Impact of Student Diversity in Medical Schools on Physician Workforce in Medically Underserved Areas

Health disparities persist in the United States, with one significant contributing factor being the geographic and specialty maldistribution of physicians. This imbalance leads to a shortage of primary care physicians and limited access to healthcare in some areas. Medical schools have been identified as playing a key role in addressing these disparities by diversifying the physician workforce. This retrospective cohort study, utilizing statistical analysis of secondary data, aimed to empirically determine the relationship between the racial/ethnic diversity of students in U.S. medical schools and two key outcomes: the proportion of graduates entering primary care practice, and the proportion of primary care physicians practicing in medically underserved areas (MUAs). Two measures of diversity were used as predictor variables: the Diversity Index Score (DIS), reflecting the probability that any two randomly selected graduates belong to different race/ethnic categories, and the proportion of graduates from racial/ ethnic groups underrepresented in medicine (PURMG). Regarding the first outcome, we found that an increase in DIS was associated with a decreased likelihood of graduates entering primary care, across all levels of PURMG within the study sample. However, the negative effect of DIS was less pronounced at higher levels of PURMG. With respect to the second outcome, the relationship between DIS and primary care physicians practicing in MUAs was found to vary with PURMG levels. At higher PURMG levels, an increase in DIS was associated with a steep decline in the proportion of primary care physicians in MUAs. At lower levels of PURMG, there was no effect on the relationship between DIS and the proportion of physicians practicing in MUAs. We conclude from this study that a narrow focus on increasing racial/ethnic diversity or the proportion of URiM students in medical schools may not achieve the purpose of increasing the number of physicians in primary care practice, or those practicing in medically underserved areas. Several personal and institutional factors and the practice environment of primary care centers, especially those located in medically underserved areas, play a role in students’ career choices. Closer examination of the structure and dynamics of institutions, and the perceptions and behavior of students, faculty, and leadership is required to better understand the factors promoting such career decisions and practice locations. Meanwhile, other strategies need to be evaluated and implemented to achieve the optimal physician: population ratio in underserved areas.