The Coastal Research Group, through its National Projects on the Outcomes of Family Medicine Residency Training and the Community Impact of Family Medicine Residency Programs, monitored the practice sites over time of a sample of 2005 through 2010 family medicine residency graduates.
A preliminary presentation on early returns of the study was presented at the Nineteenth National Conference on Primary Health Care Access in April 2008 by William H. Burnett of the Coastal Research Group and J. Scott Christman of ESRI, Inc., a leading developer of Geographic Information Systems.
Survey Inputs
Family medicine residents nearing graduation from participating family medicine residency programs were asked to fill out a survey form that included the following location information:
- The name of their residency program
- The graduate’s high school of graduation
- The medical school of graduation
- The practice location after graduation, if known
- The mailing address after graduation
Method
An ESRI GIS program was utilized to plot the locations of the high schools and the practice sites. If no practice site was yet identified, the mailing address was used as a substitute.
For the sample under consideration, 275 practice locations were identified. Additionally, 93 mailing addresses were added. These were 2005, 2006, and 2007 graduates.
There were 325 resulting matches in which both the high school and the practice or mailing address was identified. This was a first cut of the data in the geocoding process. As these data are further refined, the number of matches is expected to increase.
The ESRI software measured the distance of each graduate from their reported high school to their current practice location or mailing address.
Overall Early Findings
There were 302 records with solid matches of a graduate’s high school and practice or mailing address location. For those records, the minimum distance was less than one-half mile, the maximum was 17,000 miles, and the mean was 1,900 miles.
Because foreign medical graduates were asked to identify their high school or high school-equivalent institution, the mean is high because typically the foreign medical graduates do not return to the area in which they attended high school. Were only North American high school graduates considered, the mean distance would be considerably less and the resulting percentages in the categories described below would be higher.
43.3% 131 of 302 graduates were located within 100 miles of their high school of graduation.
50.3% 152 of 302 graduates were located within 200 miles of their high school of graduation.
63.9% 193 of 302 graduates were located within 500 miles of their high school of graduation.
ESRI GIS Map of Pennsylvania High School Graduates and Their Location (April 2008) The original article referenced a Flickr-hosted map image that is no longer available from the source URL.
Pennsylvania Graduates
Because activities of the National Project on the Community Impact of Family Medicine Residency Programs for the years under study were concentrated in California and Pennsylvania, significant numbers of records in those two states permit a comparison of data for each state’s graduates.
For the graduates of the Pennsylvania family medicine residency programs, there were 108 unique graduates for which both high school of graduation and practice site or mailing address were known:
37.0% 40 graduates were within 100 miles of their high schools of graduation.
49.0% 53 graduates were within 200 miles of their high schools of graduation.
65.7% 71 graduates were within 500 miles of their high schools of graduation.
Analogous data to Pennsylvania’s for the counties of Southern California The original article referenced a Flickr-hosted map image that is no longer available from the source URL. The caption described this as a subset of the data shown for the State of California.
California Graduates
The data for all three maps are from the same database. For each map, the rectangles with squares represent high school of graduation of a family physician residency graduate and the circles represent practice location or current mailing address. In the Southern California county map, the lines between high school and current location match data for an individual family physician.
For the graduates of the California programs, there were 129 unique graduates for which both high school of graduation and practice site or mailing address were known:
60.4% 78 graduates were within 100 miles of their high schools of graduation.
62.0% 80 graduates were within 200 miles of their high schools of graduation.
73.6% 95 graduates were within 500 miles of their high schools of graduation.
Sample of locations of California-trained family physicians and their high school of graduation The original article referenced a Flickr-hosted map image that is no longer available from the source URL.
Next Analysis
The preliminary results are especially striking for the counties of Southern California. Future analysis will include a comparison of the self-reported ethnicity of the family physician residency graduates, data from state and federal government departments of education that compile ethnicity information by high school, and census data on the populations residing in sub-county areas.
As mentioned above, these data were preliminary results of early data. Updated reports will include the 2008 graduates who have been added to the data, and the practice sites established for graduates from earlier classes who had not yet identified a practice site in the earlier surveys.
This process is expected to include further data analysis in collaboration with the Penn State University Department of Family and Community Medicine, James E. Herman, MD, Chair.