High school census tract information predicts practice in rural and minority communities.
OBJECTIVE
Identify census-derived characteristics of residency graduates' high school communities that predict practice in rural, medically underserved, and high minority-population settings.


METHODS
Cohort study of 214 graduates of the University of California, San Francisco-Fresno Family Practice Residency Program (UCSF-Fresno) from its establishment in 1970 through 2000. Rural-urban commuting area code; education, racial, and ethnic distribution; median income; population; and federal designation as a medically underserved area were collected for census tracts of each graduate's (1) high school address and (2) practice location.


RESULTS
Twenty-one percent of graduates practice in rural areas, 28% practice in areas with high proportions of minority population (high minority areas), and 35% practice in federally designated medically underserved areas. Graduation from high school in a rural census tract was associated with rural practice (P < .01), Of those practicing in a rural site, 32% graduated from a rural high school, as compared with 11% of nonrural practitioners. Graduation from high school in a census tract with a higher proportion of minorities was associated with practice in a proportionally high minority community (P = .01). For those practicing in a high-minority setting, the median minority percentage of the high school census tract was 31%, compared with 16% for people not practicing in a high minority area. No characteristics of the high school census tract were predictive of practice in a medically underserved area.


CONCLUSIONS
Census data from the residency graduate's high school predicted rural practice and practice in a proportionally high minority community, but not in a federally designated medically underserved area.
Hughes
Susan
S
Family and Community Medicine, University of California, San Francisco Fresno Medical Education Program, Fresno, CA 93701, USA. susan.hughes@fresno.ucsf.edu
Zweifler
John
J
Schafer
Sean
S
Smith
Mark A
MA
Athwal
Sukhdeep
S
Blossom
H John
HJ
D000293:Adolescent; D000328:Adult; D002140:California; D019352:Censuses; D015331:Cohort Studies; D005194:Family Practice / Q000193:education*; D005260:Female; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D008913:Minority Groups / Q000193:education / Q000706:statistics & numerical data; D010821:Physicians, Family / Q000600:supply & distribution*; D011365:Professional Practice Location / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000145:classification*; D019035:Rural Health Services; D012574:Schools / Q000145:classification; D012959:Socioeconomic Factors; D000078329:Workforce