Ever Feel Like Med School Is A Big Rich Kids Club?

[JohnGrisham]

I would've agreed with this until I saw some of the stats for GPA for interview invites this year at U of C, U of A, and Mac and UBC to a lesser extent.

How so? At least for UBC, just because a small % of people got interviews/acceptances with 79-81% GPAs...doesn't mean those aren't academically strong GPAs. Just not the ultra-hyper GPAs of premeds haha.  

 

 

[daftjustice]

How so? At least for UBC, just because a small % of people got interviews/acceptances with 79-81% GPAs...doesn't mean those aren't academically strong GPAs. Just not the ultra-hyper GPAs of premeds haha.  

 

 

Fair point. I'm just saying that not everyone getting interviews has unreal GPA + unreal ECs. And I perceive it to be more common than I would have imagined. I know of several people coming from biosci-type backgrounds with ≤3.75 GPAs with interviews this year.

[ralk]

We already admit people who have high academic competence PLUS excellent soft skills. Look at the resumes of almost everyone who applies to med school. They are littered with volunteering (meaningful volunteering too, not just resume padding), high level athletic achievement, high level achievement in the arts community, experience in other fields (nursing, law, engineering, social work, business etc.) and research. 

 

The reason we "miss" a lot of people who would make good doctors isn't because there is a favouring of academics. It's because the competition is so high that med schools can easily pick people who are high academic achievers AND have excellent non academic profiles. They aren't picking one over the other. They are picking people who have excellent levels of both.

 

I'd agree that we generally get people with good academic and non-academic profiles, but I question how good of a mix we're getting on soft skills, as non-academic profiles don't necessary reflect a person's on-the-ground skill set all that well. I've yet to meet a person with anywhere close to academic incompetence, and many who truly excel, but when it comes to soft skills, I've found the spectrum to be much wider. Some are truly deficient when it comes to their ability to communicate with patients, establish a therapeutic relationship, teach, manage a team, or even manage their own time. This gets reflected frequently when we look at where mistakes happen, what happens when patient satisfaction drops, or when there are inefficiencies in care - problems are much more frequently caused by inadequate soft skills than they are by insufficient medical expertise or academic ability.

 

A fair bit of this is due to educational priorities, which tend to emphasize academics over soft skills, but how we decide who to bring into medical school does as well - we use multiple metrics with reasonable evidence behind them to test academics, but we use fewer metrics to test soft skills, which generally only hit on a few of them, and the validity of these metrics is far less established. How we use those metrics matters too, as academic requirements are generally the first screen. Sure, medical schools try to select the applicants with better soft skills after that point, but that doesn't mean the remaining pool is full of high-achievers along those metrics - a lot of applicants with better soft skills have already been screened out.

[Edict]

I would've agreed with this until I saw some of the stats for GPA for interview invites this year at U of C, U of A, and Mac and UBC to a lesser extent.

 

Make sure you are distinguishing between cGPA and wGPA. It makes a huge difference. cGPA on average is much lower since it counts everything you've done while wGPA drops your lowest courses or in some cases your earlier or worst years. 

[NLengr]

I'd agree that we generally get people with good academic and non-academic profiles, but I question how good of a mix we're getting on soft skills, as non-academic profiles don't necessary reflect a person's on-the-ground skill set all that well. I've yet to meet a person with anywhere close to academic incompetence, and many who truly excel, but when it comes to soft skills, I've found the spectrum to be much wider. Some are truly deficient when it comes to their ability to communicate with patients, establish a therapeutic relationship, teach, manage a team, or even manage their own time. This gets reflected frequently when we look at where mistakes happen, what happens when patient satisfaction drops, or when there are inefficiencies in care - problems are much more frequently caused by inadequate soft skills than they are by insufficient medical expertise or academic ability.

 

A fair bit of this is due to educational priorities, which tend to emphasize academics over soft skills, but how we decide who to bring into medical school does as well - we use multiple metrics with reasonable evidence behind them to test academics, but we use fewer metrics to test soft skills, which generally only hit on a few of them, and the validity of these metrics is far less established. How we use those metrics matters too, as academic requirements are generally the first screen. Sure, medical schools try to select the applicants with better soft skills after that point, but that doesn't mean the remaining pool is full of high-achievers along those metrics - a lot of applicants with better soft skills have already been screened out.

I think no matter what mix of metrics you use, you'll get some people who are weak in soft skills, just like you'll get some people who are weak in academics. Honestly, it's a flawed process whereby you are guessing who will do the best 10 years down the road as a staff. It's not going to be perfect.

 

Besides, we're debating med students here. It's kind of a mute point since a huge amount of molding of a physician happens in residency, fellowship and practice. You might have a med student with great "soft skills" in the med studebt setting, who completely falls apart as a resident or staff.

[Lactic Folly]

Besides, we're debating med students here. It's kind of a mute point since a huge amount of molding of a physician happens in residency, fellowship and practice. You might have a med student with great "soft skills" in the med studebt setting, who completely falls apart as a resident or staff.

 

+1. They are called skills for a reason - they get better with practice, and there is quite a bit of life and work experience (aka dealing with people) which is compressed into clerkship, residency, and fellowship. The more important thing is to select people of good character, who are going to treat others well and work to improve themselves.

[ralk]

I think no matter what mix of metrics you use, you'll get some people who are weak in soft skills, just like you'll get some people who are weak in academics. Honestly, it's a flawed process whereby you are guessing who will do the best 10 years down the road as a staff. It's not going to be perfect.

 

Besides, we're debating med students here. It's kind of a mute point since a huge amount of molding of a physician happens in residency, fellowship and practice. You might have a med student with great "soft skills" in the med studebt setting, who completely falls apart as a resident or staff.

 

 

+1. They are called skills for a reason - they get better with practice, and there is quite a bit of life and work experience (aka dealing with people) which is compressed into clerkship, residency, and fellowship. The more important thing is to select people of good character, who are going to treat others well and work to improve themselves.

 

Well, no, I'm not just talking about medical students, I'm referring to residents and staff as well. When I mention problems in medicine being far more likely to be caused by deficient soft skills than deficient medical expertise, that research doesn't come from studying medical students, it comes mostly from studying fully-qualified physicians. Weakness in soft skills are present at all levels and from what I'm seen, not much is done through training to improve them unless they are catastrophically bad. Sure, students and residents are encouraged to perform at a level of staff, but when staff aren't all that strong themselves, there's not much of an incentive to improve. Heck, some studies show empathy going down in medical school, and with it the problems associated with poor empathy go up. Students more resistant to this drop in empathy tend to be the most empathetic students from the beginning. That's why we need to select the people with better soft skills from the start.

 

It's true that there's not going to be a perfect way to select students with soft skills. However, we put a very low emphasis on these factors during admissions. In applying (and interviewing) to three schools during my applications, my communication ability was directly evaluated for a total amount of time that's less than what it takes to write the current version of the MCAT. There's significantly less attention paid to these soft factors when compared to academic metrics. ECs hint towards some other soft skills, but not strongly, and are not evaluated with any degree of scrutiny in terms of actual performance during these ECs. And again, these factors are always considered secondary to academic factors. An applicant with outstanding soft skills but below-average academic standing has no shot anywhere, while someone with outstanding academics but below-average soft skills is virtually guaranteed an admissions somewhere. We're not going to get things perfect on the soft skills front, but we could make them a much higher priority in the selection process.

[daftjustice]

Make sure you are distinguishing between cGPA and wGPA. It makes a huge difference. cGPA on average is much lower since it counts everything you've done while wGPA drops your lowest courses or in some cases your earlier or worst years. 

Sure. Was referring to wGPA for most, but that's a good point.

[daftjustice]

 Heck, some studies show empathy going down in medical school, and with it the problems associated with poor empathy go up. Students more resistant to this drop in empathy tend to be the most empathetic students from the beginning. That's why we need to select the people with better soft skills from the start.

 

I've heard this from so many current medical students that I wouldn't be surprised if this was THE thing looked at at most interviews. #1 advice I got when I was interviewing for med school was "display empathy and compassion at all times!" And I was thinking to myself, "shouldn't that just come out naturally?"

 

And every once in a while I wonder about this, as a general concept of fairness in the interviews for applicants.

 

How do admissions know how to properly assess empathy? 

I understand that it can be conveyed in the words applicants use, but I can't help but feel that some are better are 'wearing empathy on their sleeve' than others. That is, some individuals may be extremely empathetic but don't make a whole show of it.

I guess what I'm saying is sometimes I wonder if interviewers ever confound an emotional outpouring of sympathy with empathy (a true understanding of someone's condition/situation).

 

I read U of C's admissions blog from time to time and I notice a few users have brought up the idea that maybe interviews like the MMI select extroverts over introverts. I'm wondering if they're unsuspectingly identifying the difference between an expressive, showy, display of empathy versus a quieter understanding of it.

 

This isn't a criticism of admissions, more like general musings.

[ralk]

I've heard this from so many current medical students that I wouldn't be surprised if this was THE thing looked at at most interviews. #1 advice I got when I was interviewing for med school was "display empathy and compassion at all times!" And I was thinking to myself, "shouldn't that just come out naturally?"

 

And every once in a while I wonder about this, as a general concept of fairness in the interviews for applicants.

 

How do admissions know how to properly assess empathy? 

I understand that it can be conveyed in the words applicants use, but I can't help but feel that some are better are 'wearing empathy on their sleeve' than others. That is, some individuals may be extremely empathetic but don't make a whole show of it.

I guess what I'm saying is sometimes I wonder if interviewers ever confound an emotional outpouring of sympathy with empathy (a true understanding of someone's condition/situation).

 

I read U of C's admissions blog from time to time and I notice a few users have brought up the idea that maybe interviews like the MMI select extroverts over introverts. I'm wondering if they're unsuspectingly identifying the difference between an expressive, showy, display of empathy versus a quieter understanding of it.

 

This isn't a criticism of admissions, more like general musings.

 

It's a good point - empathy is a fairly subjective concept and hard to measure accurately. I don't think schools do a particularly good job at capturing an applicant's capacity for empathy, simply because they don't spend much time specifically looking at it and even poor performance on a empathy portion of an interview could be completely outweighed by stronger performance on other parts of an interview that draw less on soft skills. There's also definitely some evidence that medical school interviews, and MMIs in particular, prefer extroverts (here's one example study).

 

However, there's a rationale behind taking more showy displays of empathy that are obvious in shorter bursts. I remember a study (can't find it at the moment) that indicated patients tend not to be able to tell the difference between a genuinely empathetic provider and one who's merely pretending to be empathetic - from a patient's viewpoint, the expression of empathy might matter more than the feeling itself. In many situations, 10-15 minutes is all a physician has to demonstrate empathy and form a connection, meaning a showy display could have more impact than a subtle approach that's only evident over a longer interview.

 

(Of course, empathy has value from the physician's end as well, with some reported correlations with clinical judgment. That makes sense, given that to be empathetic, by definition you need to understand things from the patient's perspective, an understanding which is pretty useful in determining an appropriate course of action. Feigned empathy won't come with that advantage.)

 

I'll also mention that I think we too often conflate "soft skills" with being primarily about empathy or direct communication with patients in general, and while these are important soft skills, they're only one facet. While I've seen some less-than-reassuring examples of poor empathy or communication from senior residents and staff, I'm much more concerned about deficiencies in other soft skills - things like communicating with other physicians or healthcare providers, working as part of a team or leader of a team, time management, and for many practitioners, running a business.

[indefatigable]

. 

[Lactic Folly]

How do admissions know how to properly assess empathy? 

I understand that it can be conveyed in the words applicants use, but I can't help but feel that some are better are 'wearing empathy on their sleeve' than others. That is, some individuals may be extremely empathetic but don't make a whole show of it.

I guess what I'm saying is sometimes I wonder if interviewers ever confound an emotional outpouring of sympathy with empathy (a true understanding of someone's condition/situation).

 

I read U of C's admissions blog from time to time and I notice a few users have brought up the idea that maybe interviews like the MMI select extroverts over introverts. I'm wondering if they're unsuspectingly identifying the difference between an expressive, showy, display of empathy versus a quieter understanding of it.

 

If empathy is defined as being able to place oneself in someone else's shoes, then this could be assessed by a type of question such as I received many years ago: Imagine you are a [someone of a different age, gender] facing [difficult life situation, something the applicant likely has not faced themselves]. Describe what you would be thinking and feeling (not what you would do).

 

The quality of response to this question should not really depend on extroversion vs introversion (unless the interviewer is looking for a more expressive solicitousness as evidence of empathy). I liked this question so much that I started using it in some of my interviews, as a type of question that candidates would be unlikely to have prepared answers to.

 

That being said, some people can come up with many insightful comments in response, while other very nice-seeming people really struggle - how much weight should be given to such evaluations?

[older]

To the earlier point, I am yet to meet med student who  was/is weak in academics. But  a broad range of soft skills is definitely not a norm among med students, residents and staff.  

 

There is no easy answer how to assess  soft skills at admissions. ECs and experience in areas other than science may or may not contribute to development of soft skills, and are not a good indicator per se. Volunteering in a hospice may be motivated by empathy or just adding to resume.

 

Interviews, MMIs in particular, at least give some chance to probe soft skills. Classic MMI task of telling the neighbour that you accidently run over his cat demonstrate quite a few: communication, empathy, taking responsibility etc. Organizational and team-effort tasks are designed to demonstrate other sets of skills.  Whilst scoring may be somewhat subjective, it gives at least some indication.  

 

But many qualified applicants do not reach this stage.  Also, as somebody mentioned earlier, this could be outweighed by other parts of interview and, at the end, academics still weighted more.

[premed989]

Man, I hate to revive an old forum post from 2016, but I just started medical school at McMaster this year, and I've definitely noticed this. I've noticed it so much that it really, really bugged me, I went and did some research on why the hell my class is like this, and found this thread.

I come from a middle class family. Our income was slightly above the national median, but we actually have real trouble making ends meet. During the financial aid talk this week, the professor asked how many of us had NO DEBT going into medical school, and 3/4 of the class put up their hands. I went to school in downtown Toronto, and I'd say more than 1/2 of students from my high school had to borrow from OSAP to pay for their undergraduate degree. I personally have 12k in OSAP debt from undergrad. I talked about this to my group of friends back home (some of whom want to be doctors) and all of us had OSAP debt. I told them about how my class was made up of rich kids - imagine how discouraging that must have been for them.

And then I got to know more of my class. Many of them had parents who were doctors, professors, etc. It was disproportionate, and they talk about it really casually, "my dad does family medicine at blah blah". I don't think I went to a shady high school or something, but aren't these sort of family backgrounds supposed to be somewhat rare? Among my entire circle of high school friends, not one of them came from such a good background as having a family doctor as a parent - NOT ONE. I've had no doctor mentors to take me through this process.

I hate to feel this way, but I'm beginning to feel like the whole medicine enterprise is about a bunch of rich people from really privileged backgrounds who make a ton of money taking care of the poor (it's hard to deny that medicine pays really well) - and it makes me feel really dirty. Dirty in the sense that medicine is supposed to be a public service, not a system to perpetuate privilege. Shouldn't poor kids have a better shot at moving up socioeconomically? More importantly, on the public service side, doesn't it benefit medicine to recruit students from middle class backgrounds - people who understand what it's like to work stressful factory jobs while taking care of 3 kids, people who are obese, smokers, diabetic, and have high blood pressure (all 4 of which, I'm pretty sure, are far more prevalent in people of lower SES). My family isn't that poor, but I have an understanding of what many of these things are like - my mom has three of the above conditions (obesity, diabetic, high BP), and I'm pretty certain if we had more money, she'd be in better health. I actually really understand this, because I can see the stress she's under.

I have a first hand appreciation of the social determinants of health, and I think it's a bit of a shame that not many medical students do. I mean, they learn it in class an all, and they answer all the questions correctly at the interview, but every time you tell med students about the sorts of conditions the AVERAGE canadian family (like mine) live in, they're absolutely shocked and appalled, because they've lived in nothing other than a big fancy house, with 4 course nutritious meals at dinner, living at a boarding school.

All of the things I've described above will affect the development of the kids in that family, believe it or not. The SES bias is NOT a product of tuition being too expensive - realistically i've never heard of anyone not being able to "afford" medical school in Canada, if they have an acceptance in hand - they'll manage. Yes, there's very little excuse for someone to say "I did poorly on that math test because I came from poor parents". But medical school is more than just a single math test. IT's a LOT of work to get into. To do so, you need to reach your full potential. You need not only to do very well in school, but you have to be highly accomplished. People can only do these things if their basic needs are well met. I've seen my mom cry about not being able to pay off the mortgage - imagine how that makes me feel? It makes me hurt inside every time I spend my parents' money to buy food for myself. It means I have to work every summer to be able to live away from home, because I don't want to ask my parents to pay my rent. How can I focus fully on ECs when all this is going on? I mean, I made it into medical school, but imagine how much further I could have gone if I didn't have to worry about these things. People can only reach their full potential when all their needs are met. I want to emphasize that my family income is slightly ABOVE median. The majority of Canadian students are in family backgrounds that prevent them from reaching their full potential. I remember sitting on a GO Bus listening to a student behind me talking to her friend about her med school ambitions, about all the shit that goes on at home, about her sister attempting suicide because of school-related stress - she's not that far from the average family. Imagine how hard it must be for her. I wouldn't have made it if that was my family. These sorts of problems are common in Canadian families, believe it or not, but REALLY rare in families with >100k income (do your parents make more than 100k?) - I hope none of you are surprised to hear that, because rich families have a lot more control over their lives. That sister of hers would have just moved on to business or something without a care in the world.

Some of the posts in this thread made me a little upset. It's easy to deny that family income has ANYTHING to do with medical school admissions success when you've been in a privileged household your whole life. This is my experience, and it doesn't surprise me at all now how skewed med school classes are. It's not the tuition, anyone who can get into medical school can afford it - I've never heard of any Canadian medical student being unable to attend, or even hesitant to attend, just because the tuition is expensive (quite frankly, engineering programs can cost $16k a year, medicine is a bargain). The cost of writing the MCATs and submitted applications is a factor, but not the leading factor. I'm pretty sure it's just the fact that kids from privileged backgrounds are more likely to do better in school, not because they're smarter, but because their needs are well met, allowing them to truly reach their full potential. You need to have your needs met before you can get a 4.0, before you can spent hours working on your med school/nserc/scholarship applications, before you can work at an inner city HIV clinic, or whatever the hell else premeds do. Being smart may partly be a genetically inherited factor, but I'm certain it doesn't explain a substantial part of the bias - I know plenty of smart poor kids who are definitely smart enough to be in my class.

Also, why is there only one (I think) black guy in my class?

That's why I kind of like Mac. I'm not the dean or anything, but I think at least part of the reason they don't look at ECs is because ECs favors privileged kids (I hope Queens' dean sees this). I'd still say Mac has a way to go. By the way, how many of you come from households with income above $100k? If so, you need to realize that you're somewhat privileged. You may not notice because all the kids in your school are likewise rich, another aspect of your privilege. YOU need to see what school is like in downtown Toronto. My high school produces about one med student per year. I hear many of the suburbian high school product 10s of med students per year. Are downtown kids just dumb? 

I think this article is worth a read:http://www.universityaffairs.ca/features/feature-article/medical-school-admissions-process-skewed/

[shankarpro]

wow I had no idea my classmates would be so loaded.

Means my chances of getting a bursary just shot up WOOT

[JohnGrisham]

2 hours ago, shankarpro said:

wow I had no idea my classmates would be so loaded.

Means my chances of getting a bursary just shot up WOOT

False. Many of my classmates whos parents are very well off, simply make them selves look poor on paper, like they aren't getting mommy and daddy to pay for their Europe trips. Then they get student loans and a fair amount bursaries.

It really pisses me off. Somehow this student is paying 1500$ month on a fancy bachelor pad with ocean view. But they have zero income nor debt? Mom and dad are paying rent and whole foods bill, yet the govt doesn't realize and they look poor student on paper. Classmate literally got 9000$ in bursaries and used it towards euro trip. While us fools already in boat load on line of credit debt get only a few low thousands. Dont get me wrong I'm very appreciative of ANY bursary I get, but it rubs me the wrong way how flawed the system is with rich classmates luck of draw getting more than me!

End rant.

[Bambi]

Life is what you make it. I come from poverty. I walked to university so as not to have the expense of public transport. In return, it helped with my fitness! I brown bagged my lunches, could not afford to buy bottled water, soft drinks, coffee or a snack. It did not matter, nor did it adversely affect me. I survived on student loans. This was a way of life. In med school, the LOC. I was motivated, kept my eye on the ultimate goal, treated my academic studies professionally, became a straight A student, and my financial circumstances were not the slightest handicap to my ambitions. Indeed, I had to be motivated to achieve my goal, was motivated and didn't look left or right at those around me, rather I relentlessly focused on the goal that I ultimately attained. All this to say that anything is possible, rich or poor, just put in the required effort, persevere regardless of circumstances or setbacks and you will achieve your goal. The fact that it may be harder for you than for someone else is not relevant to you and dwelling on this is not healthy or productive. We each have our own unique path to follow and this is where our individual focus must be without distraction. At least, this has been my path to success. To the extent that life has been tougher for me than others, my life experiences have only made me stronger and more sensitive and compassionate to the human condition. All in all, I always was and remain a happy camper and am grateful for having been brought up in Canada where anything is possible, and am happy that soon I will be a productive member of society making my contribution.

[1D7]

13 hours ago, premed989 said:

I come from a middle class family. Our income was slightly above the national median, but we actually have real trouble making ends meet.

 

Quote

I have a first hand appreciation of the social determinants of health, and I think it's a bit of a shame that not many medical students do. I mean, they learn it in class an all, and they answer all the questions correctly at the interview, but every time you tell med students about the sorts of conditions the AVERAGE canadian family (like mine) live in, they're absolutely shocked and appalled, because they've lived in nothing other than a big fancy house, with 4 course nutritious meals at dinner, living at a boarding school.

The median Canadian family income is ~70k/yr. I'm not denying your experiences but making more than that for a family of 4-5 is more than enough to live comfortably for most.

Quote

I hate to feel this way, but I'm beginning to feel like the whole medicine enterprise is about a bunch of rich people from really privileged backgrounds who make a ton of money taking care of the poor (it's hard to deny that medicine pays really well) - and it makes me feel really dirty. Dirty in the sense that medicine is supposed to be a public service, not a system to perpetuate privilege. Shouldn't poor kids have a better shot at moving up socioeconomically? More importantly, on the public service side, doesn't it benefit medicine to recruit students from middle class backgrounds - people who understand what it's like to work stressful factory jobs while taking care of 3 kids, people who are obese, smokers, diabetic, and have high blood pressure (all 4 of which, I'm pretty sure, are far more prevalent in people of lower SES). My family isn't that poor, but I have an understanding of what many of these things are like - my mom has three of the above conditions (obesity, diabetic, high BP), and I'm pretty certain if we had more money, she'd be in better health. I actually really understand this, because I can see the stress she's under.

Healthcare is a public service, not some sort of lottery vehicle for social mobility. Being a public service means that we should admit individuals who are most likely to become good attending physicians & least likely to drop out. Whether or not that should include someone's SES has already been debated to death in this thread.

But since you brought it up, do you think we should advantage the obese/diabetic/hypertensive/smokers when it comes to medical school admissions because they firsthand understand how those conditions affect their lives (and the lives of millions of Canadians)? Should someone who comes from a family making an income of 30k be significantly advantaged as compared to someone who comes from a family making 60k? 

13 hours ago, premed989 said:

And then I got to know more of my class. Many of them had parents who were doctors, professors, etc. It was disproportionate, and they talk about it really casually, "my dad does family medicine at blah blah". I don't think I went to a shady high school or something, but aren't these sort of family backgrounds supposed to be somewhat rare? Among my entire circle of high school friends, not one of them came from such a good background as having a family doctor as a parent - NOT ONE. I've had no doctor mentors to take me through this process.

I understand how you feel, but that's just a reality of life. Those who have more money are advantaged while those who have less are disadvantaged when it comes to family, lifestyle, career/jobs, and especially connections. I will say however that generally most children of family physicians seem to have had an upper-middle or middle class class upbringing that's not very far removed from the average Canadian's life.

I know it's trite but be appreciative of what you have. Living in Canada basically makes us the top ~1-5%ers of the entire world. Being middle class Canadian at the very least puts you in the top half of the last number. Being university educated means you're in the... and so on and so forth.

 

[mononoke]

http://jamanetwork.com/journals/jama/fullarticle/2649192

Read this @premed989 , I feel like it covers a lot of the points you've made and puts it in a different perspective. I'm also not as rich compared to some people in my class and agree with you that it's unfair sometimes...hopefully schools will start to take notice and make some changes to support less advantaged students

[Bambi]

Coming from poverty, I never for a moment considered my self underprivileged in the slightest. Financial wealth of the family you are born into is probably m0re of a disadvantage than an advantage. Children born into wealth take it for granted and may well be less motivated, not more motivated. And contacts can only get you so far. If there is no merit, substance or character, your life and contribution to society may be more of an illusion than reality. In high school, many of my classmates came from very wealthy families, and yet, I have achieved far more than them. Why? I knew what I wanted, I knew my only path was entirely dependent upon myself, I was motivated, ambitious and with a plan, which got me where I am today. I did not need wealth nor family contacts, just determination, focus, hard work and execution of my plan. This has nothing to do with fairness. We all can have a list of excuses, it gets you nowhere. Yes, my poor circumstances exposed me to prejudice. This was a blessing as it only made be both stronger and sensitive to the human condition. I went out of my way to befriend and defend those whom I encounters who faced discrimination of whatever kind. I don't get it. We are all capable of reaching our human potential regardless of circumstances in Canada. 

[bearded frog]

Having family members who are medical professionals also is an advantage on the path to medicine for a number of reasons other than SES. I don't think you'll see as much of an out of proportion number of children of successful lawyers or business people, etc.

Having a family member in medicine plants that seed early, they can help you understand the process and requirements early, suggest schools/ courses/ study methods. They can open doors for ECs and other experiences. Obviously the SES status helps too!

[Lactic Folly]

2 hours ago, mononoke said:

http://jamanetwork.com/journals/jama/fullarticle/2649192

Read this @premed989 , I feel like it covers a lot of the points you've made and puts it in a different perspective. I'm also not as rich compared to some people in my class and agree with you that it's unfair sometimes...hopefully schools will start to take notice and make some changes to support less advantaged students

Really nice article, well written. Thanks for sharing.

[BoopityBoop]

@premed989 as someone who grew up in a low-middle income house hold with immigrant parents who speak broken english - I hear you so loud and so clear. I just never had the balls to publicly rant like you do because of the back lash I knew I would receive (i.e. many previous posters who took the defensive stance). With that being said however, I think I realized a few things after feeling the way we do.

1 - I think it's important not to blame our peers. It is not their fault that they grew up in a well off household or that their parents are physicians. That's just a separate lottery than med school admissions. It is also not their fault that they are not yet fully aware of their privilege. Remember a lot of medical students hadn't had the luxury to day dream and contemplate life and reflect on their own upbringing. Most of us only had time for studying and building out CV's. Any extra time was left for - netflix or streaming/torrenting online (poor man's netflix).

2 - You are definitely right, medicine is a public service. So it is in our best interest that they see and understand the implications of SDOH through their time in clerkship, residency and fellowship. Hopefully, these experiences will help them develop a deep well of empathy for their patients (i.e. probably our aging parents). If we are really lucky, some of them may also enter the political arena and vocalize the need for improvement in SDOH. Remember that there are also tons of children from privileged families who do not understand and will never understand their privilege (i.e. the Trump's). 

3a - I think it's also important to see the positive in this situation and our role in all of this. Yes, those of us who grew up underprivileged have gone through the hair-pulling reality of having classmates who don't have student loans/debt. And yes it is even more frustrating when those peers find loop holes to receive grants and other financial aid meant for us, the less-well off kids. So I get it, it's very easy to loathe the privileged individuals and hate them with a passion. But that won't do anything except create more animosity and tension. We need to see that at the end of the day, we are becoming a MD, just like them, we got into medical school, just like them, and we'll earn a good living, just like them. We need to use our perspective and voice throughout our own journey in pre-clerkship, clerkship, residency, and fellowship and etc to help them understand. But how do we help them understand? 

3b - We help them understand by starting conversations, and calling them out. Our empathy and understanding for patients may come easily. We will understand that smoker with poorly managed type two diabetes who may need a below knee amputation. But our peers may not. So, when our peers are tired during call and see this patient in the ER and start yelling, "How the f does anyone let it get this bad?!" we will pull our peers aside and talk to them. We will tell them, "Hey bud, I know your tired, and I know it's been a busy call, but you can't say things like that. You haven't been in your shoes. You don't realize how smoking is their best coping mechanism for 14 hour days at the factory or how they don't have the time or money to go for groceries let alone the energy to cook at the end of day. If you have to take 5 minutes to just grab some tea and relax you should. It's better to see a patient 5 minutes later, then make them never wanting to come back to the hospital or see a doctor". And we also hope that our colleagues, nurses, orderlies, pt transport, paramedics will hopefully call us out (professionally) when we are richer and more privileged as staff physicians who momentarily forgot our upbringing.

Hope this helps you and anyone else reading this - regardless of your privilege.

[indefatigable]

I'm not sure if anyone mentioned this, but happy home life is sometimes worth more than >100 K income.  I've seen children of wealthy parents, even physicians, but weren't really a focus of their parent's lives and have struggled.  On the other hand, children from lower income families, can sometimes have supportive home lives which can make up the income difference and help nourish the children to success.  Second generation immigrant children for instance, will sometimes outperform due to supportive and cultural values (a member myself technically).  But, clearly, the greater the resources, the easier it is to succeed all things being equal.   Having grown up with material wealth, sometimes individuals will not focus on those aspects, and even turn against materialism: one individual I knew whose parents owned sailing yacht decided to live nearly off the grid (a focus on maintenance of the yacht and other aspects weren't too appealing).  

[GrouchoMarx]

Money begets money.
Privilege begets privilege.

Poverty begets poverty.

That is the way of the world.

Complaining about it is futile.