Sounds like those poorest counties and districts are at fault for being poor. America guaranteed equality, right? If it didn't work, and America is still working, then it's their fault!
The process has never been about equality. It wasn't when most medical school matriculants were male, and it's certainly not about equality now. It is about a
normative vision of what medicine should we, and we should all hope that it somehow works out in the end.
The demographics of current working physicians and current medical students entering medical school are dissimilar. If the process were about equal opportunity, it should succumb to market forces and the demographics of entering medical students would be the same as the demographics as current working physicians. If the process were about equality, then each applicant should have a contractual obligation to serve only the community they grew up in.
Ah, but we want to compromise, and still congratulate ourselves on our own ingenuity!