Expanding the Pipeline: how do we get more
physicians into underserved areas?
John E Delzell Jr MD MSPH MBA FAAFP
In the face of ongoing primary‑care workforce
shortages, it is important to identify ways to expand the number of physicians
who choose practice in health professions shortage areas. This also means that
more graduates will need to choose primary care specialties as many rural and underserved communities cannot easily support subspecialty practice. Several recent
articles enrich this discussion and illustrate some of the challenges and successes.
Targeted Admissions Strategy
A study by Evans and colleagues (1) from 2020 looked at
the medical school admissions process by surveying all 185 US Allopathic and
Osteopathic medical schools. Their premise was that there is an inherent social
mission of all medical schools to meet the health needs of the public. I am not
sure that all medical schools would agree with that statement, but it led to
the authors questioning how each school targeted applicants. Specifically, the
school’s admission strategy.
The authors had an impressive 72% response rate.
Schools were grouped by their targeting strategy-69% used a rural targeting
strategy and 67% used an urban-underserved targeting strategy. The strategies
used characteristics such as graduation from rural high school, growing up in
rural community, growing up in an underserved area, and stated interest in
practicing in an underserved area. Interestingly, only 20% of the schools
reserved admission slots for students with these characteristics.
Holistic Review for Admissions
Ballejos and colleagues (2) in an article published in
2025 looked at data from a single medical school (the University of New Mexico
School of Medicine) over a period of eight years from 2006 to 2013. In this
study, the authors looked at all the students matriculating each year and used
practice data to identify their post-residency practice location. They were
trying to identify objective attributes that might predict in-state practice
location. The admissions committee at UNM SOM uses a holistic review to
consider objective data (MCAT, GPA), personal attributes (gender, ethnicity),
goals (practice plans), and experiences (graduating from rural high school).
This is done, at least in part, to assess whether a given applicant is likely
to practice in New Mexico and advance the school’s mission.
They performed univariate and multiple regression
analyses to compare the graduates. The authors used in-state versus out-of-state
practice location identified by NPI number and medical licensure data. They
found that only 41.7% of graduates during that time period practiced in New
Mexico. Older students and those who graduated from an urban high school were
more likely to practice in-state after training. Importantly, most of the
variables that they looked at were not significant and the three that were
significant only explained 6.4% of the variance.
Not much help to inform the Admissions process.
Admissions impact on Primary Care choice?
Raleigh and colleagues (3) undertook a narrative
synthesis to systematically evaluate existing literature on how various medical
school admissions practices, including prematriculation programs, are
associated with graduates eventually entering primary care specialties. The purpose
of their study was to review literature that describes admissions practices and
try to determine the impact on the number and percentage of graduates entering
primary care. The performed a comprehensive search of English-language
peer-reviewed research with outcomes related to primary care choice and identified
34 qualifying articles — mainly single-institution, observational studies. They
used narrative synthesis as their evaluation method for two reasons: it allowed
them to evaluate and summarize data from a wide variety of methodologies, and
it allowed them to provide a narrative description of the identified studies.
The authors found that pre-matriculation programs were
consistently associated with higher rates of graduates entering primary care
compared to peers. Other predictive factors included self-identified interest
in primary care, rural background, and being older at matriculation. They found
that not very many schools explicitly prioritize primary care in their admissions
criteria. The authors did note that some of the studies looked at primary care
in rural environments, and those results were consistent with the overall group
of studies.
Raleigh et al. argue that medical schools should
consider pre-matriculation programs targeting students already oriented toward
primary care. They also emphasize active recruitment of applicants expressing a
primary care commitment and call for more rigorous prospective research. These
results suggest that structured prematriculation programs can influence
specialty choice outcomes, beyond self-selection effects. The program’s design
elements — mentorship, academic support, and clear pathways — likely
contributed to success.
There are some great programs out there that target
students who come from rural and underserved areas, get them into medical
school, and then encourage them to pursue practice in underserved areas typically
in primary care. Let’s look at a couple of these programs…
University of Missouri—Columbia: Bryant
Scholars Pre-Admissions Program
The Bryant Scholars Program (4) guarantees medical school
admission to qualified rural students committed to primary care and rural
practice. Students must be from Missouri and from a rural county. The program targets
rural and under‑resourced applicants, offering tailored support and conditional
admission pathways. Students are committed to the MU Rural Scholars Program
after matriculation into the medical school.
University of Kansas School of Medicine:
Scholars in Health
The Scholars in Health program (5) has two tracks for
students interested in underserved practice areas-Rural and Urban. This is an
early‑admit conditional acceptance program targeting students who come from rural
and underserved backgrounds and intend to return to practice in those areas
after graduation. The program offers academic and career mentoring, with
guaranteed admission contingent on performance milestones.
Florida State University College of
Medicine: Bridge to Clinical Medicine
The Bridge Program (6) is designed to expand the pool
of successful medical school applicants who come from rural and urban underserved
areas. FSU COM’s Bridge Program is a 12‑month Master’s in Biomedical Sciences
for applicants selected from those not initially admitted to FSU COM.
Completion with a B or higher and meeting professionalism standards leads to
direct consideration for admission.
Common Threads and Best Practices
Across MU’s Bryant Scholars, KU SOM’s Scholars in
Health, and FSU COM’s Bridge Program:
1. Targeted recruitment of students from rural and underrepresented backgrounds
2. Conditional admission or master’s bridging with performance thresholds.
3. Integrated academic and clinical exposure.
4. Ongoing mentorship and professionalism assessment.
Prematriculation programs like MU’s Bryant Scholars,
KU SOM’s Scholars in Health, and FSU COM’s Bridge Program embody the strategies
highlighted in the literature as high impact. They identify likely applicants, reduce
barriers, support readiness, foster diversity, and strengthen the rural and
underserved practice pipeline. Expanding these models nationally offers a
promising route to a more effective, equitable physician workforce.
References
(1) Evans DV, Jopson AD, Andrilla CA, Longenecker RL, Patterson DG. Targeted Medical School Admissions: A Strategic Process for Meeting Our Social Mission. Fam Med. 2020;52(7):474-482. https://doi.org/10.22454/FamMed.2020.470334.
(2) Ballejos MP, Riera J, Williams R, Sapién RE. Objective Admissions Data and In-State Practice: What Can We Really Predict? Fam Med. 2025;57(6):435-438. https://doi.org/10.22454/FamMed.2025.503525.
(3) Raleigh MF, Seehusen DA, Phillips JP, Prunuske J, Morley CP, Polverento ME, Kovar-Gough I, Wendling AL. Influences of Medical School Admissions Practices on Primary Care Career Choice. Fam Med. 2022; 54 (7): 536-541. https://doi.org/10.22454/FamMed.2022.260434.
(4) https://medicine.missouri.edu/offices-programs/admissions/bryant-pre-admissions-program
(5) https://www.kumc.edu/school-of-medicine/academics/premedical-programs/scholars-in-health.html
(6) https://med.fsu.edu/outreach/masters-bridge-program
