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The Privilege Gap in Medicine

Sabalis, Robert F. PhD

doi: 10.1097/ACM.0b013e3182956fab
Letters to the Editor

Member, AAMC Holistic Review Project Team, Washington, DC;

In Reply to Nahvi: Dr. Nahvi’s letter is a reminder of the importance of diversity, both for medical education and medical practice. However, achieving diversity—including socioeconomic diversity—is not a simple task. Academic preparation for medical school requires completion of at least three years of college; college enrollment requires adequate grade school and high school educations. Personal preparation requires life experiences that support the belief that delay of gratification and passing up immediate benefits for larger later ones will actually pay off. The encouragement of parents and teachers with realistically high expectations for their children and students is critical. The local presence of physician role models to illustrate physicians’ daily work and to prove that a person “like me” can become a physician is helpful. The impact of the cost of attendance for even the first year of medical school and of financial aid opportunities on the plans of an applicant from the lower income quintiles cannot be underestimated. Expecting a student to borrow more for that first year than the total annual income of his or her family may be unrealistic. And medical school curricula must prepare students, no matter what their backgrounds, to relate respectfully and effectively to patients from varied cultural and socioeconomic groups.

Equally crucial is what occurs at the conclusion of medical training. Health care reimbursement policies require revision so that they will support the types of health care that citizens need and physicians can provide. Each time a newly minted physician, from whatever socioeconomic background, chooses a specialty based, at least in part, on current reimbursement policies, or chooses a practice with a cohort of predominantly upper-income or well-insured patients, the chance that society’s health care challenges will be adequately addressed is diminished.

All of a medical school’s pipeline and recruitment programs will not solve the important national challenge of achieving true diversity in medicine, including socioeconomic diversity. A systematic solution is required—one that takes into account multiple factors over the course of time, from premedical preparation, to medical school and residency, to medical practice. Dr. Nahvi’s letter, written from the trenches of medical care, is a reminder of important work yet to be done.

Robert F. Sabalis, PhD

Member, AAMC Holistic Review Project Team, Washington, DC;

© 2013 by the Association of American Medical Colleges