What do you think?

[Guest MDCY]

Here's an article I read recently and I would like to see what you guys/gals think of it? Do you think there is enough diversity and minority representation in the medical field? How about some feedback from some of the moderators from different schools concerning this?

 

TORONTO (CP) - Ever get the impression the medical profession is the private preserve of the silver spoon set? New research suggests that impression may not be far off the mark.

 

Students in Canadian medical schools are drawn in disproportionate numbers from affluent, highly educated homes, a survey of medical students reveals. While women and students of Chinese and South Asian heritage have cracked the club, aboriginal and black students largely have not. And students from rural communities are under-represented as well, a fact that does not bode well for small communities already struggling to attract and retain doctors.

 

Please see below for some facts about the demographics of medical schools

 

In essence, the demographics of Canadian medical schools are widely out of sync with the demographics of the population whose medical care they will soon oversee, a group of Toronto researchers report in Tuesday's issue of the Canadian Medical Association Journal.

 

In fact, the discrepancy between doctors in training and the population in general hasn't changed much since a major study of the ethnic and socioeconomic makeup of the student bodies of medical schools was done in the mid-1960s, they said.

 

"That the magnitude of the socioeconomic difference between medical students and the general Canadian population has changed so little (in that interval) must be viewed as disappointing," they wrote.

 

Does it matter if the pool of doctors is largely drawn from the country's economic and educational elite? Lead author Irfan Dhalla believes it does.

 

Dhalla, a third-year medical student at the University of Toronto, points out that previous studies have shown that aboriginal doctors are more likely than non-aboriginals to treat aboriginal patients and doctors who grew up in low-income households are more likely to treat low-income patients.

 

Furthermore it is known that medical students who grew up in rural communities are more willing to practise in rural communities than are students from urban communities.

 

"We're worried that if the medical student body contains very few individuals from rural areas, very few individuals with aboriginal backgrounds, very few individuals from low-income families then those patient groups may have sub-optimal access to health care (in future)," said Dhalla, who did the research with three other students (one of whom has since graduated) and two professors.

 

Their concern was echoed by Dr. Henry Haddad, president of the Canadian Medical Association.

 

"For some time now, governments and organizations like the CMA have identified aboriginal health and the health of citizens in rural and remote areas as priority issues," Haddad said in a statement reacting to the study.

 

"We know that one way to help improve the health status of these groups is to ensure they are part of our physician population. The fact that they are under-represented in medical school highlights the need to do more to facilitate their inclusion."

 

Dhalla admitted in an interview that it only took a look around his class to see that "most of my classmates were from upper-income families."

 

But after surveying medical students across the country via an e-mail survey, he and his co-authors were surprised at just how big the difference was between medical students and the population as a whole.

 

(Data from Quebec medical students were not included in the analysis, because the researchers had an incomplete list of those students and because differences in the Quebec system made comparison to other parts of Canada difficult.)

 

"I find it very surprising that close to 40 per cent of fathers of medical students have a masters or doctoral degree and only six per cent of the Canadian population have that same level of education," Dhalla said.

 

"I find it quite striking that someone from a neighbourhood with an income in the top 20 per cent is seven times more likely to end up in medical school than (someone from) a neighbourhood in the bottom 20 per cent.

 

"And it's also fairly striking that none of this has really changed in 35 years. In fact, a medical student today is more likely to come from a physician family than a medical student in 1965."

 

Dhalla and his colleagues found that 15.6 per cent of today's medical students have at least one parent who is a physician as compared to 11.8 per cent in 1965-66.

 

A second study done by the same research team may provide answers as to why medical school students aren't representative of the population.

 

The group looked at how rising tuition fees are affecting class composition in medical schools, using the example of Ontario medical schools, where tuition has more than doubled since 1997.

 

The proportion of respondents with a family income of less than $40,000 dropped to 15 per cent from 22.6 per cent in the three years following the increase, they noted, though that decrease was not considered statistically significant when compared to the change observed in medical schools outside Ontario, where tuitions remained stable during that period.

 

Still, the authors were surprised at how quickly the impact was felt, said Dr. Jeff Kwong, who began the project when he was a student but who is now a medical resident in community medicine at the U of T.

 

"To see this effect so soon . . . we're actually expecting much greater effects a few years down the road," Kwong said.

 

They also found first year medical students in Ontario were expecting to be saddled with huge levels of debt when they graduate. They reported that they found their financial situations very stressful and that their expectations of debt would influence their decisions about whether to pursue a specialty.

 

Those findings make people nervous.

 

"If we want all Canadians, regardless of family income, to have access to a professional education and not be deterred by the prospect of having a significant debt load upon graduation, then governments need to ensure that universities have sufficient funding to help make tuition fees more reasonable," said Dr. William Easton, chair of the National Professional Association Coalition on Tuition.

 

"The physician shortage we already have in this country will be exacerbated because, as the study in Ontario demonstrates, these debt loads will influence students' choice of specialty and practice location," added Matthew Erskine, president of the Canadian Federation of Medical Students.

 

-

 

Some facts about the demographics of medical schools, from a study published Tuesday in the Canadian Medical Association Journal:

 

- Women make up a slight majority of medical students, 51.1 per cent.

 

- 32.4 per cent of medical students are from a visible minority. That is greater than in the population as a whole, where 20 per cent are from a visible minority.

 

- Blacks and aboriginals are under-represented as compared to their proportion of the Canadian populace; students from Chinese and South Asian backgrounds over-represented.

 

- Only 10.8 per cent of medical students come from rural communities, although 22.4 per cent of Canadians come from rural areas.

 

© Copyright 2002 The Canadian Press

 

Cheers!

[Guest RAK2005]

Yeah I read the article in the CMAJ, and it really doesn't say anything that wasn't already being talked about in the last few years. UWO had a survey out last year that stated the same thing (avg. family income was $80,000/yr).

 

Sadly, this likely will not change anytime soon, unless the good ol' goverment wants to implement a tuition reduction plan (Hahahahaahaahaahha). Queen's is looking to make the entire campus private (ie. Arts and science becoming deregulated). My own impression is that (barring a spectacular turn-of-events) things are going to keep sliding downhill until we reach a situation equal to the US.

[Guest MDCY]

Yeah, it's a sad thing. Actually, I was talking to my friend who's doing his residency now and he said that Calgary is thinking of increasing it's tuition to five figures along the lines of what it would cost to go to UT. That would suck so bad. Right now, it's only $6300/yr right now but UT's tuition is around $15,000/yr (I could be wrong about that figure). That means, they are thinking of trying to nearly triple the tuition costs which would just increase the problem as is.

Cheers!

[Guest Tony]

Hi

 

I think the selection process also has a great influence on who winds up in medical school. I think some the things that are looked for eventually are really idiotic when you sit down and think about it. Playing the piano to some really high level? Well I think more affluent families can provide children with these kinds of lessons from an early age, in addition to the 4000 Piano! I really dont see what playing an instrument to a high level has to do with being a great physician. Perhaps people who have worked to help bring income to their families or put themseleves or siblings through school should be admired in the same regard. also why does being a star athlete make u a better candidate than one who is not? Is being an olympian going to make you that much better of a doctor? What about the kids who had to work after school or take care of their younger brothers and sisters.

 

I had a friend who had this exact problem when he applied to med school. He had wicked marks, tons and tons of research (lots of pubs) and volunteering at overnight facilities for yrs becuase he had to work during the day as much as he could to help his family out and pay for school. Alot of interviewers looked down on him because he didn't do the "luxury" activities that the rich have more time and money to persue. Commments like, why work so much? your only young once, maybe you dont want to be a doctor, because your already working in field x. Or A med student said, dont you like sports why didnt you play for varsity. When he explained about the number of hours he had to work (in a great job that let him deal with lots people etc) , the student said " Chill out, I never worked that much I just asked my parents for money! Duh well that kind of attitude keeps the poor from getting a fighting chance from getting in.

 

Oh well just what I have seen

[Guest mying]

Certainly I agree that coming from a more affluent family will make your academic life easier (if you don't have to work to eat, you have more time to study).

 

But I take exception to the idea that piano lessons and sports get you into medical school. Perhaps your friend needs to work better at selling himself/herself based on their skills and experiences gained at their job.

 

Signed,

one entirely non-musically-talented, non-athletic, rural-born, med student.

[Guest Toolegittoquit]

sure mying there will be exceptions to the rule, but you are in the minority fer sure. Thats the point!

[Guest seno]

Sorry mying but I think Tony has a valid point. I'll continue to draw on the musical point although it can be applied to a broader scale...

 

I'm in first year med and the far majority of my class has had some sort of musical experience (not all but a fair majority.) Of course, this does not mean that this one activity got them in... however, it does raise the bar in the number and quality of the activity you do. In order to have an even better application then, one would have to do "piano" and "activity X." Once everyone did that combination then it would be "piano", "activity Y", and "activity Z." True, activities are not cummulative in real life but they are assigned scores and objectified on an application... and the far majority of those activities do require finances, something that lower-class families will be lacking...

 

seno

[Guest MDCY]

I think we need to remember that these are the overall trends and it doesn't necessarily imply that everybody who gets into meds will have played an instrument. How many people get in without the "typical" background? I know that some universities like to publish the fact that they accept a number of people not from the traditional science background but just how many of these non-traditional applicants get in? In my recollection, there aren't that many although I could be in error.

Cheers

[Guest Furryfrancine]

If u grew up well to do with lots of lessons being thrown at u, u will be or at least to be cultured....an med schools like that (elitness) whether its overt or not. Lets face it all people who get interviews have good grades/mcat and standard volunteer stuff. It comes down to a beauty contest.....who has more (irrelevant for medicine) talents, who has played on more semi professional sports teams. Who looks better in a miniskirt, who has a nicer smile during the interview, etc etc. I see it all the time with felow students who have applied and gotten in. Its retarted but there is more bias for med school than any other professional program. They wont even let people who have to work complete their undergrad part time. That shuts out a huge population. And then all the non tangibles only allow a certain few to enter, most who have grown up in affluence and can talk about the 'rich" life.

[Guest Ian Wong]

I can see it both ways. There are a number of classmates of mine with physicians in the family, and while my classmates almost universally have loans of some sort or another, I think the majority of us certainly didn't starve our way through elementary school, high school, university, med school, whatever.

 

The more important point to this issue is: What are you going to do about it, if anything? If you raise a point, there has to be some action to it to make it worthy of consideration.

 

The trouble is that students are disadvantaged from the beginning. An elementary school kid living in a single parent home with multiple siblings is already starting off quite likely with lesser contact time with the mom or dad. A lighter example could be that a grade school student whose parents can afford to send him/her to private school will benefit from a smaller teacher:student ratio, or as you folks have pointed out, more luxury time to spend pursuing outside interests.

 

Clearly, this is a much vaster socio-economic phenomenon, and quite simply, for most things in life, you have more flexibility if you have more money (and probably one big reason why money is so valued in this society). I'd similarly expect that parents who are university educated would have a higher rate of children who then attend university. I'd expect lots of law students to have affluent parents, perhaps even lawyers themselves. I'd expect most movie stars, Olympic athletes, whatever, to have had at least a stable enough home and family unit that they could find the time and resources to train to their high level to get them where they wanted to be. Med school admissions is no different.

 

The idea that a well-off person has the potential access to more future career options is something that I believe to exist, simply due to the additional physical and time resources that money can give you. This isn't something I would expect to be intrinsic to just med school admissions, and it isn't a problem that med school admissions can solve.

 

It all boils down to: If you know that most med students today come from relatively affluent families compared with the general population, what are you going to do about it? What can you do about it?

 

Ian

UBC, Med 3

[Guest gucio93]

Just wanted to harp a little bit more about the piano issue (however, from a rather different perspective). Has anyone considered that it is very likely not the "piano playing", or "olympian track running" that gets people into medical school, but the fact that accomplishments in these activities most definitely imply LONG hours of practice and dedication - sometimes tedious and boring, sometimes having to be done at the expense of more exciting or "fun" activities? It shows committment, and determination more than the fact that one has talent or wealthy parents. And before I get a ton of responses saying that I am biased because I got into med school only because I play or that I have wealthy parents - that did not happen. Regrettably, I do not play an instrument (although I always did love the piano ), and I have been paying for my own education for the past eight years (imagine the debt, better yet, don't . . . :b ). The point being, that although I absolutely agree with the CMAJ article and it's message about the lack of diversity in medical schools, I have trouble believing that everyone on the school committies is looking for the "advantaged" to get in - I know it certainly did not enter my mind as I was interviewing applicants this year. What I did focus on was what they did in their life, how they coped with adversity and ambivalence, and what they learned along the way. Cheers!

[Guest Ian Wong]

Here's a couple of the CMAJ articles in question:

 

<!--EZCODE ITALIC START--> Characteristics of first-year students in Canadian medical schools<!--EZCODE ITALIC END-->

www.cmaj.ca/cgi/content/full/166/8/1029

 

<!--EZCODE ITALIC START--> Effects of rising tuition fees on medical school class composition and financial outlook<!--EZCODE ITALIC END-->

www.cmaj.ca/cgi/content/full/166/8/1023

 

Ian

UBC, Med 3

[Guest deep]

I really didn't see the breakthrough in the CMAJ article. Moreover, I found some of the context objectionable.

 

Firstly, we were given this world we didn't make it (care of the late Tupac Shakur). I mean that you can't affect the situation you were born into. For example, the past winter I was coaching an indoor league, and Antonio Davis had his son enrolled. He's an athlete, most likely he feels that his son will have the ability to become an athlete. With relevance to our discussion, just as Charles Darwin's father (a doctor) wanted his son to become a doctor, educated people will always want their children to proceed further in education than themselves. What can we do about this, NOTHING!

 

Secondly, the article claims that doctors from a particular socio-economic status are more likely to serve that socioeconomic status. I still want to check out this reference, but I find this hard to believe. As future doctors, humanitarians, do any of us hold these views? If so, I think I might have to reconsider my decision to practice medicine in North america as I would have a hard time interacting with colleagues with such pompous views. Rich doctors only serving rich patients? Judging from my observation of health care delivery in my neighbourhood, I don't think so.

 

Thirdly, the authors claim that chinese and south asians are over-represented. However, they base this statement on the low proportion of the canadian population who are 15-24 with chinese or south asian descent. If anyone appreciates the past two decades of immigration to our country, they will realize that the proportion of our population in older age groups of this descent is significantly more than the young age bracket. By taking a walk through pacific mall in markham or shopper's world in brampton, I would think that this over-representation is indeed necessary if people are to receive health care in old age preferentially in their native language.

 

Oh, and about the tuition deregulation thing only allowing affluent families to afford medical education for their children, I beg to differ. Through my pre-med life, I am still to meet a person who dropped out because they wouldn't be able to afford it. Besides, I think Mike Harris has a good point in saying that physicians will make more than enough in practice to pay back educational loans. At 15 Gs, I do not think tuition is a factor yet as it is in the states. Affluence comes into play more with regard to the selection process (eg. the piano example).

[Guest m]

I can't say I argue with the tuition costs. If a school is smart at managing their finances (Queen's comes to mind) they can pool these obtained resources into increased financial support for students. I believe I heard that at Queen's, the tuition is $13,500, while the AVERAGE bursary is $9,000. This makes tuition accessible to any individual's ability to pay, while still finding a non-governmental source to fund a high quality education. Unfortunatley, there are many schools charging similar tuitions but not offering the benefits.

 

Regarding fairness amongst applicants, it's hard to control for what one may be given, but I think that the attitude obtained from life experiences shines through in the interview situation. Beyond financial support, there are other unmeasurable differences that may have huge impacts on an applicant's development. For instance, my parents always encouraged me to make things easy for myself, to not challenge myself, and never pose high goals. At times I am bitter for these attitudes, because I find myself fighting against so much more in challenging myself; however, from my parents I have attained a sense of realism and even an attitude of rebellious challenge.

 

Every applicant has experienced some advantages and some disadvantages in life. The attitude that you make of things is what it all comes down to in the interview. If you compromised your ability to get really high marks in order to fund your way through school, schools like Mac may be willing to look past this to see your great character. However, if you coasted through life with a silver spoon in your mouth, many schools will see right through your purchased resume, and realize that you lack the perseverence of many other applicants. Either way, there's probably a school that's wililng to accept you, if you're very strong in at least marks or personality (and at least decent in the other respect).

[Guest hmmmm]

I dont know about the there will be some school that will accept u. We are talking anal med school committees that pride themselves on being as generic and formalic as possible.

[Guest AniyaSG]

I would just like to add, as I believe Ian pointed out, that this is surely not a phenomenon restricted to med school. If University student populations are compared to the population as a whole I'm sure trends would show that these people come from more affluent families than the average. It is very true that people from a 'lower socio-economic standing' are disadvantaged financially. It is also true that these people are often disadvantaged in other ways by academic counsellors and school systems that encourage kids from lower income neigborhoods to pursue avenues other than those requiring university educations. As much as I like to believe that everyone can get as much as they want out of life if they only work for it, there is a large segment of the population that is told from a very young age that they are limited in their life's achievements due to the lower income of their parents.

 

In a nutshell, it's not just meds

 

Great discussion...

[Guest Mark]

Man, you guys gotta get some hobbies outside of the internet. Sure it's good to debate and all, but the sun is shining and the weather is warm, so enjoy.

[Guest KatieKat]

Mark, you've never been to SDN have you? A girl posted 2000 times in just 3 months. Some people on that board are crazy!

[Guest MDCY]

That's easy for you to say when you just finished your semester. As for the those who are in a 7-5 job, this board keeps us somewhat sane Not that work isn't *cough* interesting but it's nice to take a break and to post stuff.

Cheers!