Disparity in Doctors. Reflection on Washington Post Blog " The Outrageous cost of working in Medicine."

"The journey to and through medical school was challenging and expensive. " - Me

I grew up in a middle class family in New York City. My father was a civil engineer for the NYC department of transportation. He worked hard and gave us a humble and honorable upbringing. We had everything we needed in life. Everyone in my family made certain sacrifices to sustain our middle class life.
     Despite a New York City public school system that often gets criticism, I managed to get into a competitive exam based science high school. I never had extra tutoring or took a review course and therefore feel lucky to have gotten accepted. Today these high schools are extremely competitive and many students are paying significant amounts of money for tutoring and review courses to augment their opportunities.
     I also never had a job in high school and had time to focus on my studies. Fortunately I got into an excellent, albeit expensive university. In addition to loans, my parents luckily had the ability to stretch their budget to pay for my tuition. I also participated in the work-study program for 2 years until the mounting pressures of the pre-med life forced me to quit. I was able to focus on my MCAT's and had the financial means to pay for an expensive review course. The review course definitely helped a lot.
     I didn't get into a medical school right away and applied for 3 years. It was a process that cost me close to $10,000. Once again, my family was there to support this expense while I had a low paying research position. I persevered, got into medical school and finally was able to bear the entire brunt of my educational expenses in the form of loans in excess of $250,000. I'm recounting my educational journey through the financial lens to highlight that even starting in high school the journey has been an expensive one. This is a journey many students cannot afford to make.
    The Washington Post article highlights several critical issues facing healthcare today. The cost of medical school is immense and has been looked at as a key reason why medical students are opting for higher paying specialties instead of primary care.  I think this makes absolute sense. But interestingly, the article also highlights a very important separate issue. The fact is that only 3% of medical students come from families in the lowest 20% incomes and 60% of students come from the top 20% incomes. This reality directly correlates with the paucity of minorities (especially African American and Latinos) entering medical school and our physician workforce.
     The article argues that the cost of medical school is a reason why minorities veer away from medicine. I agree there is some truth to this. But it's a lot more than that. Getting into medicine is a series of hurdles scattered over many years. Broken public school systems, social and financial pressures make these hurdles significantly greater for students in lower socioeconomic groups. To optimize academic opportunities there are many added costs that only students and families with financial security can better handle. This includes tutoring, review courses, books and a myriad of extracurricular activities. This makes the gauntlet to medical school  immensely challenging for students in the lower socioeconomic strata. Even for middle class families, this process is a huge struggle. This is a key reason why 60% of the medical students come from families in the top 20% of incomes.
    This also brings us back to the question about why students are choosing higher paying specialties instead of primary care. There's no doubt the enormous cost of medical school is a big reason. But logically, you'd think if 60% of the students are coming from the top 20% of earners, they might have less medical school debt and therefore be more apt to choose lower paying specialties. But the reality is, one of the great motivators in human behavior is the fear of loss. In this case, if you're coming from a higher socioeconomic group, why would you pursue career paths that threatens that?
     I'm not criticizing successful successful parents who give their children every opportunity to succeed in life. Nor am I criticizing students for choosing career tracks that best suits them. But the current construct of our educational systems are not set up to solve some of the critical problems in healthcare.We have struggling primary and secondary education systems followed by woefully expensive undergraduate, graduate and medical schools. We don't have enough medical schools or enough residency spots.The people that do take those few spots are not doing primary care (the foundation of a successful healthcare system). We live in a diverse multi-ethnic country yet several key minorities are underrepresented in our healthcare system.
       This highlights just another one of the several systematic problems in our healthcare system that is self perpetuating with no end in sight.

Here's a link to the Washington Post piece.
The outrageous cost of working in medicine