{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:06:42Z","timestamp":1760234802218,"version":"build-2065373602"},"reference-count":44,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2021,6,16]],"date-time":"2021-06-16T00:00:00Z","timestamp":1623801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Georgia","award":["Internal research fund"],"award-info":[{"award-number":["Internal research fund"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJGI"],"abstract":"<jats:p>Physician shortages are more pronounced in rural than in urban areas. The geography of medical school application and matriculation could provide insights into geographic differences in physician availability. Using data from the Association of American Medical Colleges (AAMC), we conducted geospatial analyses, and developed origin\u2013destination (O\u2013D) trajectories and conceptual graphs to understand the root cause of rural physician shortages. Geographic disparities exist at a significant level in medical school applications in the US. The total number of medical school applications increased by 38% from 2001 to 2015, but the number had decreased by 2% in completely rural counties. Most counties with no medical school applicants were in rural areas (88%). Rurality had a significant negative association with the application rate and explained 15.3% of the variation at the county level. The number of medical school applications in a county was disproportional to the population by rurality. Applicants from completely rural counties (2% of the US population) represented less than 1% of the total medical school applications. Our results can inform recruitment strategies for new medical school students, elucidate location decisions of new medical schools, provide recommendations to close the rural\u2013urban gap in medical school applications, and reduce physician shortages in rural areas.<\/jats:p>","DOI":"10.3390\/ijgi10060417","type":"journal-article","created":{"date-parts":[[2021,6,16]],"date-time":"2021-06-16T10:27:07Z","timestamp":1623839227000},"page":"417","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Rurality and Origin\u2013Destination Trajectories of Medical School Application and Matriculation in the United States"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0199-9509","authenticated-orcid":false,"given":"Lan","family":"Mu","sequence":"first","affiliation":[{"name":"Department of Geography, University of Georgia, Athens, GA 30602, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8339-361X","authenticated-orcid":false,"given":"Yusi","family":"Liu","sequence":"additional","affiliation":[{"name":"College of Resource Environment and Tourism, Capital Normal University, Beijing 100048, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donglan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, University of Georgia, Athens, GA 30602, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1562-6228","authenticated-orcid":false,"given":"Yong","family":"Gao","sequence":"additional","affiliation":[{"name":"Institute of Remote Sensing and Geographic Information System, School of Earth and Space Sciences, Peking University, Beijing 100871, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3130-0607","authenticated-orcid":false,"given":"Michelle","family":"Nuss","sequence":"additional","affiliation":[{"name":"August University\/University of Georgia Medical Partnership, Athens, GA 30602, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janani","family":"Rajbhandari-Thapa","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, University of Georgia, Athens, GA 30602, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5351-3489","authenticated-orcid":false,"given":"Zhuo","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, University of Georgia, Athens, GA 30602, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 A.","family":"Pag\u00e1n","sequence":"additional","affiliation":[{"name":"Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY 10003, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"},{"name":"Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6513-2907","authenticated-orcid":false,"given":"Gang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, University of Georgia, Athens, GA 30602, USA"},{"name":"School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heejung","family":"Son","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, University of Georgia, Athens, GA 30602, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,6,16]]},"reference":[{"key":"ref_1","unstructured":"Warshaw, R. (2017). Health Disparities Affect Millions in Rural U.S. Communities. AAMC News Insights, Available online: https:\/\/www.aamc.org\/news-insights\/health-disparities-affect-millions-rural-us-communities."},{"key":"ref_2","unstructured":"AAMC (2020). The Complexities of Physician Supply and Demand: Projections from 2018 to 2033, IHS Markit Ltd."},{"key":"ref_3","unstructured":"Sheps Center for Rural Health Services Research (2017). Rural Health Snapshot 2017, Rural Health Research Gateway."},{"key":"ref_4","unstructured":"AAMC (2016). Medical School Graduation Questionnaire: 2016 All Schools Summary Report. Assoc. Am. Med Coll., 1\u201347."},{"key":"ref_5","unstructured":"Petterson, S., Phillips, R.L., Bazemore, A., and Koinis, G.T. (2013). Unequal distribution of the US primary care workforce. Am. Fam. Physician, 87."},{"key":"ref_6","unstructured":"Grover, A. (2021, June 11). Strategies to Address Physician Shortages in Rural and Underserved Communities. Available online: https:\/\/www.aamc.org\/download\/431632\/data\/20150506_ruralandunderservedbriefingatugroverppt.pdf."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1016\/S0140-6736(95)90753-X","article-title":"Physician shortages in rural America","volume":"345","author":"Schroeder","year":"1995","journal-title":"Lancet"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S1353-8292(02)00067-9","article-title":"Using a GIS-based floating catchment method to assess areas with shortage of physicians","volume":"10","author":"Luo","year":"2004","journal-title":"Health Place"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1016\/j.healthplace.2009.06.002","article-title":"An enhanced two-step floating catchment area (E2SFCA) method for measuring spatial accessibility to primary care physicians","volume":"15","author":"Luo","year":"2009","journal-title":"Health Place"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1016\/j.apgeog.2008.12.003","article-title":"Measuring spatial accessibility to primary care in rural areas: Improving the effectiveness of the two-step floating catchment area method","volume":"29","author":"McGrail","year":"2009","journal-title":"Appl. Geogr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.healthplace.2004.02.003","article-title":"Assessing spatial and nonspatial factors for healthcare access: Towards an integrated approach to defining health professional shortage areas","volume":"11","author":"Wang","year":"2005","journal-title":"Health Place"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.1016\/j.socscimed.2009.08.002","article-title":"Why doctors choose small towns: A developmental model of rural physician recruitment and retention","volume":"69","author":"Hancock","year":"2009","journal-title":"Soc. Sci. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1016\/0277-9536(87)90012-8","article-title":"An analysis of medical students\u2019 residency and specialty choices","volume":"25","author":"Taggart","year":"1987","journal-title":"Soc. Sci. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1016\/j.ajic.2013.12.006","article-title":"Relationship between local family physician supply and influenza vaccination after controlling for individual and neighborhood effects","volume":"42","author":"Gai","year":"2014","journal-title":"Am. J. Infect. Control"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.healthpol.2008.09.004","article-title":"Medical education program with obligatory rural service: Analysis of factors associated with obligation compliance","volume":"90","author":"Matsumoto","year":"2009","journal-title":"Health Policy"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1016\/j.socscimed.2011.06.010","article-title":"Physician shortages in rural Vietnam: Using a labor market approach to inform policy","volume":"73","author":"Vujicic","year":"2011","journal-title":"Soc. Sci. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1156","DOI":"10.1016\/j.amjmed.2009.07.010","article-title":"The Anticipated Physician Shortage: Meeting the Nation\u2019s Need for Physician Services","volume":"122","author":"Kane","year":"2009","journal-title":"Am. J. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"S17","DOI":"10.1097\/ACM.0b013e3181ed3e78","article-title":"Where Do They Come From and Where Do They Go: Implications of Geographic Origins of Medical Students","volume":"85","author":"Pretorius","year":"2010","journal-title":"Acad. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1097\/ACM.0000000000002688","article-title":"Geographic Distribution of Regional Quota Program Graduates of Japanese Medical Schools: A Nationwide Cohort Study","volume":"94","author":"Matsumoto","year":"2019","journal-title":"Acad. Med."},{"key":"ref_20","unstructured":"AAMC (2019, December 01). Who We Are. Available online: https:\/\/www.aamc.org."},{"key":"ref_21","unstructured":"University of Wisconsin Population Health Institute (2020, December 10). County Health Rankings & Roadmaps. Available online: https:\/\/www.countyhealthrankings.org\/."},{"key":"ref_22","unstructured":"Ratcliffe, M., Burd, C., Holder, K., and Fields, A. (2016). Defining Rural at the U.S. Census Bureau. Am. Community Surv. Geogr. Brief, 1."},{"key":"ref_23","unstructured":"ESRI (2020). ArcMap Desktop, 10.7, ESRI."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1109\/TVCG.2009.143","article-title":"Flow Mapping and Multivariate Visualization of Large Spatial Interaction Data","volume":"15","author":"Guo","year":"2009","journal-title":"IEEE Trans. Vis. Comput. Graph."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2043","DOI":"10.1109\/TVCG.2014.2346271","article-title":"Origin-Destination Flow Data Smoothing and Mapping","volume":"20","author":"Guo","year":"2014","journal-title":"IEEE Trans. Vis. Comput. Graph."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.apgeog.2017.07.014","article-title":"Difference of urban development in China from the perspective of passenger transport around Spring Festival","volume":"87","author":"Xu","year":"2017","journal-title":"Appl. Geogr."},{"key":"ref_27","unstructured":"Gephi.org (2020, December 10). Gephi, 0.9.2; 2019. Available online: https:\/\/gephi.org\/."},{"key":"ref_28","unstructured":"IBM (2019). SPSS Statistics, IBM."},{"key":"ref_29","unstructured":"SAS Institute Inc (2020). JMP, SAS Institute Inc."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1016\/j.apr.2016.05.001","article-title":"Distribution patterns and characterization of outdoor fine and coarse particles","volume":"7","author":"Mohammed","year":"2016","journal-title":"Atmos. Pollut. Res."},{"key":"ref_31","unstructured":"Bruce, P., and Bruce, A. (2017). Chapter 5: Classification. Practical Statistics for Data Scientists: 50 Essential Concepts, O\u2019Reilly Media."},{"key":"ref_32","unstructured":"Gephi.org (2020, December 10). Tutorial layouts, Gephi User Man., Available online: https:\/\/gephi.org\/users\/tutorial-layouts\/."},{"key":"ref_33","unstructured":"Cromley, E.K., and McLafferty, S.L. (2011). GIS and Public Health, Guilford Press."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1289\/ehp.6735","article-title":"Spatial Epidemiology: Current Approaches and Future Challenges","volume":"112","author":"Elliott","year":"2004","journal-title":"Environ. Health Perspect."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.sste.2010.10.001","article-title":"Spatio-temporal epidemiology: Principles and opportunities","volume":"2","author":"Meliker","year":"2011","journal-title":"Spat. Spatio-Temporal Epidemiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1080\/00045600701734224","article-title":"A scale-space clustering method: Mitigating the effect of scale in the analysis of zone-based data","volume":"98","author":"Mu","year":"2008","journal-title":"Ann. Assoc. Am. Geogr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1080\/00045608.2014.968910","article-title":"A Place-Oriented, Mixed-Level Regionalization Method for Constructing Geographic Areas in Health Data Dissemination and Analysis","volume":"105","author":"Mu","year":"2015","journal-title":"Ann. Assoc. Am. Geogr."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1097\/ACM.0000000000001839","article-title":"The Road to Rural Primary Care: A Narrative Review of Factors That Help Develop, Recruit, and Retain Rural Primary Care Physicians","volume":"93","author":"Parlier","year":"2018","journal-title":"Acad. Med. J. Assoc. Am. Med. Coll."},{"key":"ref_39","first-page":"469","article-title":"The Northern Ontario School of Medicine: A long-term strategy to enhance the rural medical workforce","volume":"47","author":"Strasser","year":"2007","journal-title":"Cah. De Sociol. Et De Demogr. Med."},{"key":"ref_40","first-page":"488","article-title":"Canada\u2019s first rural medical school: Is it needed? Will it open?","volume":"166","author":"Sullivan","year":"2002","journal-title":"Can. Med. Assoc. J."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s12960-017-0191-6","article-title":"Impact of the rural pipeline in medical education: Practice locations of recently graduated family physicians in Ontario","volume":"15","author":"Wenghofer","year":"2017","journal-title":"Hum. Resour. Health"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"S14","DOI":"10.1097\/ACM.0000000000002924","article-title":"Defining Rural: The Predictive Value of Medical School Applicants\u2019 Rural Characteristics on Intent to Practice in a Rural Community","volume":"94","author":"Wendling","year":"2019","journal-title":"Acad. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1097\/ACM.0000000000001823","article-title":"The Effect of a Community-Based Medical School on the State and Local Physician Workforce","volume":"93","author":"Phillips","year":"2018","journal-title":"Acad. Med. J. Assoc. Am. Med. Coll."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1097\/ACM.0000000000003048","article-title":"The Development of New MD-Granting Medical Schools in the United States in the 21st Century","volume":"95","author":"Whitcomb","year":"2020","journal-title":"Acad. Med."}],"container-title":["ISPRS International Journal of Geo-Information"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2220-9964\/10\/6\/417\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:17:09Z","timestamp":1760163429000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2220-9964\/10\/6\/417"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,16]]},"references-count":44,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,6]]}},"alternative-id":["ijgi10060417"],"URL":"https:\/\/doi.org\/10.3390\/ijgi10060417","relation":{},"ISSN":["2220-9964"],"issn-type":[{"type":"electronic","value":"2220-9964"}],"subject":[],"published":{"date-parts":[[2021,6,16]]}}}