The lack of socioeconomic diversity in medicine

I recently read some statistics that shocked me, but not really. In the U.S., 60% of medical students come from families with incomes in the top 20% of the nation. Meanwhile, only 3% come from families with incomes in the lowest 20%. Not much socioeconomic diversity in the house of medicine.

Now, I realized early on that I didn’t have a lot of company in this respect, but I didn’t think it was as lonely as a mere 3%. As a first generation college graduate, let alone doctor now, I know all too well that feeling that I had stumbled into an exclusive club to which I didn’t perfectly fit in. More often than not, it seemed like many of my classmates had parents who were physicians or at least some better sense of what a life in medicine was like. Looking back on my journey into medicine, I remember firsthand the challenges facing aspiring doctors from lower socioeconomic backgrounds.

If nothing else, my personal journey illustrates the importance of early recruitment and sustained mentorship in the field of medicine. It’s just more challenging for those without any prior exposure to higher academics to realize that a career in medicine is a possibility. To this day, I can’t say exactly what it was that first made me think that it was feasible for me. My father delivered takeout, and my mother was a seamstress in a factory. In my family, a high school diploma already made me a pioneer in education. I was very fortunate though. I got accepted into medical school at the age of 17 through a joint BA-MD program. While most would consider the greatest benefit of this set-up to be a guaranteed seat in medical school during undergraduate, I actually considered the greatest benefit to be the mentorship and guidance that I was connected to through the program. Even with a guaranteed seat in medical school, I would never have successfully made it to medical school without that added support, direction, and community.

Of course, the other large obstacle, perhaps the greatest impediment of all, is the exorbitant cost of medical education today. The AMA reports the average debt of medical students in 2013 to be around $170,000, and that amount can easily be as high as $250,000 or more, especially if you attended a private university for both your undergraduate and medical degrees, as I did. In my case, I consider myself very fortunate once again because I received a near-full ride scholarship from my generous alma mater for my undergraduate education.

As for medical school, it was a combination of scholarships and loans that was pretty typical for many medical students. As a result, I still owe some people a lot of money, but perhaps not nearly as much as I could have for someone in my position. It’s hard to say how these things may have affected my choices in retrospect. If I didn’t get that scholarship in college, would I have dared to take on more debt by going to medical school? If I was in more debt, would I have felt more compelled to go for a more lucrative specialty?

The ramifications of a lack of socioeconomic diversity in medicine are great and significant to patient care. Looking back, it seems obvious how we can start to remedy the problem. We need more outreach to those from lower socioeconomic backgrounds early on and more learning opportunities for those interested. We need to provide sustained mentorship to those already on the medical track. And, most importantly, we need major reforms to the funding and costs of medical education today. It will take more than just 3% of us to improve this. As a profession, we must recognize increased diversity in our field as an important goal to strive towards.

Eric Lee is an emergency medicine resident who blogs at Chasing Life in Scrubs. He can be reached on Twitter @EricLeeMD.

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  • John C. Key MD

    The quest for “socioeconomic diversity” is a fool’s errand. Why should it be a goal? Do poor people become better clinicians than the wealthy? i came from poverty, worked my way through, but am definitely no better a doctor than those from more privileged backgrounds. It’s about intelligence, work, and gifting–not diversity.

    The holy grail of diversity is just another false god of our declining culture.

    • Mengles

      I disagree with you here, Dr. Key. There’s one reason — it’s easier to empathize with someone who is middle class or poor, when you yourself are born into those circumstances. By only recruiting from the rich, you get more entitled medical students who believe medicine is a way to get rich, rather than as a calling. They have no problem leaving those who aren’t rich behind as patients. It isn’t perfect, but it’s better than doing nothing.

      • RuralEMdoc

        But medical schools are not “recruiting from the rich”, they don’t recruit at all. They just sit there and thousands and thousand of people apply every year.

        • rbthe4th2

          How many of these are from the upper/middle/lower classes?

      • rbthe4th2

        I see that this a lot. On top of that doctors dont figure in work time loss, paying for copays, etc. that if they had to deal with getting time off, paying for meds, etc. then they might make better decisions. I make cost effective decisions and I have had doctors who can’t justify their reason(s) for return visits, etc. I’m not the only one.

        • guest

          Just out of idle curiosity, what exactly makes you think that we doctors don’t have to pay co-pays when we go to the doctor, pay for our medications, and deal with the stress of trying to figure out how to get time off from work to go to our doctors? The answer is that we do. I have personally not been to the dentist in two years, because it’s too stressful to carve out time to get up there and then deal with getting into work that late.

          The reason that doctors make you schlep in for appointments is that that’s the only way they get paid for caring for you.

          The reason that they appear unsympathetic is that a) they don’t consider it to be their fault that your insurance company sets up their compensation that way (and they are right, it really isn’t),

          and b) because they are expected to cope with identical challenges in their own personal lives and just suck it up without complaining, they expect their patients to be just as stoic as they are.

          • rbthe4th2

            Guest,

            I don’t say that you all don’t. Lets face it you can self diagnose and go right to the problem. I had to go through 4 different doctors just for one issue. If you went to a doctor, they would have accepted your diagnosis because you are a doctor and moved on.

            I agree, it isn’t their fault. However, if I can’t make a $66 to $91 dollar treatment a day because I don’t make $200K year salary, that is a difference. How many doctors are paycheck to paycheck? I was called non compliant because I couldn’t afford that. Doctors can. You can’t tell me there aren’t special insurance people who go after doctors because as a group they are paid well.

            http://www.modernhealthcare.com/article/20140719/MAGAZINE/307199981
            “Uwe Reinhardt, a Princeton University health economist who has written about physician pay, said doctors shouldn’t complain. He pointed out that median U.S. household income decreased from $56,000 to $52,000 in recent years. “The median income of patients they serve has fallen, so they should fall on their knees and thank God their income has remained flat,” he said. “Physicians have to realize that they are covering their lifestyles out of the paychecks of the patients they serve.”

            http://www.ncbi.nlm.nih.gov/pubmed/10068390
            Soon, half of all physicians may be married to other physicians (that is, in dual-doctor families). Little is known about how marriage to another physician affects physicians themselves.
            “Marriage to another physician had distinct benefits (P < 0.001) for both men and women, including more frequent enjoyment from shared work interests and higher family incomes."

            If you pull in $400 a year (say 2 internists) and your paycheck goes up every year (which mine haven't in the past 4-5), its a lot easier to pay the above example I used for treatment than it is for us who live paycheck to paycheck.

            Do doctors get called non compliant and dismissed because they can't afford the treatment? When they differ, do they bring medical info and ask to discuss it and are they obliged because their docs.

            Sorry, very different lifestyle for those of us not on the cusp. As I remember on one of the discussion areas, a doctor said it is coming to the point where it is who you know in medicine in terms of what type of care you get. Dr. Jerome Groopman pointed out in How Doctors Think that if a doctor likes you, you'll get better care. Other doctors look out for other docs.

          • Patient Kit

            When I was unemployed and about to lose my COBRA’d insurance, I had a doctor tell me that I probably had cancer and that I needed to “find the money” for surgery. And she said it like she thought enough money to pay for surgery should be findable. I have no idea where she expected me to find that money. She didn’t give me any clues.

          • rbthe4th2

            Yes. I got the same thing when I got hospitalized and a few other things a couple of years ago. Blew everything we had out of water. The doc didn’t see it as a problem.

          • querywoman

            Yeah! Cancer societies collect a lot of money! Sometimes they do spend it on patients.
            The real needle in the haystack search is for dental money.

          • JustADoc

            My pay went down $5000 last year despite seeing more patients as overhead went up more.
            Health insurance premiums went up $300/month($3600/yr).
            I worked harder and made $8600 less last year. Add in the extra $2200 as the 2% reduction in social security taxes expired and that is almost $11,000 less.
            That is a big hit regardless of your income.

          • rbthe4th2

            Hmm. A $5K hit out of $70 in a year is 7%. 11K out of $200 is 5%. Buddy took a 10% cut out of $60K so I never say anything in front of him.

          • JustADoc

            This was in reply to a post that stated doctors should be happy their income is flat. It isn’t is all I am saying

          • Suzi Q 38

            Yes, it is, but at least you have a job that pays fairly well.
            What you are describing is what we have experienced for most of the past decade.

            My hours got cut 40%, and I wasn’t the only one.
            Thank goodness my husband is still employed and I am semi-retired, anyway.
            No one wants to get paid less, but if it has to be O.K. for lower and middle America, then doctors have to understand that they aren’t exempt.

            I do see, though, quite a few jobs open at the local hospitals and clinics.
            There are a few people I know who have not been able to find a job at all.

          • querywoman

            One of my dentists told me lawyers had the worst teeth. I said that’s cause they talk too much and abuse their teeth. Like my mother’s divorce lawyer, who wasted time talking about when he drove a cab, how it cost him to make his boy a judge, and asking about her personal friend.
            She wanted to talk about her divorce.
            My dentist said lawyers work a lot and don’t have time.
            I still say they talk too much.
            I didn’t make it through law school, but I do talk too much like a lawyer. I have a friend who admits he isn’t a very good lawyer. He’s too quiet to be a decent lawyer!

        • Suzi Q 38

          My doctors have to ask me if they can order a test. When I was desperate (needed C-spine surgery stat), I let them order whatever. Now that I am no longer acute, I take my time, and talk it out with them. Do I really need this test now, and why?
          Also, the teaching hospitals are more expensive.
          Go home and get the blood tests if it does not matter.

          • querywoman

            Have you ever tried to get a skin biopsy? To get a wart, mole, or other lesion removed?
            I can have a mammogram anytime I want one. Now I’m at the age where it’s being suggested I get a colonscope stuck up my @$$. I refuse both.
            I was researching my own dermatologist a while ago. I saw that he’s one who doesn’t advocate biopsying most rashes because it makes no difference in care.
            His eyes are surely good at recognizing various spots.
            But, a simple skin scraping and a dermatoscope exam can determine whether or not a patient is delusional. And they are not done!
            Why can a doctor do a Pap smear but not a skin biopsy on a lesion on my arm?

      • fatherhash

        is this an opinion or a fact? is it only the poor upbringing doctors that can empathize? and only rich students who “believe medicine is way to get rich”?

        not to mention, i can’t see why entitled rich kids would want to go through all the work to become doctors if they are already rich.

      • John C. Key MD

        Everyone can disagree based upon their philosophy and life experiences. I have never observed the scenarios that you describe. Never saw any doctor “[leave] those who aren’t rich behind” but I have seen governent and insurance do it a lot.

      • Patient Kit

        I agree with you. Diversity does matter. There’s nothing like firsthand experience to really understand how other people live. And if we can manage to get more good doctors from our lower classes in this country, we need to find a way for them to share what they know about the socioeconomic class they come from with all the doctors who started life with more advantages. Rather than hide their personal backgrounds, doctors should be encouraged to share their background experience like the valuable info it is.

      • querywoman

        I once had a Nigerian home health nurse who also worked in the ministry. He couldn’t conceive of money the way we do.
        He described wealth as a Mark Cuban, and most so called rich people are nowhere near Mark in the dollars. The nurse would have been quite happy with a million. So would I.
        He told me once it’s only the poor who need ministry. I looked at him and said, “That’s not true. They have the same problems everyone else does, like alcoholism.”
        I often mention this in the church where my membership is. Most of my church members are seasoned like me, and have been around the rich and the poor.
        Church conversations about helping always “deteriorate” to helping the poor. Most of the people around us aren’t poor, and have plenty of needs. Most poor in American live in homes with water, heat, air, and cooking facilities.

    • querywoman

      I come from a blue collar family and grew up in a dead world: a white, blue collar suburb.
      Now I live in a large urban area with rich and poor and all races and backgrounds.
      When I was younger, wealth used to dazzle me. Mostly, in terms, I didn’t feel right around them.
      Now I’ve known good and bad people from all socioeconomic backgrounds. I’ve worked in public welfare, done church charitable work, and been around lots of the rich.
      I’ve seen doctors and their families serve poor people meals at Christmas.
      Doctors work for their money, though. Most of the upper middle class does too.
      Yes, I’ve been around the truly wealthy also, those with inherited wealth.

  • Thomas D Guastavino

    From reading many of the opinions on kevinmd it is clear that a large number of physicians believe that it is difficult, if not impossible to be a good physician and take economic factors into account. In some cases it rises to level of contempt. So perhaps we should just stop accepting applications to medical schools of anyone who would have to accumulate any debt.

    • PoliticallyIncorrectMD

      Perhaps we should stop accepting applications to medical schools of anyone who wants to enter the field for wrong reasons regardless of their academic achievements and their ability to pay.

      • Thomas D Guastavino

        I agree

      • John C. Key MD

        What’s a wrong reason? Almost everyone I know went into medicine because it was (1) interesting and (2)offered high income.

        • PoliticallyIncorrectMD

          This is exactly the wrong reasons. This is why public has issues with physicians! Being a stock broker is interesting and offers high income. Being a Physician to me implies a lot of selfishness, sacrifice and commitment. Many people I know share this position. Why would I trust with my life to somebody who finds me interesting and makes fortune on my illness?

          • John C. Key MD

            I see nothing wrong with making a high income if a quality service is provided for value received. In my time the old saw of going into medicine “because I want to help people” was used only for medical school interviews. As you rightly state, “sacrifice and commitment” are necessary ingredients of the stew. Money may be a motivation, but that alone will not bring doctors through the sacrifices, stress, and long hours.

          • PoliticallyIncorrectMD

            “In my time the old saw of going into medicine “because I want to help people” was used only for medical school interviews.” I appreciate your honesty, but if you admit this openly, you shouldn’t be surprised about public’s mistrust in medical profession. Don’t look for their support when you cry out about being screwed by big government, lawyers and insurance companies. The whole generation of physicians placed the emphasis on their financial interests in stead of serving patients? Very sad if it is true! No wonder the healthcare is falling apart! Its only hope are the people who genuinely go to medicine to help others. There are still some around.

          • Suzi Q 38

            Bravo.
            I have said this before:
            Too bad you (some physicians) didn’t admit that you weren’t sincere at the medical school interview.
            The one where you said that you wanted to “help and/or heal others?”
            If you were truthful, they would never have let you in.

          • PoliticallyIncorrectMD

            Patients need to rise to rid of bad doctors and embrace those who care. That is the only way anything will change!

          • Suzi Q 38

            That, my good doctor, is what I am doing…now and in the future.

          • querywoman

            I have never been able to get a doctor to change his or mind and be able to stay with the person. I fire them and move on, and often send them a letter.
            I learned to laugh at the baddies a long time ago.
            The baddies now get plastered with my internet reviews. The good ones get good reviews, just like I just rewarded an electronics recycler whose picked up for me twice with a glowing review.

          • querywoman

            And at least send the baddie a note explaining the terminated relationship!

          • Suzi Q 38

            I agree that you are being boldly honest, but I am glad that not all doctors think this way.

            It is my hope that they wanted to help patients, regardless of what they were paid….this is what they were “born” to do.

            Few want a physician whose primary motivation for being their doctor is the money.

          • querywoman

            I have no problem with high income for doctors of lawyers if they work for it and treat people fairly and equitable.
            All medical education in this country is government subsidized, even if your rich parents pay.
            Every college and university in this country feeds heavily at the government trough. If you are independently wealthy and pay, the school is still getting a ton of money for most of your classmates from the government.
            I do think medical and law graduates owe something back to the public.

      • Suzi Q 38

        I agree wholeheartedly with you, doctor, but how would be monitor that? Applicants would just lie.

  • SteveCaley

    The nature of the post-graduation field is such that, unless one comes from an old “doctors’ family” or a wealthy family, it is now nearly impossible to establish a primary care practice independently. After all the education debt, add several hundred thousand dollars to start a practice. Perhaps that is why poorer person are “crowded out.”

    • John C. Key MD

      It only restrains the non-entrepreneurial. For setting up a direct pay practice, where there is a will there are many ways. Survival of the fittest…and most creative.

      • SteveCaley

        But our society reserves its greatest contempt for the “entrepreneurial physician.” Making a profit is despicable – but that is what must be done to start a conventional independent practice. Why encourage physicians to do what society offers its greatest contempt for?

        • DeceasedMD

          Is it better for hospitals to make the profit from a societal view point? Not sure the “greedy” doctor fits in anymore with CEO salaries in the news.

    • Suzi Q 38

      Being from a wealthy family certainly makes life easier.
      You can actually study, instead of worrying where your money for tuition, room, food and books are going to come from. Maybe you can actually have money to pay for those courses to get into med school, or private tutors. Maybe you can socialize more with others by paying for your own meal or coffee at a restaurant.

      • querywoman

        If you are from a wealthy family who won’t pay for your education, then you cannot get financial aid unless you have lived away from your parents a couple of years.

    • querywoman

      I can believe that. But independent practices are dying! Most doctors function better in groups where they can share being on call.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    Socioeconomic diversity is a new catch phrase to legitimize and institutionalize poverty. Diversity is when you have people of different religions, different skin tone, different sexual preferences, maybe different languages. Poverty is not a term that should be incorporated into the diversity rubric. Poverty is a calamity that should be eradicated.
    The goal shouldn’t be to have a proper percentage of poor people, in medical school. The goal should be to have no people living in poverty.

    • Eric W Thompson

      Great idea, but not likely to happen. I grew up with too many people who didn’t care, skipped school and wouldn’t study. Plus used to kick my butt for likeing to read and getting good grades. Most are on some type of government subsidy, those who are still alive. I have little sympathy for the lot.

      • Suzi Q 38

        Hey, you are describing relatives of mine….

        I know what you are saying, but there are always the good. They just happen to be poor and could use some guidance, tutoring, or other assistance.

        Also, many have had really tough lives and horrible parents and living conditions.

        I got more advice and assistance from good people rather than my own family.

        • Eric W Thompson

          My father was an alcoholic. He had a GED. The kids who did well and got out did so by trying. Those who partied and didn’t try failed. Pretty cut and dry. You have to CHOOSE to leave that environment behind.

          • Suzi Q 38

            True, but it is really hard for most 18 year olds to be strong and figure it out.

            Not everyone is strong enough to get it together and save their money to get out of a bad situation.
            Some parents are so bad that they brainwash their kids and teach them that they are nothing and worthless without them.

            It is not only choose. If it were that easy, a lot of kids would do so in a heartbeat.

            The first one that least this type of environment is the “teacher” of the others. My brother taught me that living in a beater car was better than suffering the physical and verbal abuse day after day. He lived in his car and homeless shelters for several months before he was able to save enough to get a small apartment with a friend.

            The rest of us thought: in order to get out of here, we have to live in our cars and homeless shelters?? Then maybe we thought that the abuse was not so bad after all (which was far from the truth). Then, one day, I got the strength to leave, too. Things got too crazy at home and I had decided that the next time it happened, I was leaving.

            I say so from experience, because living in foster care is no “picnic,” and getting the money for college when your grades are not stellar is not easy either. By then, my parents owned a home.
            Because of that, I was not eligible for student aid.

            Yes, we can make it out of our situations, and “choose” as you say, but I don’t think all the adult children from tough neighborhoods figure out what to do to get themselves a better life.

            This life that they have, albeit a bad one, is the only life that they know.
            To the “weak,” they are brainwashed to think that it is normal.

            I try to give the benefit of the doubt to most of these kids. When I com across a good kid, who wants more out of life, I try to help out here and there.

          • Eric W Thompson

            I agree that there are those that would leave if they could. Many don’t care until they are older and it is probably too late.

            I never had SAT prep courses nor a private school. Became a father at 18 and went into construction. There are always jobs, just have to take the crappy ones. The help wanted signs around here are multiplying like rabbits. Public assistance along with section 8 housing makes it almost comfortable to live is you have low ambition and zero self esteem.

            One horrible cultural trait is the ‘studying and getting good grades is acting white’. The president even mentioned it. That can’t be fixed. Not by me or society as a whole. It comes from within. I got a taste of something similar as a kid – from whites. Getting good grades as a negative social image.

            Elementary school is where the culture sets in.
            Our prisons are full.
            What are we going to do about it?

          • Suzi Q 38

            “….One horrible cultural trait is the ‘studying and getting good grades is acting white’. The president even mentioned it. That can’t be fixed. Not by me or society as a whole. It comes from within. I got a taste of something similar as a kid – from whites. Getting good grades as a negative social image……”
            Yes, my son was harassed as a kid for being smart. He would sometimes act up in class and get some attention from his peers that way.

            I finally told him that these losers that he is trying so hard to emulate and impress are not going to pay your rent or other bills when you are 30.
            In other words, you need to work hard now for the future. Who cares about them?

            Some schools do not glorify intelligence as much as they glorify sports.
            I even had a couple of my friends tell me that they were concerned about my kids. They asked: “Did you know that your son is a nerd?”
            “Aren’t you upset that your daughter hasn’t had a real boyfriend at 16 yet?”
            Good thing I had a good sense of humor.

            It is not just the other students. Some of the other parents are almost as bad.
            No, I didn’t care that my son was a “nerd.” I finally pulled him out of that school and found another public magnet school that was full of “nerds.” He had a lot of company there, and was allowed to flourish.
            Instead of volunteering for soccer, we had to now volunteer to be judges for the debate team, or donate prizes for the computer club’s “Festival of Programming.”

          • Eric W Thompson

            You did well. I don’t know what the majority of Americans will do. Most can’t afford private school. Once the kids grow up and hit about 30, they might begin to understand. But for most by then it is too late. I see no solution.

          • Suzi Q 38

            Thank you.

            Thank goodness I knew of a public magnet school. Its emphasis was Technology (computer science) and International Baccalaureate.
            It was very rigorous, and not for every kid.
            Our son was allowed to do what he loved…programming to his hearts content in high school. These types of classes were usually seen at the local colleges.

            The only reason why I knew about it was because I graduated from the same high school thirty years prior…when it was a comprehensive public high school. The district was faced with declining enrollment, so they changed their school into a magnet school and only accepted the best within a 30 mile radius.

            They usually got a lot of students from elite, private elementary schools.

            My husband and I made the commitment to make sure that education was celebrated in our home.
            School and homework came first.

            At least our area had this option.
            We did not have to pay any tuition.

            Our daughter wanted to go to the inner city high school, so we allowed this. Her grades had to be good, or we would not allow her to play varsity volleyball. She loved volleyball, so she studied and did well. We told her that school and college were more important. Moreover, it was not likely that the professional volleyball association was going to offer her a contract anytime soon, as she was only 5’9.”

          • Eric W Thompson

            Well, I am not a Dr. I work for the VA in Customer Service (not the best place to be currently.) I didn’t feel like I escaped from the old neighborhood, just moved on. I couldn’t walk the streets there now.

          • querywoman

            You can learn in any school. They all have the same books. Every school will have some very bright kids and some really low IQ kids. Some schools have higher percentages at both ends.

          • Suzi Q 38

            I want to clarify that the magnet school and all schools that my two children went to were public.

          • Eric W Thompson

            Not all schools are the same. Most public school districts are not flexible and most are not magnet or charter schools. Bureaucracy fights change – even for the children.

          • querywoman

            My father had an 8th grade education and an army GED. He was very intelligent and well-read. He said he read, “The Odyssey,” once in Alaska out of boredom.
            He used to read the encyclopedia for pleasure.
            He took some college courses and various electrical and repair courses. He eventually got a master’s electrician license. The master electrician test is really hard. The master plumber test is even harder.
            He was a heavy industrial electrician. He hung a lot of conduit, a strong electrical wire in factories.
            He worked hard and was intelligent, but not cut out for office works. My only lawyer uncle worked many more hours. Engineers who actually have a job these days work longer hours than the electricians and welders in my family.
            I don’t need medical doctor airs. I am a former student of law, and I know lawyer limitations. It’s very difficult to find a lawyer who will work and file timely.

    • Suzi Q 38

      Nice idealistic idea, but how soon would you be able to get this or any president to make this happen???
      Not in anyone’s lifetime.
      I think an “outreach” for a certain percentage of med students would be a nice start. Maybe doctors from all socioeconomic backgrounds helping the lower income students who want to become doctors with their mentoring and donations of money for applications and books.

  • PoliticallyIncorrectMD

    Why is inhomogeneity is bad thing? In nature inhomogeneity means life, homogeneity ( entropy ) means death ? But back to the article: why not support high potential students INDEPENDENT of the background ?

    • Suzi Q 38

      Because the money and mentoring is sorely needed by those without money and disadvantaged backgrounds.

      • PoliticallyIncorrectMD

        I am not against helping those who need it, but it should be merit based. In fact it is already done – called Federal Financial Aid.

        • Suzi Q 38

          There are even more kids who need aid and don’t get it.

          Culturally, I notice the Asian families are at the”top” with how aggressive they are with their children’s education. It is definitely a priority for them. Some move here from out of the country in order to prepare their children in elementary and middle school for high school and college.
          In return, I was told that these children are expected to financially support their parents when they need it as they enter old age.

          That is fantastic, but not all cultures are the same.
          Not all families are the same. In my case, my family was so happy to own a couple of houses, so they were not willing to fund any of our college needs.

          Yes, the Federal Financial Aid is there, and I see it helping a few kids in our neighborhood. Usually these kids have always lived in apartments, and their parents don’t own any property. Their income is also low.

          It doesn’t cover all the students who need it. Maybe their parents make a bit too much to qualify, but not enough to cover undergrad and medical school for their children who desire to be doctors.

        • querywoman

          It is financially merit based, but it is not based on ability.
          I’ve asked before: does anyone ever get a full scholarship to medical school?

          • PoliticallyIncorrectMD

            Agree… Ability comes first – no question about it! And No I have not heard of full scholarship to medical school.

          • querywoman

            The steady flow of financial aid based on economics has probably given us a plethora of subcompetents in all professions, especially teachers.
            I am a liberal. I’ve been a food stamp eligibility worker.
            But is a college degree a necessity?
            State colleges admit anyone with a certain GPA and enough government money.
            The way you docs gripe on this site certainly leaves me with the impression that almost everyone has to use loans. There are lots of docs here from all backgrounds griping, and many of them had doctor parents.

  • James O’Brien, M.D.

    It’s only going to get worse. Only the rich are going to be able to afford the idealistic gamble.

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      …at which point it will be neither idealistic, nor gamble….

    • guest

      And the children of the truly rich would never put up with being treated the way that the typical doctor is being treated these days.

      • Suzi Q 38

        I would have to agree with that.
        On the other hand, why is that?
        Maybe it is because some physicians appear not to care and make careless errors. Other physicians witness this and don’t warn the doctor(s) and assist the patient.
        Word gets around and it is blasted all over the news and the internet. Not to mention other media outlets.

      • querywoman

        I have read on sites about bad family relationships that medical student children of doctors are expected to get their doctor parents to contribute some to their education.
        It’s very hard for anyone of any socio-economic to explain why he or she does not speak to parents.

        How does the typical doctor get treated?
        How do they treat me?
        I’ve been to lots who think they are so much better than the rest of us. No way. I’m just as intelligent as most doctors whom I have seen. I have come from a hard-working blue collar family. We didn’t get a free ride on anything, but we are true to ourselves.
        Regrettably, because of certain disabilities, finding work has not always been easy for me. Plus, I could not get any financial aid for my own bachelor’s degree because my parents’ income shot up the year before I graduated from high school. They certainly didn’t have the money stockpiled they would have if they’d been making that income for years.
        I was not oriented toward medicine, but I could not get any financial aid to pursue any career I wanted at that age. I attended community college, worked various jobs, sometimes didn’t work, sometimes attended an upper level college 9 hours a week while working full-time and commuting 2 hours per day on a busy stacked urban freeway.
        I just hated to see students on financial aid sleeping on campus.
        Had I been a slightly poorer white person, I could have got grants and loans.
        The children got their parents to pay, or maybe they didn’t.
        I couldn’t join the military either. I started taking thyroid medicine in my teens. That’s a disqualification, though I certainly wasn’t as limited as I am now.
        The poor can go to college free. I’m not really sure how much they have to take out in student loans now.
        I tried law school in my early 40s, but that whole year I had car trouble, bad luck, and my blood sugar was averaging 250 in the morning. I went on insulin after about 6 months of law school.
        My health is not good enough to try again. I keep my loan in deferment or an Income Based Repayment.
        Yet, I could get financial aid now, lots, to get a second bachelor’s degree or some other graduate degree.
        We are getting many more doctors with various shades of darker skin around here. Not ever doctor from a poor background is compassionate toward the poor!

  • ninguem

    “Top 20% of household income”, from Wikipedia check, is $100,000 or above.

    “Bottom 20% of household income” is $25,000 or less.

    http://en.wikipedia.org/wiki/Household_income_in_the_United_States

    Lots of middle-class people break into that “top 20%”

    I have a cousin in the fire department, with seniority and overtime, makes over a hundred grand regularly.

    Same with a brother-in-law in the power company, with overtime, he earns a little over a hundred thousand.

    Even more two-earner families in all sorts of middle class jobs.

    And does bottom 20% have a disproportionately low number of children at college age to consider medical school?

    As in, are the bottom 20% retirees, families without any children, and families starting out?

    The factoid might maybe be useful if we saw how many med student come from the truly rich, the top 10%, top 5%, top 1%.

    My hypothesis would be that you got fewer medical students in the very high income ranks, the very rich are able to find much easier lines of work than medicine.

    • HJ

      RE: Lots of middle-class people break into that “top 20%”

      Less than 20%…

  • PoliticallyIncorrectMD

    Initial footing is not equal and will never be – we all come from different backgrounds. For the record, I am a first generation immigrant who came to the US with no money, limited English and no qualifications to fit in any “underprivileged” groups. Such as life : ( Thinking it will be any different is utopia. The only solution is merit-bsed academic promotion / financial assistance for EVERYBODY qualified. Creating special groups is not going to help inequality, it will promote it.

    • rbthe4th2

      Yes and no. I’ve seen certain groups of “immigrants” that push education, education, education and are involved, involved, involved in getting their kids whatever is needed for that. Whether the parents work 2nd jobs, help with loans, take them out, these people do it. These are kids getting support like the rich kids. Most of the middle and lower classes don’t get that.

      • fatherhash

        so if a poor parent works hard to teach their kids and promote education(like the certain “immigrants” you refer to, their kids should not get the extra support from society? you are equating the poor immigrant kids to rich kids simply because the parents are working harder?

        is societal support to be reserved only for the poor kids of parents that don’t try as hard?

        • rbthe4th2

          I’ve seen the poorer kids with family and culture support and I do think they should be encouraged to that. I don’t have a problem with extra support for the parents of kids that dont try hard, but only to a point. I need to see buy in from the kids.

          • James O’Brien, M.D.

            At this time in history, poor kids who are bright, clever and hard working would be better off avoiding medical school.

          • rbthe4th2

            Maybe MSTP programs only?

          • James O’Brien, M.D.

            I’d be pretty ticked off if I went from a trailer park at 18 to 1/2 million dollars in debt at 36.

          • rbthe4th2

            You get the stipend (small I know) so you don’t get the debt the MD only students get.

          • James O’Brien, M.D.

            I’d say learn programming and work for a video game company. By 30 you’ll have 500K in the bank instead of being 500K in the red.

          • rbthe4th2

            No, knew a couple of the guys who were in Decipher. Even when one left and ran stuff for their cons, they didn’t make that kind of dough. One who wrote Oracle books, worked for Oracle, traveled, taught, and did emergency middle to large range fixes, now he made endo’s salary easily. A friend who worked in Cal. had problems, while the salary was good, so was the mortgage payment.

          • James O’Brien, M.D.

            Well anyone can run into problems if they can’t control spending.

            My point is that years in school spending money is lost opportunity instead of making the money that will actually earn you the most interest if you have the discipline to save it.

          • rbthe4th2

            Then why is it that doctors have insurance people chasing after them to provide retirements, etc. and my buddies that work in IT don’t? They are not expecting $300 or more K in retirement. They’re not living in the same areas as docs are. Drive the same cars. Bottom line once the loans are paid off/down, docs can put a lot more away.

            Btw, the only IT programmers making $92 in this area are more than 10 years experience. The docs, even mid range FP’s, are $170+.

            Randy

          • James O’Brien, M.D.

            Docs won’t be averaging 170K in ten years

          • Suzi Q 38

            Good point.
            That, Dr. O’Brien is not fair.

          • Suzi Q 38

            Especially if they are married to other physicians.
            I have several who are married to other docs.
            I am sure they are doing just fine financially.

          • rbthe4th2

            Oh yes! The ones I know have a “lower” paying non specialty/specialty married to a “higher” one. Some are from medical families. That cut down on their rates of what they needed to take out. The surgeons I know (a handful) ALL married other docs. One, and this guy isn’t a slouch at all, married another surgeon. Probably the only dumb thing the man has done in his life.

            The doctor families I know put funds away to help pay for the kids’ school and med school.

          • Suzi Q 38

            Not even close.

            One of my specialists is married to a radiologist.
            My former neurologist is married to a general surgeon.

          • rbthe4th2

            Yep they are seeing more and more it is a doc to doc thing, especially among the women. The rates of docs marrying docs is going up, and that was a recent stat. If it was such a bad thing, why not marry out? The issue is money … because it is a lucrative profession, no matter what the hassles and there are lots of support to stop you from really getting hit in a lawsuit. Sorry but there are enough stats and experiences to show it.

          • Suzi Q 38

            I agree.

          • Suzi Q 38

            You won’t be saving all that much if you have a family.
            You’re right, $92K is not physician salary.

            Also, being a computer engineer is difficult and tedious work, sitting in front of a computer at night. Yes at night. This is when programmers design their games and try them out.
            My son works at 12 noon and quits at 9:00PM, then goes home and works long hours into the night.

            It is a very different way to live and work.

          • querywoman

            In the early 1980s, I knew a lot of well-paid computer engineering and programming types who made so much more than me. A few years later, I’d see them bonking out from all that time on the computer.
            I especially remember a young woman who had really gone batty from computers. Very sad! An older guy with good taste asked me, “Is that the girl who used to be so good looking?”

          • Suzi Q 38

            At the age of 24 my son and a friend designed a game and created a company, complete with a corporate patent lawyer. They then sold the company to the highest bidder, and then stayed on at their company as “consultants” for two years. Their meetings and discussions for this bidding “war” occurred at a Starbucks, as the “boys” (as I call them) had no office.

            They made far more than $500k by the time they were 30.

            You are right. We paid for our son’s undergrad, so he was not in debt with any student loans whatsoever. His undergrad cost us $100K for all 4 years, and he does not need any further education to continue making a living.

            Just keep in mind that he has to continually design, program, code, and create programs and games, so there is continual pressure.

            Also, many run out of ideas and are considered “out of it” and too old by the time they hit 50.

            Their earning power is erratic at best.

            Isn’t being a physician more stable over the long haul? Do you have opportunities to get your benefits paid and retirement?

            Can you invest your money in real estate or other businesses?

          • querywoman

            Lots of professions besides medicine experience continual pressure.

          • DeceasedMD

            Pretty sad commentary about working for a video game company but so true. What does that say about American values that video games are more of value than medicine?

          • querywoman

            A lot of tekkies get good pay for a few years, and then end up permanently laid off.

          • querywoman

            Where should they go? Tech firms would rather hire foreign grads like those from India who speak English and work cheaper.

        • kjindal

          that’s right. the crying about lack of diversity somehow does not apply to e.g. Asian immigrants. When THEY do well e.g. Stuyvesant HS admissions in NYC, the interpretation by some is that the admissions test is “culturally biased”.

          http://collegeinsurrection.com/2014/07/nyc-pushing-to-get-rid-of-merit-based-admissions-for-prestigious-high-schools/

          • Suzi Q 38

            I read about this school with interest.
            Thank you for sharing the link.

            I understand what you say about the Asian students. They have become a very strong presence if not the majority of several ethnic races represented at many schools in our state.

            I have observed these students. Rich, middle class, or poor, these students have a common trait amongst them:

            They study their “butts” off.

            They have managed to pass various entrance tests (including the SAT and ACT) that have been the standards for students for decades….with “flying colors.”

            I am sure the medical schools are no exception.

            I can not fault an ethnic group who plays fair and studies more in order to gain entry into a coveted school of their choosing.

            My point is that we help students regardless of color (yes, even anglos) who could use some guidance and/or financial assistance with certain things that they need for school.

          • querywoman

            I studied my butt off too and got no aid for my bachelor’s. I see other people post all over the net about how they have excellent grades and repeatedly applied for scholarships, but never got any.
            Oh, I forgot, I did get one $100 scholarship payable over 2 semesters for my bachelors. I also got a couple of short term loans, about $200.

          • Suzi Q 38

            Yes, good for you.
            Studying your butt off is no guarantee, but it puts you in better shape to get into an elite high school or college.
            The free money is not automatically forthcoming.
            My point is that the education is also more rigorous in other countries, so the young students who come over here are testing higher and performing at a higher level than many of our American born students who were educated in our regular public school system.

            When it comes to college, if your kid is just average or below, they can easily get edged out of our public 4 year colleges.

            The competition for college is different and more difficult for our kids than it was 30 or more years ago.

          • querywoman

            As the number of high school graduates rises, there are lots and lots of very bright HS grads every year, bright young people who want and need challenging education careers.
            Regrettably, we really don’t have places for all of them, particularly in engineering and the hard sciences.
            Overseas grads work cheaper in tech fields.
            The best law and medical schools are the public ones. People want to go there and end up owing less.
            While I have a very good GPA and had a fairly good LSAT, it was not good enough to get me into a public law school. It would probably easily get me into some other grad programs.
            There are private law schools all over the place that would love to re-admit me, and get that government money. But, as I approach 60, I lack the energy and health for it. And legal grads have started suing the schools over the lack of jobs.
            Nevertheless, at this age, with my never defaulted student loan, I could get plenty of loans for more education. The chances of my working full time and productively enough to repay it are not good at all.
            Medicine always needs a certain amount of doctors. It differs from law in that the need always arise. Now, with the internet, one can do a lot of legal work for oneself.
            As people live longer and longer, we get diseases associated with again and the medical professions has and continues to develop therapies for stuff like cardiac problems and diabetes.
            Most of us, if we live long enough, will die or heart attacks or some other cardiac problem. There is also a high chance of catching pneumonia as we age and dying quickly of it.

          • Suzi Q 38

            Yes, it was difficult to get my kids into one of the more desirable public colleges.
            The reason why I sent them there was 1)it supposedly had a good reputation, 2.) It had a lot of majors to choose from since my daughter was not sure of what major to choose, 3.) My son wanted Computer Science and 4.) The tuition was a third of the cost of private schools.

            Because of its popularity and cost, it was very difficult to gain admission to.

            They went to U.C. Berkeley.
            Any of the U.C.’s (especially the ones with medical schools) are tough to get into.
            Berkeley does not have a medical school program, but UCLA, UC Davis, UC San francisco, and U.C. Irvine does.

            Their medical schools are very competitive to get into. I am sure the same for Law…

          • querywoman

            Public law and medical skills have additional criteria beyond the GPA and entrance, A local public college with LVN and ADN programs have really tough entrance criteria.

          • querywoman

            I was just told my local nursing schools need a 3.8 GPA. They also need a good HESI entrance exam score.
            It’s fairly easy to get into a 2nd or 3rd rate law school. Law schools pop up everywhere because they are fairly cheap to operate. Books and a few computers nowadays don’t cost all that much.
            The universities crave that public money for law education. Law grads from 1st rate law schools can’t always get jobs these days.
            Medical schools are much more expensive to operate. Just take a look at any medical school complex!

      • PoliticallyIncorrectMD

        So, now the society is responsible for pushing them instead of patents? I have the solution. It is called personal responsibility. Unless the society as a whole changes to realize that each individual is responsible for themselfs and their family nothing will change. Introducing more handouts will only make matters worse,

        • rbthe4th2

          I’m sorry. I never indicated that they shouldn’t, only that the support is there in terms of family and potentially culture. Yes, it is personal responsibility. That being said, do I agree what what you said about handouts. Yes. Do I think there needs to be some sort of trade off? Yes. In other words, make it clear we will help, say maybe thru high school however if you make wrong choices, you pay for it.

          Medical school is such that the gamble isn’t there for many or they can’t afford to wait that long for $$$. Plus they may end up choosing specialties simply due to needing more $$$ in the end, rather than primary care types of specialties.

        • Suzi Q 38

          A “handout” might be in the form of food or meal vouchers while going to school. Another handout might be a year’s worth of textbooks paid for.
          Why is it wrong to help those in need and show them a better life with not only material assistance, but free mentoring?

          • PoliticallyIncorrectMD

            Mentoring is great, I am all for it! But the bigger goal should be changing society’s values and making family responsible for such mentoring.

          • Suzi Q 38

            Yes, I agree, but it does not appear that this will happen in our lifetime, especially with this recession.

  • RuralEMdoc

    It seems unnecessary to recruit more people into medicine at this time for the sake of “diversity”.

    It is my understanding that half of everyone who takes the MCAT looks at their scores and never applies to medical school, and 50% of those who do apply get rejected to every school they apply to.

    You should choose medicine because it is what you want to do. You should choose it because you could never imagine yourself doing anything else. It is a hard road to becoming a physician. It is a very stressful job.

    If they want this job, they will come on their own

  • William Viner

    This article makes no sense to me. I also came from a poor background, but since I was nearly a delinquent in high school, I didn’t receive any scholarships. I joined the military to pay for my undergraduate degree and worked during medical school at a prison doing physicals, handing out meds and standing by for any minor injuries. I chose my specialty based on what I was interested in studying for the rest of my life. I ruled out specialties that were not interesting to me. I never thought of the income until after completing a residency.

    I knew some of my classmates in med school were from medical families and I can admit that I didn’t feel entirely comfortable around them. But I certainly don’t recall knowing anyone that was trust fund rich. Maybe it’s because I have always attended state run universities and not ivy league schools.

    Opportunities are there and if they aren’t available to you, then you have to make your own way. It’s just your lot in life.

  • James O’Brien, M.D.

    What are the prospects in ten years? No one knows but given the way things are going not good. Especially in primary care.

  • Suzi Q 38

    Thank you, Dr. Lee for your story.
    I am glad that you “made it” through.
    Now the real work starts, and I wish you the very best.
    Just pay off all of those loans ASAP.
    I think every fortunate person, wealthy or not, should help the younger ones with dreams, desire, and ability to get though school.
    There are so many things we can do for others. Mentor a few students, it will help them. If they are only in high school, tell them which courses to take and how to volunteer at the local hospital. If they are in med school, give them a gift card for food at the local grocery store. Offer to buy them a needed textbook or two.

  • Eric W Thompson

    Actually most left. Most did try. Even a small effort works. Don’t skip school. Avoid drugs and alcohol. Study. And I wasn’t even talking about college, just trying in high school is a big help. Those who stayed weren’t trying to make things better, they were too stoned to know the difference. A couple of guys from my high school class did become millionaires. Not even that bright. But I noticed that I didn’t see them at the parties and drinking.

  • Suzi Q 38

    I agree. Life is not easy for all.
    The low-income neighborhood and family experience affects every person differently.
    Not everyone has the toughness and opportunity for figure a way out.

  • Suzi Q 38

    You make a good point.
    It sounds like Dr. Carson’s mother was a kind person, and did the best she could by helping them read everyday. Not everyone has a parent who is loving and nurturing….or celebrates education in the home.
    It is not impossible to succeed with horrible parents, but it is not easy to do so.
    Mrs. Carson sounds extraordinary…a parent who did the best she could with what little financial resources that she had.
    Did Dr. Carson have any mentors to assist him with his desire to be a physician? It is not just monetary assistance.

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