Increasing the medical school applicant pool: a key to training more rural physicians.

CONTEXT: Workforce studies show shortages of physicians in many areas of the United States. These shortages are especially severe in states such as Kentucky with many rural counties and are predicted to worsen in the future unless there are changes throughout our educational system to build aspirations and prepare students for medical school education. PURPOSE: To examine rural-urban differences and community characteristics of applicants and matriculants to Kentucky's two allopathic medical schools and influences on the educational aspirations of young students who wish to become physicians. METHODS: The number of Kentucky applicants and matriculants to allopathic medical schools was obtained from the Association of American Medical College's data warehouse for the period from 2002-2006. A continuous, multidimensional measure was used to classify counties by degree of rurality. Socio-demographic variables were selected for the counties of residence for applicants and matriculants. Model variables were tested in a least squares multiple regression model for their ability to explain patterns among Kentucky's 120 counties in the number of both resident applicants and matriculants to medical school. Data from a survey of middle school participants in summer health camps were analyzed to help identify important influences on young students aspiring to a career as a health professional, especially becoming a physician, and how these might be supported to increase the supply of rural medical school applicants. FINDINGS: The low number of rural applicants to medical school was highly correlated with the relative rurality of their county of residence, a low physician-to-population ratio and a low number of total primary care physicians. The percentage of county residents having a bachelor's degree level of education or higher had a positive impact on the application rate. Respondents became interested in health careers at age 15 or younger, and parents and grandparents, teachers, and close associates stimulated their aspirations, with teachers being the most influential. CONCLUSIONS: Prospective students respond to their perception of need for physicians. Rural students are influenced by those who are more highly educated. To overcome the shortage of physicians in rural communities efforts must be made to increase the aspirations for medical education of prospective students from rural counties.

Physician computer skills: a prerequisite to the future in healthcare services.

Physicians in Kentucky have been slow to endorse and implement electronic medical records and other forms of information technology (IT), although this technology is available to them. Information was ob tained from medical relicensure data for all licensed Kentucky physicians and through two sample surveys to assess the use of IT in Kentucky medicine. Sixty-eight percent of licensed physicians recorded an e-mail address on their annual relicensure application, but more physicians were knowledgeable about IT than indicated by this relicensure response. A recorded e-mail address was more likely for younger physicians, physicians in hospital-based specialties, and those in larger medical specialty or academic physician groups. Those entering an email address were more likely to use IT for e-mail, word-processing, searching medical literature, and even consulting with other physicians. Only 10% of physicians with an e-mail address and 4.5% ofj those who did not list an e-mail address used e-mail to communicate with patients. Physicians entering an e-mail address were also more likely to employ an electronic medical record in their practice. Increased use of IT in medical practices is likely only if it can be associated with an increase in reimbursement or an improvement in quality of care.