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March 9, 2023

Medical Schools Can Do More for Social Mobility

We’ve discussed the importance of diversity in the healthcare workforce before, and how racial and ethnic diversity can improve the quality of care for all patients. While gender, race, and ethnic diversity are all critical, there’s another aspect of diversity that’s often overlooked: socioeconomic diversity.

Studies have shown for years that there are disproportionately few doctors and other healthcare professionals from working-class or even middle-class backgrounds. Instead, most new medical students come from the wealthiest fraction of society–and new evidence indicates that this overrepresentation holds true regardless of a student’s race or ethnicity. Beyond the loss of talented students from modest or low-income backgrounds, this lack of socioeconomic diversity has implications for patients and communities. 

In this article, we offer an overview of how serious this issue is, why it matters, and look at Tiber Health President David Lenihan’s proposal for one way to help hold medical schools accountable when it comes to social and economic mobility.

20% of the Nation’s Population Accounts for 50.5% of Its Medical Students

Each year, the American Association of Medical Colleges (AAMC) carries out the Matriculating Students Questionnaire (MSQ), a survey that asks new medical students questions about their backgrounds and the paths they took to arrive at medical school. A recent study by the University of Minnesota looked at AAMC MSQ data to find out about the economic class background of new medical students.

This study, published in 2022, looked at the 2017, 2018, and 2019 MSQ responses. Of the 30,373 students who provided information about their parental household income:

  • 50.5% were from the top 20% of U.S. households by income
  • 24.0% were from the top 5% of U.S. households by income

This data indicates that just over half of new medical students over this three-year period came from the very wealthiest households. What’s more, the University of Minnesota study found that this overrepresentation of rich students held true across ethnic and racial lines. That is, Black or Hispanic medical students were much more likely to have been raised in a wealthy household than a Black or Hispanic person from the general population.

What’s Causing the Lack of Socioeconomic Diversity?

Obviously, the soaring cost of medical school tuition is a major driver behind the disproportionate representation of wealthy students in medical schools. As of 2019, the most recent year for which data is available, the AAMC reports that the median debt for medical students at graduation is $200,000

Other costs add up, too. The lead author of the University of Minnesota study, Arman Sharhihar, pointed out in an interview with Minnesota Public Radio that incidental out-of-pocket costs, like subscriptions for exam-prep question banks, or the cost of owning a car to get to clinical rotations, can run to thousands of dollars a year. 

Students from modest or low-income backgrounds often stumble on these kinds of costs, for which there is no aid. Students from lower income brackets also report having to take time off during their studies to support their families financially and, according to a 2022 study from Yale University, are more at risk of dropping out of medical school entirely compared to students from wealthier backgrounds. The result is a system that, as Tiber Health President Dr. David Lenihan put it in a Forbes Magazine roundtable, “[makes] a bunch of rich students richer.”

Putting Social Mobility Front and Center

Dr. Lenihan is passionate about the need to reconnect medical schools with the social mobility aspect of their mission. In a January 2023 opinion column for STAT News, he advocated adopting a medical school economic mobility index number (MSEMI) to help hold medical schools accountable for how they help  graduates move from one economic class to another. Based on the “social mobility index” proposed by Michael Itzkowitz of the Washington, D.C.-based think tank Third Way, the MSEMI would compare the average parental wage of incoming students with the average wage of graduates placed in medical residencies.

Dr. Lenihan’s MSEMI would also factor in where medical school graduates work, not just how much they earn. In his op-ed, he notes that medical school graduates from underrepresented backgrounds often choose to work with underserved communities, including their own communities of origin. “Impoverished areas desperately need the services of physicians and other categories of medical professionals,” Dr. Lenihan writes. Adopting a measure like the MSEMI could help medical schools demonstrate “how successfully the school’s grads were using their education and skills to upgrade the health outcomes for America’s neediest patients.” This could help accelerate the much-needed process of refocusing medical schools on their commitment to supporting talented students of all income levels–and their future patients.

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