RESUMEN
Using national databases of the Association of American Medical Colleges, the authors have examined reasons for the rising indebtedness of U.S. medical students, looking across the past decade at the influence of tuition and fees (tuition-fees) alone and the total costs of attending school, the effects of the changing demographics of medical school enrollments and lengthened graduation times, the relationship between the availability of school-funded scholarships and the amount of student loan disbursements, the pattern of student financial aid, and the reliance on borrowing to cover the costs of medical education. In constant dollars, the average indebtedness of students graduating from public schools increased 59.2% between 1985 and 1995, and that for graduates of private schools increased 64.2%. The fraction of graduates bringing debt with them when they entered medical school declined from 42.1% in 1985 to 33.6% in 1995. Premedical debt as a fraction of total debt declined at public schools from 9% in 1985 to 7% in 1995, and at private schools from 7.8% in 1985 to 5.9% in 1995. For public schools, tuition-fees increased 60.1% between 1985 and 1995, and average medical school debt increased 60.9%; for private schools, tuition-fees increased 30.1% over that period, while average medical school debt increased 66.2%. On average, public school graduates accrued debt greater than their four-year tuition-fee payments, while the average debt accrued by private school graduates was less than tuition-fee amounts. In 1995, graduates of public schools had debt accumulations representing 62% of the average total cost of attendance (tuition, fees, books, supplies, equipment, and living expenses), and the indebtedness of private school graduates was 55% of the average total cost, findings suggesting that total costs were the stronger driver of the amounts borrowed. On a national scale, the influences on medical school debt of longer graduation times, the growing number of women students, greater racial-ethnic diversity, and the admission of more older students age were negligible or small. The average parental income, adjusted to constant dollars, actually increased between 1985 and 1995. For public schools, the aggregate amounts of student aid have climbed at a steeper rate than schools' tuition-fee revenues during the past decade. For public schools, tuition-fee revenues rose 66.7% between 1985 and 1995, while the amount of loans to students at public schools increased 92.7%. For private schools, tuition-fee revenues went up 36.5%, and the amount of loans to students rose 57.9% during the same period. Federal Stafford Loans represented the major financing source, increasing from 71.5% of public schools' tuition-fee revenue in 1985 to 92.2% in 1995, and from 23% of private schools' tuition-fee revenue in 1985 to 38% in 1995. Over the decade, scholarship support kept pace with tuition-fee increases at public schools, but lagged behind the increases at private schools. The recent escalation of student debt has coincided with the lifting of the federal loan borrowing limits under the Higher Education Act. In parallel, entering medical students have declared their intentions to rely more heavily on loans as a means of financing. These findings, although based on national data and trends, provide a framework for exploration of the factors affecting educational costs and financing at individual medical schools. The importance of doing so is mounting, as students may be throwing caution to the winds in the more favorable climate for borrowing, ignoring indicators of changing practice opportunities and incomes ahead.
Asunto(s)
Educación Médica/economía , Estudiantes de Medicina/estadística & datos numéricos , Apoyo a la Formación Profesional/tendencias , Centros Médicos Académicos/economía , Adulto , Factores de Edad , Femenino , Humanos , Masculino , Factores Sexuales , Apoyo a la Formación Profesional/economía , Estados UnidosRESUMEN
Using national databases of the Association of American Medical College, the authors employed logistic regression analysis to show the relative predictive influences of selected demographic, structural, attitudinal, and educational variables on the specialty careers choices of 1995 U.S. medical school graduates. Plans to pursue certification in family practice or an unspecified generalist career could be predicted with moderate success, while choices of general internal medicine and general pediatrics could not. The intentions of the 1995 graduates to pursue generalist specialty, were significantly associated with demographic factors such as female gender, older student age, and rural hometown; early interest in the generalist specialties; attitudes favoring helping people over seeking opportunities for leadership, intellectual challenge, or research; the presence of a department of family medicine in the medical school; and ambulatory care experiences in the third and fourth years. In the multiple-regression models used in this study, a number of factors widely touted as important to the cultivation of generalism were not significant predictors of generalist decisions; an institutional mission statement expressly addressing the cultivation of generalist careers; giving admission preferences to applicants who vowed an interest in generalism; public (versus private) school sponsorship; discrete organization units for general internal medical or general pediatrics; the proportion of institutional faculty in the general specialty of medicine and pediatrics; the level of educational debt; the students; clinical experiences in the first and second years of medical school. The authors acknowledge the danger of inferring causal relationships from analyses of this kind, and described how the power of previous associations--e.g., that between a required third-year clerkship in family medicine and graduates' family practice career choices--may be weakened when the independent variable spreads across institutional cultures that at present are less conductive to primary care. The findings of this analysis add to the evidence that generalist career intentions are largely carried on the tide of students' interests and experiences in family medicine and ambulatory primary care. In terms of the predictive values of the input variable in this study, career decisions for the other two generalist specialties--general internal medicine and general pediatrics--were essentially a crapshoot, either because the tactics to promote interest in these fields were ineffective (or confounded), or because the efforts were underdeveloped. Moreover, the statistical models of this study employed quantifiable variables that can be discerned and manipulated to guide the result, whereas medical students tend to identify less tangible elements as more powerful factors influencing their career choices. The results sharpen the strategic focus, but must be combined with those of other, descriptive analysis for a more complete understanding of graduating students' career decisions.
Asunto(s)
Selección de Profesión , Medicina Familiar y Comunitaria , Estudiantes de Medicina , Adulto , Factores de Edad , Atención Ambulatoria , Actitud , Prácticas Clínicas , Toma de Decisiones , Demografía , Educación Médica , Medicina Familiar y Comunitaria/educación , Femenino , Predicción , Humanos , Sistemas de Información , Medicina Interna/educación , Modelos Logísticos , Masculino , Medicina , Objetivos Organizacionales , Pediatría/educación , Atención Primaria de Salud , Análisis de Regresión , Población Rural , Facultades de Medicina/organización & administración , Factores Sexuales , Especialización , Apoyo a la Formación ProfesionalRESUMEN
The authors report on the specialty intentions that graduating students declared on the 1995 AAMC Medical School Graduation Questionnaire (GQ) and compare the pattern of career choices in 1995 with that in 1992. Family practice was the leading choice of graduates in 1995, followed by internal medicine subspecialties and general internal medicine. These choices represented significant gains over those made in these specialties in 1992 and were at the expense of declines in the interest of 1995 graduates for internal medicine specialties, radiology, anesthesiology, obstetrics-gynecology subspecialties, and some other fields. In 1992, 14.6% of graduating students declared plans to pursue careers in one of the generalist specialties; in 1995, 27.6% declared such plans. In 1992, no school graduated 50% or more students with generalist intentions, and only one school reached 40%; in 1995, five schools graduated more than 50%, and another 15 graduated more than 40% who favored generalist careers. Medical schools with significant GQ response rates (110 out of 125) were aggregated by level of generalist production (top 25%, middle 50%, and bottom 25%) according to the percentages of their 1995 graduates selecting careers in the individual generalist specialties of family practice, general internal medicine, and general pediatrics, and in these generalist specialties in toto. Within these groups, the linking of GQ responses to declarations given by the same students on the Matriculating Student Questionnaire (MSQ) made it possible to determine the extent to which graduates' specialty choices represented early interests that were retained or interests acquired later during medical school.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Selección de Profesión , Medicina Familiar y Comunitaria , Medicina Interna , Estudiantes de Medicina , Humanos , Pediatría , Facultades de Medicina , Estados UnidosRESUMEN
The authors used data from the AAMC Matriculating Student Questionnaire and Medical School Graduation Questionnaire to ascertain how closely the specialty or subspecialty choices of the 1991 and 1994 graduates of U.S. medical schools matched the preferences they had declared when they were matriculated; the extent to which these students strongly considered and then rejected choices that arose during medical school; and the graduation choices of the substantial number of students in both cohorts who were undecided about their careers when they entered medical school. Approximately 80% of the graduates in both classes rejected the specialty intentions they had declared when they began medical school. However, matriculation interests in the generalist specialties--family practice, general pediatrics, and general internal medicine--were more enduring for the 1994 cohort, while interests in the medical, surgical, and support specialties were less so. Large percentages of the 1991 and 1994 cohorts were undecided about their careers at matriculation (20.8% and 26.2%, respectively), and nearly the same proportions remained undecided at graduation. However, more of the graduates in the 1994 cohort who had initially been undecided reached decisions favoring one of the generalist specialties than was true for the 1991 cohort. Nearly half the 1994 graduates had strongly considered and then rejected an alternative to their matriculation interest that arose during medical school. Within the generalist specialties, both early and later interests in family practice were more durable than were those in general pediatrics and general internal medicine: for every student who retreated from tentative interest in family practice, another student's interest was reinforced or kindled.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Selección de Profesión , Medicina , Especialización , Estudiantes de Medicina , Estudios de Cohortes , Toma de Decisiones , Humanos , Encuestas y CuestionariosRESUMEN
In this baseline study, the authors analyze in detail many of the factors that influenced the research career intentions of the 1994 U.S. graduates of MD-only programs. Studies of the research interests of the nation's medical school graduates are important because MD-PhD programs do not produce sufficient numbers of physician-scientists, and the remainder must come from the regular population of medical graduates. Data on school characteristics and medical students' demographics, research career intentions, and educational experiences were derived from the AAMC's Institutional Profile System (IPS), Student Application and Information Management System (SAIMS), Matriculating Student Questionnaire (MSQ), and Medical School Graduation Questionnaire (GQ). The 1994 GQ was used as the index instrument to make the correlations reported in this article. A number of findings emerged concerning the 1994 graduates. A greater percentage of these students who began medical school with strong research career intentions and maintained these intentions had entered private medical schools. The lower rate of research interest amongst the students enrolled in public medical schools was compounded by the significantly greater loss of earlier research intentions of those in public schools compared with those in private schools.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Selección de Profesión , Investigación , Estudiantes de Medicina/psicología , Evaluación Educacional , Femenino , Humanos , Masculino , Medicina , Propiedad , Facultades de Medicina/organización & administración , Especialización , Especialidades Quirúrgicas , Estudiantes de Medicina/estadística & datos numéricos , Encuestas y Cuestionarios , Apoyo a la Formación Profesional , Estados UnidosRESUMEN
The authors characterize the demographic changes that transpired with the decline and rise of the medical school applicant pool over the past decade, and describe the variations in academic antecedents, attrition, and graduation rates of students matriculated during that time. Data over the ten-year cycle, derived from the AAMC's Student and Applicant Information Management System (SAIMS), were examined in the context of published education and employment statistics. The contraction and expansion of the applicant pool were related to changes in the number and pattern of undergraduate majors and to changes in the employment conditions for college-educated youth. Furthermore, a significant part of the variations in size of the applicant pool is an artifact of changes in the number of repeat applications. Matriculants' pre-medical grades and MCAT scores dropped slightly during the period of applicant decline, and rebounded as admission committees were able to exercise greater selection when the pool expanded. The attrition of medical students rose and fell during this time, but the changes were small and of little discrete influence on graduation rates during the period. The downturn and rebound in applications over the past decade appear to be more related to cycles in the employment market for college graduates than to applicants' perceptions of unfavorable/favorable conditions in medical education and practice.
Asunto(s)
Educación Médica/estadística & datos numéricos , Evaluación Educacional/estadística & datos numéricos , Etnicidad , Selección de Personal/estadística & datos numéricos , Estudiantes de Medicina , Prueba de Admisión Académica , Femenino , Humanos , Masculino , Metaanálisis como AsuntoRESUMEN
The authors followed the academic progress and graduation rates of students matriculating in U.S. medical schools each year between 1976 and 1988. The four-year graduation rates of medical students in MD programs declined from 91.4% for students who matriculated in 1976 to 81.2% for 1988 matriculants. During the same period, the percentage graduating in five years increased from 5.5% to 10.6%, while those still enrolled or on leaves of absence after five years rose from 1.9% to 4.1%. The lengthening of undergraduate medical education is associated with students' spending extra time on special studies or research, but to a greater extent graduation has been delayed for remediation of academic difficulty or slowing of the pace of education to overcome handicaps in academic preparation and learning skills. Underrepresented minority students, particularly black Americans, have lower four-year graduation rates than majority students, and the rate has fallen steadily across successive classes matriculating between 1976 and 1988. The longer periods of undergraduate medical education since 1984, however, have been accompanied by a reversal of the growing attrition rate for black-American students, probably the result of more appropriate pacing of education over the first year or two and the wider availability of student academic support. The longer road to graduation also accumulates greater educational costs, contributing to the escalation in student indebtedness that has been out of proportion to increases in tuition and fees.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Educación de Pregrado en Medicina/estadística & datos numéricos , Adulto , Distribución por Edad , Selección de Profesión , Femenino , Humanos , Masculino , Grupos Minoritarios , Distribución por Sexo , Factores de Tiempo , Estados UnidosRESUMEN
The authors describe how the 8,128 medical school seniors who completed the 1993 AAMC Medical School Graduation Questionnaire (GQ) rated the influence that each of 36 factors (such as interest in helping people) had on their specialty decisions, using a 0 to 4 Likert-type scale where 4 indicated a major influence on specialty choice. The list of factors and their mean ratings are presented to show those of greatest influence (e.g., type of patient problems encountered, rated 3.44), of moderate influence (e.g., type of patients encountered; 2.75), and of limited influence (e.g., length of residency; 1.18). Factors' ratings also are compared across specialty groups. While the seven most influential factors were given about the same weight by the seniors regardless of their specialty choice, there were significant differences in the ratings of other factors across specialties (e.g., patient contact factors were rated higher by future generalists than by graduates favoring other specialties). The GQ respondents' ratings of factors over time are compared for 1991, 1992, and 1993. Last, those respondents who had changed their minds about a specialty were asked to rate the 36 factors according to how strongly they had influenced the rejection of the previous specialty choice; most of the factors were rated as having been of minor influence. As a general rule, income prospects and educational debt were not strong influences, either on specialty choice or rejection. The authors state that the influences of the factors they have reported are those that set the initial direction of graduates' residency training.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Selección de Profesión , Fuerza Laboral en Salud , Especialización , Estudiantes de Medicina/psicología , Humanos , Internado y Residencia , Estilo de Vida , Personalidad , Estados UnidosRESUMEN
The authors compared data from the 1993 AAMC Medical School Graduation Questionnaire (GQ) with data from earlier GQs to examine the relationship of debt to specialty choices among graduates of U.S. medical schools. The authors report the continuing increase of educational indebtedness among medical students graduating in 1993 compared with the debt of those graduating in earlier years, the greater increase in higher-level indebtedness of graduates of private medical schools, and the rising influence of debt on graduates who choose surgical specialties and support specialties. Despite the rising debt of 1993 graduates, however, they favored the generalist specialties more and the medical and support specialties less than did their 1992 predecessors.