Medical students are a further concentration of rich and poor with an explosion in the gap since 1997 and admissions of highest income students (parents over $100,000 income in 1997) increasing from 23.5% to 51.5% and eroding into half of poorest quartile (parents less than $40,000 in 1997) and 15% of both middle quartiles.
The following are a reflection of the distance between rich and poor in the nation, in proximity in miles from medical schools, in urban vs rural, in income vs poverty, in top schools vs poor schools, in college educated and professional vs those with high school education and below, in health and wealth vs poor health and being poor.
Admissions Ratios and Allopathic Medical Students
Ratio of Population to
Medical Students
Medical Students 1994-2000
% of Medical Students
22.6 Asian Indian 8,136 6.5%
59.7 Chinese 4,882 3.9%
63.2 All Asian Students 20,340 16.2%
67.2 Top Quintile Income 75,329 60.0%
83.6 Vietnamese 1,424 1.1%
138.6 All Urban Born* 109,228 87.0%
201.7 US All Student Total 125,549 100.0%
201.7 2nd Quintile Income 25,110 20.0%
214.1 White, average all 81,973 65.3%
279.9 All Foreign Born* 7,533 6.0%
314.7 Only Native American 871 0.70%
356.9 All Rural Born * 16,321 13.0%
373.6 3rd Quintile Income 15,066 12.0%
422.4 Black students, M&F 8,880 7.1%
501.3 Any Native American 871 0.70%
616.4 4th Quintile Income 10,044 8.0%
677.6 Low Income Rural* 3,690 2.9%
756.3 All Hispanic (rough est.) 5,975 4.8%
915.1 Mexican American 2,887 2.3%
2689.8 Bottom Quintile 2,511 2.0%
Estimates of bottom quintile difficult, rang 1 – 3% or 1 in 1600 to 1 in 4000.
*data derived from AMA Masterfile for 1994 – 2000 classes, all other AAMC data
The range basically involves those who gain admissions at 99% levels to those who do not escape from achievement tests or high school.
The changes in admissions in the past 8 years involve a replacement of the physicians most likely to distribute to rural and underserved areas and primary care and family medicine careers with those least likely to distribute. The current rapid medical school expansion favors those who are poised at the top ready to take advantage of more medical school positions.
Those less likely to be admitted, rural or inner city origin, had to decide by secondary school and work for extra years and decades and still were admitted 4 or more years later than typical medical students. Such is the gap that had to be overcome that existed by age 5 or 10 or 12 and took a lifetime to overcome. Of course this effort has shaped these individuals in a way most suited for careers involving people and health care, which is why older students choose primary care, family medicine, psychiatry, underserved primary care, and rural careers at increasing levels with age at graduation of 70 – 150% higher.
The youngest students had the least obstacles in education and income and the most direct path to elite colleges and medical schools and MCAT scores and board scores and subspecialty choice and major medical school zip code practice locations, just like the zip codes where they were born, raised, educated, and trained. As a group in the top subspecialties, they also have the highest dissatisfaction levels with their subspecialty careers.
Somewhere along the line many never managed to integrate the necessary people skills with their academic development and no one ever told them that a medical career, most involving people, was a poor match for those that failed to develop people and management abilities.
All along the line the lower and middle income types were told, formally and informally, that they would never make it. Because of the barriers of income and education they constantly had to rely on people skills to get by. And the few that have survived make impressive contributions as physicians in the most critical areas.
Fortunately life is tough enough so that enough high income kids at some point over a 30 year period will have to develop, even those such as myself who learned later in life through interactions with my different kids and dissonant school systems. For those that never had to grow up or never chose to grow up and have failed to find assistants with people skills to protect and advise them, I fear for their patients.
In the past 8 years, more and more service oriented young professionals will have decided that the gaps are too wide to overcome, and will choose other careers or will avoid medicine entirely.
Robert C. Bowman, M.D.
rbowman@unmc.edu