ROCHESTER, Minn. — The nation’s medical school student body remains over-represented by those from higher-income households, no matter the race, ethnicity and gender, a study from the University of Minnesota shows.

The Research Letter,

published on Tuesday, March 15, in the journal JAMA Network Open,

is believed by its authors to signal a wealth-favoring pipeline to the profession that both drives and adds to inequities of racial and ethnic diversity.

“There’s been some difficulty increasing the diversity of the medical student body in the last two decades,” says Arman Shahriar, lead author and one of several medical students joined on the paper by researchers and clinicians from Boston, the University of Minnesota and Hennepin Healthcare. “So we looked at socioeconomic diversity to see if it’s perhaps contributing to this problem.”

The authors reviewed parental income data gathered by the Association of American Medical Colleges between 2017 and 2019. After creating equal income level groups, the researchers sorted 30,000 participating students by their socioeconomic status.

Contributed

Their analysis then compared medical school student body demographics to those of the general population as determined by the U.S. Census Bureau.

The analysis determined that more than 50% of the nation’s medical students hailed from the top 20% of the nation’s households by wealth. Conversely, students from the bottom 60% of U.S. households made up consistently less than their share of the nation’s soon-to-be doctors.

Stratified by race and ethnicity, these findings suggested a growing racial and ethnic diversity within medicine that nonetheless fails to encompass socioeconomic diversity.

The study reported, for example, that more than 50% of Chinese-identifying and more than 60% of Indian-identifying medical students were from the top 20% of the nation in terms of household wealth.

“More even income distributions,” the study added, “were observed for medical students identifying as Korean, Vietnamese, Bangladeshi and other Asian ethnicities.”

While Black families made up just 10% of the nation’s households in the top 20% economically, over 27% of Black students admitted to medical school had come from homes in that income bracket.

A similar wealth over-representation was identified among Hispanic medical students, citing over 33% of those seeking an MD coming from the top 20%, compared to just 12% of Hispanic households reporting top-20% income.

“There’s obviously overlap, for reasons rooted in deep structural racism in this country, between race, ethnicity and socioeconomic status,” Shahriar said about the problems delineating effects of wealth from race and ethnicity. “That doesn’t mean that they can’t have their own independent effects.”

White students from wealth were also over-represented in the JAMA analysis, with white doctors-to-be from wealthy homes making up 57% of all medical students, despite coming from just under 23% of the U.S. population.

“Socioeconomic diversity gets much less press than visible forms of diversity like gender, race and ethnicity,” Shahriar said.

“I think that’s in part due to the visibility of other forms of identity, and also due in part to the fact that in our society, we don’t really talk about money.”

Shahriar said the project stemmed from conversations among classmates. He says they witnessed an ease, for example, with which medical students seemed to absorb sudden surprise expenses.

“There’s a lot of ancillary purchases that have to happen while you’re in medical school,” he said. “Some students can quickly pull a trigger $500 here, a couple hundred dollars there. For other students it’s more difficult, even with loans.”

Besides the lack of proportional access, he says, this wealth bias in medical training negatively affects patient care.

“Generally speaking, patients do better when they are seen by physicians who share some form of identity with them,” Shahriar said.

“Students who have had life experiences due to certain demographic factors like race, ethnicity or socioeconomic status are able to better relate to patients who have those sorts of life experiences … Those are all elements that establish trust between providers and patients.”

The solution, he thinks, “is going to take a lot more intentional interventions by medical schools and organized medicine upstream. We’re talking middle school, early high school years.”

“Those critical educational years where students who are born and raised around a certain profession are making early decisions to go into it.”