medical school admission, barriers to medical school admission, bias, barriers to admission

Every year, thousands of students apply to medical school, many seeing the positive effect medical school admissions consulting has in getting accepted. Admissions consulting can help level the playing field, allowing every applicant a fair chance of admission, regardless of their socioeconomic status and cultural background. Similarly, many medical schools are seeking ways to holistically review applicants and improve the diversity of their medical school student body. However, according to the AAMC, in the past three decades, 75% of all medical school matriculants in the US come from the top two household income quintiles. So, why does medical school favor the wealthy? Why isn't there equal opportunities available to those from low-income families? Why are students from low socioeconomic backgrounds more likely to leave medical school in the first two years of enrolment? In this blog, we'll explore 4 barriers to medical school admission students from low-income families face.

1. Access to college education.

The average cost to attend a public college in the US is roughly $17,000 annually, an expense many low-income families simply can't afford. The National Center for Education Statistics conducted a longitudinal study to assess the relationship between young adult education and employment outcome by family socioeconomic status (SES). Nearly 78% of students with the highest SES enrolled in post-secondary education, while only 28% of those with the lowest SES enrolled. Similarly, a study sampling 3000 public college students with average family incomes under $25,000 in Wisconsin found that more than half of these students dropped out of college without obtaining a degree, and less than 20% graduated within 5 years.

Students from low-income families that do make it to college are at a disadvantage from the get-go. According to research analyzed by Pew Research Center, 31% of all students enrolled in undergrad education are in poverty. Some students from low-income families even struggle to meet their basic needs, in fact, 11% of four-year college students come from food-insecure families. In addition to food insecurity, some of these students will experience housing instability and may have to work one or two jobs to try and help their families make ends meet. Others may be forced to take time off from school in order to save money. All of these challenges faced by these students will have a knock-on effect academically, or worse will result in these students dropping out before they have even achieved a college degree. Without obtaining a Bachelor's degree and completing medical school prerequisites these students will be unable to apply.

2. Medical school application costs.

Medical school admissions favor those from higher-income families, in fact, 50% of accepted applicants are from families earning a minimum of $100,000 annually. Without even considering the cost to attend medical school, the second barrier to those from low-income families is the expensive application process. Most medical applicants will either apply through AMCAS for allopathic medical schools or AACOMAS for osteopathic medical schools. AMCAS charges $170 for a primary application, with each application thereafter costing $40. AACOMAS has a similar fee structure of $195 for a primary application and $45 for each additional program. Many students will have to complete medical school secondary essays which cost between $75-$150 on average. Writing the MCAT will add on another $320 and students who seek professional assistance to help them prepare for the MCAT could spend roughly $2500 on a preparation course. As most medical school applicants apply to 16 medical schools on average, the overall cost to apply can be over $5000. These high application costs are a huge barrier for financially disadvantaged applicants. While wealthy applicants have the option of applying to many medical schools, those from low socioeconomic backgrounds don't have the same luxury. The more schools a student applies to, the better chance they have at admission, so by sending fewer applications due to financial restrictions, already disadvantaged applicants become further disadvantaged.

The average four-year cost to attend medical school is $255,517 at public school and $337,584 at private school which is expensive in general, let alone for those from low-income families. Each year students are expected to pay, on average, $37,556 in medical school tuition at public medical schools or $62,000 at private medical schools. While there are many opportunities for financial assistance, medical school students who do borrow money come out with a hefty amount of debt, $200,000 on average. These numbers don't even take into account the extra expenses that students will have to pay including books, accommodation, and food. How can those from low-income families afford this when these expenses far exceed their family's annual household income?

3. GPA and MCAT scores.

Although the initial cost of the MCAT may seem reasonable at $320, the cost to prepare for the test is much higher. According to a study published in the Medical Education Journal, 59.8% of test-takers paid for practice tests and 45.1% registered for preparation courses. Test takers with families in the highest income bracket were more likely to participate in paid MCAT preparation. In fact, test takers whose parents earned more than $100,000 annually were 54% more likely to enroll in a preparation course compared with those whose parents earned less than 100,000 annually. In addition, 52% of test-takers had parents or family members contribute or completely pay their MCAT related expenses. Overall, 76% of all respondents felt that the costs associated with the MCAT represent a financial hardship in the admissions process. From this study alone, we can see that students from lower incomes are at a disadvantage when it comes to preparing for the MCAT. While others from higher socioeconomic status can enroll in preparation courses, those with lower socioeconomic status are less likely to have this opportunity. If all students cannot prepare with the best resources, how can we expect these students to perform as well and score as high?

The same principle applies to students with lower GPAs. Admissions committees are looking for students that can handle the difficulty of medical school education and training, which they believe will be demonstrated through excellent academic records. As previously mentioned, students from lower socioeconomic backgrounds are more likely to have to work during their schooling with some having to work multiple jobs in order to support themselves and their families. Between the constant stress of financial insecurity and the reduced study time, students from poorer backgrounds are severely disadvantaged when it comes to obtaining high GPAs. A student from a high socioeconomic background has the opportunity to devote more time to studying without needing to source employment. They even have the resources to hire a tutor to help ensure they will achieve excellent grades. Is it possible to get into medical school with a low GPA? Medical school advisors will answer yes, but it's difficult. According to medical school acceptance rates published by the AAMC, those with excellent MCAT scores (517+) with GPAs between 3.0-3.19 have a 49% acceptance rate compared with the 87.8% acceptance rate for those with GPAs above 3.79. If a student's GPA and MCAT score are both low, their chances of acceptance go from difficult, to slim to none.

4. Extracurricular experiences.

Extracurriculars for medical school are an important part of medical school applications and are one of the factors admissions committees use when determining which students should gain admission. In the AMCAS work and activities section, in particular, students will include up to 15 different significant experiences to prove to admissions committees that they are both dedicated and suitable for a career in medicine. Students from disadvantaged socioeconomic backgrounds don't have access to the same experiences and opportunities as those from higher socioeconomic backgrounds. When reviewing medical school personal statement examples, it is evident that those with parents who are physicians can secure excellent opportunities. These students have a lot to discuss in their personal statement and through these experiences, they are able to gain and strengthen a variety of desirable skills. Students whose parents are well connected may never have to learn how to ask to shadow a doctor or worry about how many shadowing hours are required for medical school because they have access to physicians through their parent's connections. Having a well-connected family, a strong support system and access to required resources gives affluent applicants a big advantage over financially strapped applicants.

Another important aspect of medical school applications are letters of recommendation. Most medical schools require students to submit three letters of recommendation to support their application. While a student from an affluent family may have the luxury of shadowing a variety of doctors, developing relationships, and forming tight bonds with mentors and supervisors, others may not be so lucky. As students from lower-income families may not have had the opportunity to gain clinical experience working closely with physicians and mentors, they will be unable to secure strong letters of recommendation, if any. Similarly, securing research experiences, mandatory for MD-PhD programs, teaching experiences, volunteer activities or even pursuing hobbies can be out of grasp for those working non-stop, without connections, struggling to make ends meet. When it comes to practicing with medical school interview questions and answers, the wealth of hands-on experience and knowledge possessed by wealthy students is advantageous for proving their suitability for the profession. Admissions committees are interested in admitting students with strong clinical experiences that highlight the steps students have taken to ensure they are motivated to pursue a career in medicine. Students without access to these opportunities may be just as motivated and suitable to become physicians but with constant challenges and current admissions practices, the odds of success are not tipped in their favor.

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