Geographic and specialty distributions of WAMI Program participants and nonparticipants.

In an effort to make the geographic distribution of physicians closer to the distribution of the population as a whole, in 1971 the states of Washington, Alaska, Montana, and Idaho established the WAMI Program. In a departure from the Flexnerian model of medical education, the WAMI Program was organized to distribute the components of medical education throughout the region, both at the medical center at the University of Washington School of Medicine and at remote sites. In the present article, the authors describe the results of the first seven years of the program (1975-1981) in terms of the geographic and specialty distribution of the school's graduates before and after the establishment of the program. At the time of the study, 23 percent of the graduates with WAMI Program experience practiced in nonmetropolitan areas as defined by the U.S. Bureau of the Census. Only 13 percent of all U.S. physicians practiced in such areas in 1981, while 24 percent of the U.S. population lived there. In addition, 61 percent of the graduates with program experience were in primary care practice in contrast to 35 percent of all U.S. physicians. If all U.S. physicians behaved as these graduates do, the distribution of U.S. physicians would be reversed, with the proportion of physicians practicing primary care in nonmetropolitan areas being larger than the proportion of the population living in those areas.