Why don’t our doctors look like us?
“Privilege is when you think something is not a problem because it is not a problem to you personally”
I’ve spent the past five years mentoring and guiding students who are underrepresented in medicine (URiM) through medical school admissions in the United States (US). With their permission, I will share two stories to highlight some of the systemic causes for why doctors often do not reflect the populations they serve.
Andre identifies as African American and was born and raised in northern California. Although he faced many challenges growing up, he persevered and graduated from the University of California, San Diego (UCSD). Andre’s educational background was astounding: not only had he graduated from UCSD with a 3.95 grade point average, but along the way he had published four papers in the field of molecular biology and was working as a medical scribe in a primary care clinic in Sacramento. However, when Andre sat for the US Medical College Admissions Test (MCAT), he scored in the 48th percentile—a score completely incongruent with his intelligence. After learning more about how he had prepared for the exam, it became quite clear why he scored lower than he was capable of. Andre was whip-smart and great at taking exams, but he didn’t know which resources to utilise and how to effectively prepare for a standardised test. No one had told him which question banks to buy, what books were the best, or how to develop a long-term study plan. The MCAT isn’t just any college exam; it often requires strategic knowledge and information privy to those with rich networks and resources. Once Andre had that information, he scored in the 97th percentile and is now a medical student in California pursuing primary care. Andre’s story shows how standardised tests are about more than a student’s intrinsic ability and will to achieve; they reflect the privilege and inaccessibility of higher education. There are also the temporal and monetary costs of taking the exam. Taking the MCAT once costs about $300 and students study for 30–40 hours per week for about three months. Both present additional obstacles for an exam that is touted as an equaliser in the field of medicine.
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“Standardised tests are about more than a student’s intrinsic ability and will to achieve; they reflect the privilege and inaccessibility of higher education.”
Tiffany lives in San Francisco and attended school on the East Coast of the United States. She aspired to go to medical school so she could be a physician in the community she grew up in. She speaks Vietnamese and understands the culture and background of her neighborhood. Previously, Tiffany was a stellar student and earned excellent grades and test scores, but her obstacles lay beyond her report card. Her extracurricular list was much shorter than her colleagues. Coming from a lower income household, she worked two jobs during her undergraduate to make ends meet. This meant she couldn’t pursue the same opportunities in research, community service, and unpaid clinical work as her classmates. I could feel her concern, worry, and lack of confidence. Despite her hard work, Tiffany did not see herself as an equal and valuable participant in the application process. She felt behind her classmates, and imposter syndrome settled into her psyche. Tiffany recently scored in the 90th percentile on her MCAT, and is now working as a medical technician at an ophthalmology clinic with plans to apply to medical school next year. Situations like Tiffany’s are sadly common, where bright students who would excel in medicine simply don’t have the money, either from their own pockets or from their family, to finance a diverse and impressive list of extracurricular activities. These students have no choice but to take a gap year (or more) to slowly build up an extracurricular list that can compete in the admissions battleground. Many students become consumed by these gap years and lose interest in a career in medicine. A truly equitable system should create opportunities for students, regardless of their financial situation.
Today, medical education includes a renewed focus on understanding and accommodating our patients’ backgrounds, and there has been much research into the benefits of a diverse physician workforce. These studies largely revolve around the idea that concordance between physicians and patients promotes greater understanding of the socioeconomic and cultural determinants that play a role during a given patient’s healthcare. To achieve such goals, the medical education system must create pathways to success for students who will represent and contribute to a diverse physician workforce so that one day our doctors look like our patients.
“The medical education system must create pathways to success for students who will represent and contribute to a diverse physician workforce.”
