High School of Graduation and Family Doctor Practice Sites

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, is monitoring 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.

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.

An ESRI GIS program was utilized that plotted the locations of the high schools and the location of the practice sites. If no practice site was yet identified, the mailing address was used as a substitute.

For the sample under consideraiton, 275 practice locations were identified.  Additionally, 93 mailing addresses were added. (These were 2005, 2006 and 2007 graduates.)

There were a resulting 325 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 has the capacity to measure the distance of each graduate from their reported high school to their current practice location or mailing address.

There were 302 records with solid matches of a graduate’s high school and practice/mailing address location.

For those 302 records, the minimum distance was less than one-half mile and the maximum was 17,000 miles. The mean is 1900 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.)

For those 302 records, 131 (43.3%)  graduates are located within 100 miles of their high school of graduation.

For those 302 records, 152 (50.3%) graduates are located within 200 miles of their high school of graduation.

Of those 302 records, 193 (63.9%) are located within 500 miles of their high school of graduation.

ESRI GIS Map of Pennsylvania High School Graduates and Their Location (April 2008)
ESRI GIS Map of Pennsylvania High School Graduates and Their Location (April 2008)

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/mailing address were known:

40 (37.0%) are within 100 miles of their high schools of graduation.

53 (49.0%) are within 200 miles of their high schools of graduation.

71 (65.7%) are within 500 miles of their high schools of graduation.

Analogous data to Pennsylvanias for the counties of Southern California. (This map is a subset of the data shown below for the State of California)
Analogous data to Pennsylvania’s for the counties of Southern California. (This map is a subset of the data shown below for the State of California)

The data for all three maps are from the same data base. For each map, the rectangles with squares represent high school of graduation of  family physician residency graduate and the circles represent practice location or current mailing address. In the middle map of Southern California counties, the lines between high school and current location matches data for an individual family physician.

For the graduation of the California programs there were 129 unique graduates for which both high school of graduation and practice site/mailing address were known:

Sample of Locations of California-trained Family Physicians and Their High School of Graduation
Sample of Locations of California-trained Family Physicians and Their High School of Graduation

78 (60.4%) are within 100 miles of their high schools of graduation.

80 (62.0%) are within 200 miles of their high schools of graduation.

95 (73.6%) are within 500 miles of their high schools of graduation.

The preliminary results are especially striking for the counties of Southern California. Future analysis will include an comparison of the self-reported ethnicity of the family physician residency graduates, data from state and federal government departments of education, which 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 in the earlier surveys not yet identified a practice site.

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.)