COMMENTARY

Is Privilege the Real Prerequisite for Med School?

Kunal Sindhu, MD

Disclosures

October 23, 2019

"Any doctors here who really 'started from the bottom?'" a medical student asked on Reddit. The poster explained that they hadn't encountered many medical students or doctors who actually come from less-privileged backgrounds, leading them to believe medicine is "an exclusive club for those who have the money and support."

At every step along the way of my seven years of medical training, I have been struck by the economic homogeneity of my classmates and colleagues. The vast majority of medical trainees I have encountered come from families with six-figure incomes. Many actually come from two-physician households. Personally, I may not have made it this far, had my family not removed various financial obstacles in my path.

The circumstances of one's birth have no bearing on qualities that a quality physician should possess, things like diligence, compassion, and curiosity. However, because the American medical system includes high financial barriers to entry, the wealth of a student's family can exclude her from a career in medicine. Now that I am a member of this community, I am concerned that medicine's gatekeepers are not doing enough. Too few opportunities are provided to students from less wealthy backgrounds. Privilege, it seems, has become a prerequisite for a medical career in America.

Medicine and the Aristocracy

A quick glance at the evidence shows the scope of the problem. The median combined annual income of an incoming American medical student's parents was $130,000 last year, up from $125,000 the year prior. This places those families squarely in the top 20% of earners nationwide. Only 5% of incoming medical students came from families in the lowest quintile of America's income distribution. This is not a new phenomenon. Over the last decade, those from the third quintile or below have never accounted for more than a quarter of first-year medical students.

Part of the reason why American medical schools preferentially attract the rich may have to do with the increasing difficulty of actually getting into medical school. In the 2018 application cycle, only 41% of students who applied actually ended up matriculating. With such slim odds, students have been engaging in an escalating arms race, creating ever more sophisticated applications to improve their odds. This process requires years of stellar grades, high scores on the Medical College Admission Test (MCAT), and participation in a plethora of extracurricular activities. This often necessitates substantial financial investments that students from less wealthy families are often unable to afford.

The process of simply applying to an American medical school is enormously expensive, costing as much as $5000-$10,000. Having applied to a number of medical schools, I can attest to this. Not only are applications expensive, most schools require an in-person interview for admission. All of this is before students agree to spend enormous sums on tuition and forego four years of pay in order to become a physician. Combined, these conditions strongly favor students from privileged backgrounds.

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