduate Medical Education (GME) expansion. State and federal stakeholders should find ways to coordinate medical school and GME expansion to meet societal needs for more equitable distribution of physicians according to specialty and geographic location.


About the Robert Graham Center

The Robert Graham Center for Policy Studies in Family Medicine and Primary Care works to improve individual and population health by enhancing the delivery of primary care. The Center staff generates and analyzes evidence that brings a family medicine and primary care perspective to health policy deliberations at local, state, and national levels.

Founded in 1999, the Robert Graham Center is an independent research unit affiliated with the American Academy of Family Physicians (AAFP). The information and opinions contained in research from the Center do not necessarily reflect the views or policy of the AAFP.