We began medical school orientation with several anonymous ice breakers. The idea was to learn more about the class’ demographics through a few clicker questions. Most were innocuous: are you in-state? Did you take a gap year? Were you a science major? They were standard questions in the boring small talk repertoire of medical school orientation. One question though, incited murmuring among students: How many of you came from households with six figure incomes? After a few seconds of furious clicking, the results indicated a majority. A couple of the students at my table turned to each other incredulously and exclaimed, “Are you serious?!”
I wasn’t surprised — I had suspected that medical school was the domain of the upper middle class and the wealthy. During the application process, I kept a meticulous Excel sheet to track my application expenses. The final total was staggering. I wondered how people could even afford to pay for medical school application costs, let alone medical school itself. While it’s true that a majority of medical students choose to take out a loan to cover tuition and living expenses, the impact of parental wealth and education status goes beyond just paying for medical school. According to data collected by the AAMC, a majority of medical students have parents with graduate degrees. Another report shows that the median family income of matriculating students is $100,000. To put that into perspective, the median family income at the time of the report in 2006 was $48,451. Most medical students come from the top two quintiles of family income, meaning they’re some of the most privileged members of society.
For many people in the lower income quantiles, college is expensive enough as it is. Why would they choose to pursue another, even more expensive post-graduate degree? Even if most physicians eventually end up making six figure salaries, it’s usually in their 30s and coupled to a six figure debt. For the students that do decide to step foot on the path to medicine, they sometimes find that they just can’t keep up with their more economically advantaged peers.
Students from more privileged backgrounds can afford to go to more competitive colleges. They can afford private tutoring when they struggle with classes. Because their parents are professionals, these students also have access to initial jobs and internships based on the strength of their connections. This makes it much easier for them to check off boxes on the seemingly endless list of volunteer activities, shadowing, research and leadership positions. Much of this work is also unpaid which means these activities aren’t always feasible for people paying their way through school. They’d need to use that precious time after class to do paid work, which doesn’t leave a lot of room for more eye-catching extracurriculars like cancer research or going on a global medical brigade trip to Peru. These students are also disadvantaged when it comes to the testing process. The MCAT alone costs $305. Most of the applicants I know also used an MCAT test prep course which can run anywhere from $2000-$4000. Taking all these factors into account, it’s easy to see how much steeper the road to medical school is for economically disadvantaged students.
But you say, isn’t everything just harder for the economically disadvantaged? Especially education? Even undergraduate education is a struggle for those not blessed with financial fortune. While this is true, the field of medicine is especially tough to break into. With other professions that don’t require graduate degrees for entry level jobs such as engineering or finance, the disadvantage is less pronounced. Even among other graduate degree programs like doctorate programs, the application process, while just as rigorous, is also more targeted. When I watched my friends apply to PhD or masters programs, there was no need for them to volunteer for 100 hours or participate in five different clubs. Even if they did unpaid lab work or research, it was usually in a field that they wanted to pursue their doctorate in. This isn’t to say that other graduate schools are slack in their admissions. Rather, it’s to point out that perhaps the activities that medical schools think make a “well-rounded” candidate are really just more barriers for less economically privileged students.
Indeed, for a profession that aims to promote diversity, the lack of economic diversity is embarrassing. No more than 5.5 precent of matriculating students are from the bottom two quintiles of parental income. Of course, this can’t be fundamentally addressed without considering other, larger problems in the medical education system. Namely, the exorbitant price of attending medical school and the cookie cutter admissions process that selects for “well rounded,” often rich applicants. These problems aren’t easy to solve. The solution might require rethinking how we train doctors and how this training is funded. This kind of consideration is often beyond the scope of most medical schools, but that doesn’t mean the issue should be ignored by the medical education community. How can they open up a profession that seems to be the domain of the upper middle class to students that might be the first in their families to ever go to college?
I suspect a small fix has to start at the bottom level with increased mentorship. The advantage of wealth goes beyond the monetary. It also provides access to circles of knowledge that can seem exclusive. In the competitive world of medical school admissions, this can be as simple as having access to doctors to shadow or having a leg up in getting a coveted internship. With a more robust mentorship program, students from disadvantaged backgrounds can also have access to networks that allow them to get a more in-depth glimpse at the medical world. Though it’s not a fix for the more pressing problems in medical school education, mentorship programs for disadvantaged students could be the right step in encouraging these students to consider medicine as a viable career and give them the guidance they need to make it a reality.
Education in the United States is more expensive than ever. Medical education especially so. Although financial aid and scholarships for medical school do exist for under privileged students, most of these students never even make it to medical school. The medical school application process is obviously rigorous to ensure that only the best candidates are selected, but the unwanted side effect is that it often selects for wealthy candidates and discourages less wealthy ones. Like I stated before, there’s no simple solution. Although substantial reform in the medical education system is probably the ideal solution, it’s not feasible in the foreseeable future. Instead, what’s required is an understanding of how the medical education system creates medical school classes heavily skewed towards the upper middle class. If we’re to see a future of economically diverse class of medical students, we have to be cognizant of this and work to increase outreach and mentorship to financially underprivileged students.