Walking a single log bridge into the dark

this is a multifactorial problem, symptomatic of a larger trend in education: in a race towards the same finish line, not everyone gets the same starting line.

there's a number of different ways that minority status creates barriers to education, starting even before preschool. minorities in general tend to be poorer, which is true across race, gender, and disability status. fundamentally, just being poor can be an educational barrier. you can't focus on class if you're hungry because you couldn't afford lunch, and you can't get all your homework done if you have to work long hours after school. regardless of intelligence or academic talent, students in these situations either have to work far, far harder than their peers or end up screwed over on their report card.

beyond that, discrimination is prolific. I don't even need to cite this, professors have told me to drop out of their course or simply denied my accommodations entirely, but I will cite it anyway. for students who are struggling or trying to make a good impression or just don't understand a concept, teachers are supposed to be a resource to help. but would you go to your teacher for extra help with coursework if they've made it clear they think less of you because of your identity?

I can't emphasize enough how severe the problem of educational inequity is. illiteracy is still a problem in the US.

focusing specifically on medical education, exactly when that system begins is difficult to source, but generally speaking students often start to decide in high school, frequently enough that there's multiple guides on it. additionally, some high school students will enter direct med programs, which either combine an undergraduate and medical degree, or assure acceptance into a certain med school under certain terms.

From the very beginning of college, premedical students begin a grind for the best application. Applications tend to go out in the third year, although many students will take gap years or pursue post-bacc education (a way to take more classes without pursuing a degree, often to improve chances of getting into a grad school). The recommendations for a med school application are brutal: a high GPA, often upwards of 3.5 (straight As); 300-500 hours of studying for the MCAT; 200-300 hours of clinical experience; a semester at least of research experience; and 100 hours of volunteering. That's just the start. Beyond that, medical schools often want to see soft qualities like diverse interests and leadership, which usually require extracurriculars.

The cost of this is prohibitive - it's a massive amount of unpaid work for students that are simultaneously putting themselves in an average of roughly 40,000 USD of debt. Plus for the eventual application they're also paying up to 10,000$ in application fees, testing fees, and travel costs. by comparison, PhD programs have largely phased out standardized testing, have application fees of usually less than 100$ each, and reimburse for travel costs (these are very different kinds of programs, but the point still stands).

all of this to then take on another 200,000$, on average, in med school debt.

Students who are poor (which are often minorities) and have received a lacking education are disproportionately affected by this. For students whose parents cannot financially support them, and who have to work through college to eat, the time and financial demands are impossible. For disabled students who have constant medical appointments, high time demands for things like physical or psychiatric therapy, and additional financial strain from medical debt, graduating with an undergraduate degree at all is a struggle, much less applying to med school.

Clinical experience, shadowing, and affording all of this gets a lot easier if you're not the first doctor in your family - accordingly, one in five medical students has a doctor for a parent. from the same source, half of all medical students come from the richest 20% of the population.

so the med school process selects for who can afford it, which is often the wealthy. minorities are less likely to be wealthy, and by extension, less likely to achieve the academic success required for medical school admission. what else?

med school applicants who express any kind of criticism of past doctors or the medical system are rejected almost out of hand. on the one hand, this makes sense, because why accept an applicant who is critical of their dream career? on the other hand, if expressing even the slightest criticism isn't allowed, those who want to change the system from the inside are excluded.

What follows is my opinion, not fact:

as an additional layer, which is perhaps obvious: getting accommodations is difficult in medical school. doctors aren't sparing their coworkers or students from their ableism.

and finally, there's the concept of the ivory tower. more so than high schools, to which attendance is mandatory, colleges often pride themselves on selecting only the very best and brightest to work or study there and exclude the rest. academia becomes insular and invite-only (and this includes medical schools). for many in the academic community, they expect students to meet a certain outdated "standard" to join the ranks of higher education.

I argue that the medical education process, at both the undergraduate and graduate level, teaches students to devalue their health. premedical students are more depressed than other undergraduate students, with minority premedical students being more depressed than white male premedical students (I'll note here that data on premedical students is mixed). also, medical students are more depressed than the average person, and become more depressed over the course of their first semester (this is relatively undisputed).

don't be afraid to ask questions if you've got em.

furthermore, medical students have a high prevalence of musculoskeletal pain compared to the general population. one horrifying study suggests the stress of premedical and medical students is physiologically measurable, although my opinion is that the data is weak. anecdotally, some of the only people to recognize my compression tights on sight are medical students, because they're frequently used to help combat the effects of standing too long.

for students who have passed every barrier, managed to get through every challenge, and contributed massive amounts of time at the expense of their health to become doctors, their perseverance is a point of pride. is it any surprise that a group of people who managed to push through difficulty and pain for academic and socioeconomic success have little empathy for the pain of their patients?

It's not a completely hopeless situation - this is why medical schools have begun to include diversity essay questions, and why minority scholarships exist. the observable trend of educational inequity is the basis for Affirmative Action policies. CME courses (required trainings on current topics in the medical field) on disability identity and discrimination have also become available.