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Julie Kim, MD / PhD, is an associate professor of Pediatrics at the Geisel School of Medicine at Dartmouth College. This piece was written as part of Dr. Kim’s participation in the Dartmouth Public Voices Fellowship program.
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Approximately 54,000 students have started or are about to start their 2018 applications to medical school. Ideally, those who become doctors will both serve and represent our diverse population since many studies show that patients are more likely to follow the advice of providers who are of similar background.
Yet the aspiring doctors who apply, are accepted, then graduate will not reflect the race and ethnicity of the US population. At every step of the way, the disparity for underrepresented minorities increases.
To start with, a disproportionately low number of African-American/Black, Hispanic/Latino, American Indian/Alaska Native, Native Hawaiian/Pacific Islander, or economically disadvantaged people will apply.
Of those minority applicants, their acceptance rates will be lower compared to their white and Asian counterparts.
Finally, for those minorities who are accepted, even fewer will graduate within four years (unless they attend a historically black medical school such as Meharry, Morehouse, Howard or Drew). Data from the Association of American Medical Colleges suggests that Hispanic or Latino medical students are half as likely to graduate in 4 years compared to their white classmates.
I am the chair of the remediation committee at my medical school. When students fail a class, I review their academic careers and meet them personally. I am always impressed by their achievements, sincerity, and early dedication to helping others. They have accomplished more than many current physicians did at that same time in medical school. These students have great potential. Most of the time the student remediates and continues on, occasionally with additional difficulties.
Knowing that underrepresented minorities have higher attrition, it is reasonable to assume they come before remediation committees across the country in greater numbers. But because of the potential negative optics, no medical school openly publishes data about their struggling minority students.
Why are underrepresented minorities less likely to graduate?
It is not intellectual ability. Many other students with similar prematriculation GPAs and test scores will graduate. Historically black medical schools have been successfully graduating well-qualified physicians for over a century.
Nor is it about a lack of willingness on the part of schools to support underrepresented minority students. Medical schools are trying. Each has a cornucopia of support services, multicultural and diversity offices and liaisons, learning resource centers, wellness programs, and faculty and peer advising.
We can find some numbers. A medical school may boast about their number of underrepresented minorities at a given moment, but that number does not indicate how many started, how long each student took to graduate, or reasons for attrition. We cannot tell what learning and teaching styles were used, what academic difficulties students may have had, what remediation occurred, and what supports were useful.
If the U.S. is really to have doctors that reflect the diversity of the patients they will serve, medical schools need to share this information so we can learn from each other and improve student success. The goal should be not only to graduate competent physicians, but also to avoid the need for remediation in the first place.
For one thing, remediation adds to the already-expensive cost of the medical school. The typical course to finish medical school is 4 years with a median cost for a private medical school is $278,455 and $207,866 for a public school. Remediation extends the time – and increases the loans needed for tuition and living costs. And for some students, having to remediate results in loss of financial aid or scholarships. If the student is unfortunate and does not complete medical school, this debt still must be repaid.
Remediation also affects future earnings. Medical students who had hoped to pursue a career in a, high-income earning field, such as orthopedics or neurosurgery, will not be considered for these extremely competitive training spots if they have a history of remediation.
No medical school applicant thinks they will have academic difficulty since they have generally been very successful thus far. The students at my Ivy League medical school have been the best of the best. But medical school success pushes the limits of knowledge acquisition and utilization and not everyone can remain the best as the competition peaks. Some students are going to struggle and fail.
My advice to underrepresented minority applicants is to know the probability of graduating successfully, and at what financial and psychological cost. A school’s history in remediation, withdrawals, suspensions and expulsions should influence your list.
Institutional reputation and the amount of financial aid given may be less important. Obtaining a medical degree from a lower-ranked institution with a higher loan repayment is far better than failing out of a higher-ranked institution that offered outstanding financial aid -- which would still need to be repaid, even if the borrower does not graduate into their expected career. The ultimate goal is to successfully graduate as a doctor.
