I recently read some statistics that shocked me, but not really. In the US, 60 percent of medical students come from families with incomes in the top 20 percent of the nation. Meanwhile, only 3 percent come from families with incomes in the lowest 20 percent. Not much socioeconomic diversity in the house of medicine.
Now, I realized early on that I didn’t have a lot of company in this respect, but I didn’t think it was as lonely as a mere 3%. As a first generation college graduate, let alone doctor now, I know all too well that feeling that I had stumbled into an exclusive club to which I didn’t perfectly fit in. More often than not, it seemed like many of my classmates had parents who were physicians or at least some better sense of what a life in medicine was like. Looking back on my journey into medicine, I remember firsthand the challenges facing aspiring doctors from lower SES backgrounds.
If nothing else, my personal journey illustrates the importance of early recruitment and sustained mentorship in the field of medicine. It’s just more challenging for those without any prior exposure to higher academics to realize that a career in medicine is a possibility. To this day, I can’t say exactly what it was that first made me think that it was feasible for me. My father delivered takeout, and my mother was a seamstress in a factory. In my family, a high school diploma already made me a pioneer in education. I was very fortunate though. I got accepted into medical school at the age of 17 through a joint BA-MD program. While most would consider the greatest benefit of this set-up to be a guaranteed seat in medical school during undergraduate, I actually considered the greatest benefit to be the mentorship and guidance that I was connected to through the program. Even with a guaranteed seat in medical school, I would never have successfully made it to medical school without that added support, direction, and community.
Of course, the other large obstacle, perhaps the greatest impediment of all, is the exorbitant cost of medical education today. The AMA reports the average debt of medical students in 2013 to be around $170,000, and that amount can easily be as high as $250,000 or more, especially if you attended a private university for both your undergraduate and medical degrees, as I did. In my case, I consider myself very fortunate once again because I received a near-full ride scholarship from my generous alma mater for my undergraduate education. As for medical school, it was a combination of scholarships and loans that was pretty typical for many medical students. As a result, I still owe some people a lot of money, but perhaps not nearly as much as I could have for someone in my position. It’s hard to say how these things may have affected my choices in retrospect. If I didn’t get that scholarship in college, would I have dared to take on more debt by going to medical school? If I was in more debt, would I have felt more compelled to go for a more lucrative specialty?
The ramifications of a lack of socioeconomic diversity in medicine are great and significant to patient care. Looking back, it seems obvious how we can start to remedy the problem. We need more outreach to those from lower SES backgrounds early on and more learning opportunities for those interested. We need to provide sustained mentorship to those already on the medical track. And, most importantly, we need major reforms to the funding and costs of medical education today. It will take more than just 3% of us to improve this. As a profession, we must recognize increased diversity in our field as an important goal to strive towards.