Paul L. Caron

Wednesday, December 4, 2019

NY Times: Hidden Costs Of Medical School Pose Barrier For Diverse Students

New York Times, ‘I Have a Ph.D. in Not Having Money’:

American medical schools are the training grounds for a white-collar, high-income industry, but they select their students from predominantly high-income, and typically white, households. Ten years ago, a national study found that over 75 percent of medical school students came from the top 40 percent of family income in the United States, representing an annual income above $75,000. A study last year from the Association of American Medical Colleges re-examined medical school demographics and found that the numbers had barely budged. Between 1988 and 2017, more than three-quarters of American medical school students came from affluent households.

Students from low-income families who choose to apply to medical school find the path lined with financial obstacles. The application phase entails MCAT registration ($315) and preparation, application fees ($170 for the first school and $40 for each additional one), travel and attire for interviews (on average more than $200 per school). After enrollment, students are expected to purchase equipment and study aids. Each year brings new certification tests, with registration fees running upward of $600.

Aspiring doctors know that tuition is costly; the median educational debt held by medical school graduates in 2018 was $200,000, up 4 percent from the previous year. But less advertised are all the hidden costs of a medical education. ...

Shawn Johnson was born just outside Stockton, Calif. ... His first time buying a suit was for medical school interviews. A janitor in a hospital hallway taught him how to tie his tie. But he didn’t realize that in getting accepted he had cleared only his first hurdle.

As soon as Mr. Johnson began medical school classes, the costs began to pile up. There was an itemized list of equipment he had to buy, including a stethoscope and ophthalmoscope, totaling nearly $1,000. There were study-aid subscriptions that were considered essential: the test prep site UWorld ($499), the question bank SketchyMedical ($200), the exam review book First Aid ($40). Then the test registrations: $630 for the United States Medical Licensing Exam Step 1 (“the boards”), $1,290 for Step 2 Clinical Skills, $630 for Step 2 Clinical Knowledge. He watched his classmates whip out their credit cards “like they were ordering something for $5 on eBay.”

“You have to decide, do you use your loans for a study aid or for a rainy-day fund in case someone at home gets sick?” Mr. Johnson said. “I haven’t had dental insurance in two years. When tuna is on sale for 80 cents a can, I go buy 30 at CVS.” ...

Mr. Johnson said he experienced almost daily reminders of his socioeconomic status. A professor recently asked students, as an icebreaker, to describe their favorite family vacation spot. Mr. Johnson began to sweat, racking his brain for an answer before awkwardly offering the truth: His family had never taken a vacation. ...

That top medical schools seem to favor the rich is especially disturbing to low-income students because they know that their diverse experiences and perspectives are an asset, not a liability. A 2018 study showed that black patients have better health outcomes when treated by black doctors. Mr. Johnson said that emergency room patients have told him they feel more comfortable having a doctor who is African-American and from Stockton, someone who, like them, struggles to afford his medication.

“I have a Ph.D. in not having money,” Mr. Johnson said. “That’s not easy to explain.”

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This article is amazingly disingenuous. First of all, the fact that the majority of medical students come from families making $75,000 or more does not mean they are receiving any financial contributions. Medical school is about $100,000 per year, so what could a family making $75k contribute to that, maybe $5k. And most families are tapped after making payments for undergrad. So the truth is, subject of the article and his white classmates are mostly in the exact same boat.

Second, why don't we give it another couple decades, after Mr. Johnson has long been making a six-figure salary to revisit his financial circumstances.

Posted by: JM | Dec 4, 2019 11:54:53 AM

If several years of expensive pre-med and medical school is tough for doctors and their patients who struggle to afford it, law schools' requirement of a degree in something that *need not be useful and generally isn't because the grading they value is easier* before even applying is outright cruel and wrong.

Let's expand access and employment to our specialty through that Congressionally-mandated (and difficult) Tax Court exam!

Posted by: Anand Desai | Dec 5, 2019 5:56:53 AM