To the Editor:
The push to increase gender, ethnic, and racial diversity in medical education is stronger now than ever—a valiant and necessary initiative. The socioeconomic diversity gap, however, remains, and it may be widening. More than 48% of medical students come from the top income quintile, while less than 6% come from the bottom quintile.1 The idea that anyone from any background can pursue a career in medicine is slipping away. Why?
First, the median indebtedness for a typical medical graduate is $183,000 and rising.2 This is in addition to the loss of income while in medical school. And what about residency after that? Most physicians do not start their careers until their early 30s. Such significant initial investment can be prohibitive for students without strong financial safety nets. An expensive and competitive application process presents additional obstacles. Premedical candidates are expected to succeed academically, shadow physicians, volunteer, conduct cutting-edge research, and spend thousands of dollars on exams, applications, and interviews. Connections, mentorship, and resources are vital in this process. As an immigrant and a first-generation college student, I felt like the expectations of medical schools were impossible to meet.
My parents, who emigrated from Vietnam in 2001 with $50, no English, and minimal education, encouraged me to dream big at a young age. Fortunately, I grew up with friends who inspired me and mentors who guided me. Financial aid and scholarships carried me through college, and the Association of American Medical Colleges fee assistance program lowered my cost of medical school applications. Throughout my journey to medicine, I was in the right place at the right time and surrounded by the right people. Many who come from similar backgrounds cannot claim such a luxury.
If this trajectory continues, how can future physicians deal with the vast socioeconomic diversity typical of today’s society? Future recruitment efforts, research positions, summer enrichment programs, and networking opportunities should endeavor to expand socioeconomic diversity. Application fees should be fully waived, traveling for interviews reimbursed, and deposit fees eliminated for low-income applicants. Any student from any background should have a fighting chance to enter any career in the United States. I hope that this will remain true, especially for the medical profession that I so love.
Hai H. Le
Third-year medical student, Johns Hopkins University School of Medicine, Baltimore, Maryland; email@example.com.
1. Jolly P. Diversity of U.S. medical students by parental income. AAMC Analysis in Brief. January 2008;8(1). https://www.aamc.org/download/102338/data/aibvol8no1.pdf
. Accessed April 25, 2017.
2. Association of American Medical Colleges. Medical student education: Debt, costs, and loan repayment fact card. https://members.aamc.org/eweb/upload/2015%20Debt%20Fact%20Card.pdf
. October 2015. Accessed April 25, 2017.