Two years ago, my wife spent $2,000 on medical school application fees and $300 on a plane ticket to her first interview. Shortly after she arrived, she heard a physician wonder aloud why med schools struggle to attract students from disadvantaged backgrounds.
Despite initiatives to improve the diversity of matriculating classes, medical school is increasingly for the children of the rich and well-educated. In 1992, nearly half of medical students had mothers with no college degree. By 2008, that number had declined to just 25 percent. The corresponding numbers for the general population showed a much milder decline, with the share of Americans whose mothers have no college degree falling from 81 percent to 70 percent.
Part of this phenomenon is beyond the control of medical school admissions committees. College graduates with high GPAs and impeccable test scores aren’t evenly distributed across demographic groups.
But admissions committees can fix problems that compound this disparity. Almost every non-academic component of the application process places an undue burden on students with limited financial resources. That’s unfair, but perhaps more importantly, it prevents medical schools from attracting talented students who aren’t wealthy.
The most obvious example is exorbitant application fees, which can run as much as $150 per school. With applicants applying to an average of sixteen schools, total costs can easily exceed $2,000. To be sure, applicants can apply to a fee waiver program to reduce that burden. But even if the waiver is granted, they’re still responsible for the cost of traveling to interviews, which can run into the thousands of dollars.
Other requirements impose subtler but even more important burdens. Applicants must explicitly report the number of hours they’ve spent shadowing physicians. At some schools, the initial admissions screen weights this number as heavily as GPA or test scores. Children of physicians can casually rack up sixty hours of shadowing during a two-week visit home. By contrast, less well-connected students face the prospect of cold-calling medical offices to find a sympathetic physician. In light of disparities like this, it’s unsurprising that 1 in 5 medical students has a physician parent.
Even more onerous is the expectation that applicants will have completed significant amounts of volunteer work or community service. The AMCAS application (which is used by most medical schools) requires students to explicitly classify experiences as paid or unpaid, and the difference isn’t trivial. Most medical schools require applicants have a certain number of volunteer hours, and the instructions make it painfully clear that paid work doesn’t count.
But this leads to an absurd situation for applicants who perform community service work-study as part of their federal financial aid. They work side by side with wealthier students who volunteer in the same programs, and they have the same impact on their community. But when admissions time comes, the value of their labor is discounted.
To be clear, activities like shadowing and volunteering are worthwhile for aspiring physicians. In particular, a few days of shadowing can dispel an applicant’s misconceptions about medicine before she embarks on a decade of training. And volunteer work gives applicants a chance to demonstrate their desire to have a positive impact on their community. Admissions committees learn something by looking at how much time applicants spend on these activities.
But counting hours is a crude, narrow metric. Essays and interviews give medical schools ample chances to holistically evaluate the skills and traits of applicants. If admissions committees truly wish to attract students from a range of backgrounds, they should accept that students will have developed their skills through a range of activities. Instead, they continue to emphasize unpaid activities, regardless of the burden that places on students who work to put themselves through college.
If medical schools are serious about improving the diversity of their incoming classes, they need to take a hard look at the arbitrary barriers they place in front of poorer applicants. Few enough individuals possess the intelligence, diligence, and empathy that we need in our physicians. Requiring that they also be born wealthy is wasteful and amoral.
Max Rosett is a software engineer and data scientist.
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