The Steep Price of Admission: Tackling Minority Underrepresentation in Medicine

Hartej Gill, PhD(c)


December 16, 2021

When I was growing up in the 2000s, the media representation of Asian populations in popular Western culture often followed a stereotypical pattern. This included the casting of characters that achieve high levels of academic success or experience cultural pressures to perform as such, often focused on the practice of medicine.

The reality of national representation of minority groups in medicine, however, is markedly different. A recent study found that the physician population in the United States is not proportionate to the demographic characteristics of the general population. My personal experiences navigating and working in academia and medicine have underscored the underrepresentation of minority groups in this field. 

Gian Agtarap, a current student at the University of Toronto School of Medicine and an active voice in the Filipino medical community, discussed with me the challenges he has faced from both a cultural and institutional standpoint.

Did your community or family always promote a career in medicine?

I grew up with very supportive parents. However, neither of my parents were physicians or worked in medicine.

From a family perspective, it was difficult to navigate the system and understand the path to academic success. I grew up in a primarily Filipino community and very few of my peers wanted to pursue medicine.

Was the lack of community mentors and peers with a similar career outlook a significant challenge during your path to medical school?

Absolutely. Not knowing anyone in the field who can be used for advice and a lack of mentorship is a huge challenge.

Within my community, I often witnessed a lack of social capital in medicine. The path to medical school can be very convoluted at times. Knowing someone who has gone down this path and paved the way is absolutely very advantageous.

Community and cultural factors are very important for future outcomes. Why do you think your peers lacked interest in medicine? Do you believe it is a lack of perceived accessibility or understanding of this particular career path?

I do a lot of research in that area because it's a particular interest of mine. The historical immigration patterns that Filipinos have followed have encouraged them to pursue positions in the service sector, such as nannies, nurses, and personal support workers. Owing to a sense of familiarity, some of these careers, namely nursing, would be encouraged and propagated down generations. This, combined with a lack of accessibility and knowledge of medicine, contributed to the disparity of Filipino youth pursuing medicine.

I wouldn't necessarily call it a lack of interest, but rather a lack of knowledge and resources to promote an interest in medicine. 

Opening Up Medicine to Underrepresented Groups

What are the priority avenues to help make higher education and medicine more accessible for future generations?

I believe it's a multi-step process to tackling underrepresentation. The first step should begin with raising awareness. I do not believe many people are aware of the proportions and demographic statistics of minority groups that are able to succeed.

That's something I've taken the initiative to raise awareness about. I founded the Filipino Association of Medical Students, which aims to tackle the underrepresentation of Filipinos in medicine. We've looked at the stats across Canadian medical schools and are exploring the current factors contributing to the underrepresentation.

We have seen progress in this regard. The University of Toronto has the Community of Support, which aims to help visible minorities and low socioeconomic status (SES) groups enter medical school. At Western University in London, Ontario, a similar initiative called the ACCESS Pathway is under way. Getting this information out to the stakeholders and decision-makers will definitely be an important first step.

The next step will be to fulfil these important leadership positions with a more diverse background.

How do we make a difference at a community-based position to promote knowledge dissemination and mentorship for youth wanting to pursue careers in academia and medicine?

We have to use a bottom-up grassroots approach. However, change will take time. As institutions (eg, universities, medical schools), information should be provided at an earlier timepoint than simply high school for lower SES communities.

Community-based and leadership numbers can only increase with an increase in individuals pursuing these career paths. Once more individuals are walking through these doors, raising awareness and having effective outreach for the youth becomes a priority next step.

In recent years, a larger number of people who identify as a minority entered medicine and academia. An important step to inspiring youth in low SES minority communities will begin with better accessibility to quality education and the dissemination of knowledge related to these career paths.

A recent study has suggested that lower SES in minority communities is associated with lower expectations and beliefs about academic success. These beliefs are reflected in poorer testing outcomes and trust in the education system. The education system and institutions that are responsible for opening doors to a better future should not serve as a barrier. 

You can find more information related to the work Gian is doing with the Filipino Association of Medical Students on Twitter, Instagram and Facebook.

Hartej Gill is a PhD candidate and researcher at the Canadian Rapid Treatment Center of Excellence and the Institute of Medical Science at the University of Toronto. He has expertise in mood disorders, investigating the etiology and pathophysiology of mental health disorders from both a clinical study and population health perspective, with over 50 peer-reviewed publications.

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