Expanding the Pipeline: how do we get more physicians into underserved areas?

 

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