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Research ArticleOriginal Research

Community College Pathways to Medical School and Family Medicine Residency Training

Efrain Talamantes, Anthony Jerant, Mark C. Henderson, Erin Griffin, Tonya Fancher, Douglas Grbic, Gerardo Moreno and Peter Franks
The Annals of Family Medicine July 2018, 16 (4) 302-307; DOI: https://doi.org/10.1370/afm.2270
Efrain Talamantes
1Center for a Diverse Healthcare Workforce, University of California, Davis School of Medicine, Sacramento, California
2Department of Medicine, Division of General Internal Medicine, University of California, Davis School of Medicine, Sacramento, California
MD, MBA, MSc
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  • For correspondence: etalamantes@ucdavis.edu
Anthony Jerant
3Department of Family and Community Medicine, University of California, Davis School of Medicine, Sacramento, California
MD
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Mark C. Henderson
1Center for a Diverse Healthcare Workforce, University of California, Davis School of Medicine, Sacramento, California
2Department of Medicine, Division of General Internal Medicine, University of California, Davis School of Medicine, Sacramento, California
MD
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Erin Griffin
1Center for a Diverse Healthcare Workforce, University of California, Davis School of Medicine, Sacramento, California
PhD
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Tonya Fancher
1Center for a Diverse Healthcare Workforce, University of California, Davis School of Medicine, Sacramento, California
2Department of Medicine, Division of General Internal Medicine, University of California, Davis School of Medicine, Sacramento, California
MD, MPH
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Douglas Grbic
4Association of American Medical Colleges, Washington, DC
PhD
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Gerardo Moreno
5Department of Family Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
MD, MSHS
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Peter Franks
3Department of Family and Community Medicine, University of California, Davis School of Medicine, Sacramento, California
MD
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Article Figures & Data

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    Table 1

    Characteristics of USMGs 2010-2012 by Undergraduate College Pathway

    CharacteristicUndergraduate College Pathway Total
    Non–Community CollegeHigh School–Community CollegeCommunity College–TransferPostbaccalaureate–Community CollegeP Valuea
    All graduates, No. (%)32,138 (74.1)4,846 (11.2)1,241 (2.9)5,157 (11.9)–43,382 (100)
    Program type, No. (%)<.001
     MD only29,698 (73.6)4,535 (11.2)1,187 (2.9)4,930 (12.2)40,350 (100)
     MD dual degree2,440 (80.5)311 (10.3)54 (1.8)227 (7.5)3,032 (100)
    Age, mean (SD), y23.6 (2.2)23.5 (2.2)25.4 (3.4)24.7 (3.2)<.00123.7 (2.4)
    Sex, No. (%)<.001
     Male16,655 (74.2)2,413 (10.8)761 (3.4)2,605 (11.6)22,434 (100)
     Female15,483 (73.9)2,433 (11.6)480 (2.3)2,552 (12.2)20,948 (100)
    Race/ethnicity, No. (%)<.001
     White21,379 (75.1)3,043 (10.7)745 (2.6)3,318 (11.7)28,485 (100)
     Asian6,557 (74.1)1,151 (13.0)226 (2.6)916 (10.4)8,850 (100)
     Black or African American1,879 (72.7)238 (9.2)85 (3.3)383 (14.8)2,585 (100)
     Latino1,514 (64.6)282 (12.0)159 (6.8)390 (16.6)2,345 (100)
     Multiple809 (74.4)132 (11.8)26 (2.3)150 (13.4)1,117 (100)
    Time in medical school, mean (SD), y4.25 (0.70)4.25 (0.68)4.27 (0.69)4.21 (0.59)<.0014.25 (0.68)
    First-generation college student, No. (%)2,893 (62.8)714 (15.5)294 (6.4)706 (15.3)<.0014,607 (100)
    High school US region, No. (%)<.001
     West5,174 (57.9)1,924 (21.6)479 (5.4)1351 (15.1)8,928 (100)
     Midwest8,273 (75.0)1,060 (9.6)267 (2.4)1,426 (12.9)11,026 (100)
     Northeast8,255 (88.4)319 (3.4)98 (1.1)671 (7.2)9,343 (100)
     South10,436 (74.1)1,543 (11.0)397 (2.8)1,709 (12.1)14,085 (100)
    • USMG = US doctor of medicine (MD)-granting medical school graduate.

    • Notes: Non–community college: medical graduates who never attended a community college; high school–community college: medical graduates who attended a community college while in high school and before graduating from high school; community college–transfer: medical graduates who attended a community college after graduating from high school and before transferring to a 4-year university; postbaccalaureate–community college: medical graduates who attended a community college after graduating from a 4-year university.

    • ↵a ANOVA test for continuous variables and χ2 test of differences for proportions when both variables were categorical.

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    Table 2

    Comparison of USMGs 2010-2012 Who Trained in Family Medicine Residency vs Other Residency Specialties

    CharacteristicFamily Medicine
    (n = 3,787)
    Other Residency Specialtiesa
    (n = 39,595)
    P Valueb
    College pathway, No. (%)<.001
     Non–community college2,489 (7.7)29,649 (92.3)
     High school–community college580 (12.0)4,266 (88.0)
     Community college–transfer157 (12.7)1,084 (87.4)
     Postbaccalaureate–community college562 (10.9)4,596 (89.1)
    Program type, No. (%)<.001
     MD only3,551 (8.8)36,799 (91.2)
     MD dual degree236 (7.8)2,796 (92.2)
    Age, mean (SD), y23.7 (2.4)24.4 (2.9)<.001
    Female, No. (%)2,245 (59.3)18,703 (47.2)<.001
    Race/ethnicity, No. (%)<.001
     White2,631 (9.2)25,854 (90.8)
     Asian446 (5.0)8,404 (95.0)
     Black or African American327 (12.6)2,258 (87.4)
     Latino268 (11.4)2,077 (88.6)
     Multiple115 (10.3)1,002 (89.7)
    Time in medical school, mean (SD), y4.31 (0.65)4.24 (0.69)<.001
    First-generation college student, No. (%)606 (13.2)4,001 (86.8)<.001
    High school US region, No. (%)<.001
     West928 (10.4)8,000 (89.6)
     Midwest1,128 (10.2)9,898 (89.8)
     Northeast548 (5.9)8,795 (94.1)
     South1,183 (8.4)12,902 (91.6)
    • USMG = US doctor of medicine (MD)-granting medical school graduate.

    • Notes: Non–community college: medical graduates who never attended a community college; high school–community college: medical graduates who attended a community college while in high school and before graduating from high school; community college–transfer: medical graduates who attended a community college after graduating from high school and before transferring to a 4-year university; postbaccalaureate–community college: medical graduates who attended a community college after graduating from a 4-year university.

    • ↵a Pediatrics, internal medicine, neurology, dermatology, radiology, surgery, and other specialties.

    • ↵b ANOVA test for continuous variables and χ2 tests of differences for proportions when both variables were categorical.

    • View popup
    Table 3

    Odds of Training in Family Medicine Residency Among USMGs 2010-2012 by Undergraduate College Pathway

    College PathwayOdds Ratio (95% CI)P ValueaMarginal % (95% CI)
    Unadjusted analysis
     Non–community collegeReference–7.7 (7.5-8.0)
     High school–community college1.62 (1.47-1.78)<.00112.0 (11.1-12.9)
     Community college–transfer1.72 (1.45-2.05)<.00112.7 (10.8-14.5)
     Postbaccalaureate–community college1.45 (1.32-1.60)<.00110.9 (10.0-11.7)
    Adjusted analysisb
     Non–community collegeReference–8.1 (7.8-8.4)
     High school–community college1.47 (1.33-1.63)<.00111.4 (10.5-12.3)
     Community college–transfer1.27 (1.06-1.52).00910.1 (8.5-11.6)
     Postbaccalaureate–community college1.17 (1.06-1.29).0029.3 (8.6-10.1)
    • USMG = US doctor of medicine (MD)-granting medical school graduate.

    • Notes: Non–community college: medical graduates who never attended a community college; high school–community college: medical graduates who attended a community college while in high school and before graduating from high school; community college–transfer: medical graduates who attended a community college after graduating from high school and before transferring to a 4-year university; postbaccalaureate–community college: medical graduates who attended a community college after graduating from a 4-year university.

    • ↵a Wald test.

    • b Adjusted for age, sex, race/ethnicity, years in medical school, parental education, high school US region.

Additional Files

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    Supplemental Table

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  • The Article in Brief

    Community College Pathways to Medical School and Family Medicine Residency Training

    Efrain Talamantes , and colleagues

    Background With both a growing demand for primary care physicians and declining medical student interest in the field, this study examines a possible pathway to meeting the United States' primary care workforce needs.

    What This Study Found The study of US medical school graduates from 2010 to 2012 finds that graduates who attended community college as pre-medical students are more likely to train in family medicine than those who attended other institutions. Specifically, among 43,382 medical school graduates, 3,787 (9 percent) trained in family medicine and, of those, 1,298 (34 percent) attended community college. According to logistic regression analysis models, community college attendees were more likely to train in family medicine compared to all other specialties. In addition, sensitivity analysis revealed that community college attendance was not significantly associated with training in internal medicine, pediatrics, and combined internal medicine/pediatrics. Within the family medicine residency workforce, 51 percent of Latinos, 35 percent of Asians, 33 percent of whites, and 32 percent of African Americans/blacks, as well as 42 percent of first generation college students, attended community college.

    Implications

    • Nurturing early interest in family medicine during high school and community college may be one strategy to increase the supply and diversity of the United States' primary care physician workforce, the authors explain. They call for longitudinal research that follows high school, community college, and four-year university students to better understand the experiences and programs that influence their career decisions.
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The Annals of Family Medicine: 16 (4)
The Annals of Family Medicine: 16 (4)
Vol. 16, Issue 4
July/August 2018
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Community College Pathways to Medical School and Family Medicine Residency Training
Efrain Talamantes, Anthony Jerant, Mark C. Henderson, Erin Griffin, Tonya Fancher, Douglas Grbic, Gerardo Moreno, Peter Franks
The Annals of Family Medicine Jul 2018, 16 (4) 302-307; DOI: 10.1370/afm.2270

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Community College Pathways to Medical School and Family Medicine Residency Training
Efrain Talamantes, Anthony Jerant, Mark C. Henderson, Erin Griffin, Tonya Fancher, Douglas Grbic, Gerardo Moreno, Peter Franks
The Annals of Family Medicine Jul 2018, 16 (4) 302-307; DOI: 10.1370/afm.2270
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