Beyond Academics: What Our Conversations About Med School Overlook

When we talk about medical school, our conversations tend to gravitate to a few key issues, particularly undergraduate grades, MCAT scores, and school prestige. These are undeniably major concerns – the average medical school student had an undergraduate GPA of 3.79 for the 2018-2019 admission cycle, demonstrating just how hard it is to get a prime placement – but there’s a lot more to the future of the profession than who gets into the top few schools.

A meaningful conversation about medical education also needs to tackle issues like diversity, population-level health needs, and soft skills like compassion and collaboration. More than who attends Harvard or what residency students earn later on, these are the factors that will influence how well future doctors serve their communities.

How Money Shapes Medicine

Medical school is expensive; the median debt load is $200,000, and many students carry more than that. Meanwhile, the average first year resident makes about $55,000, hardly enough to start repaying those loans, and many students don’t feel comfortable taking on that amount of debt, often on top of undergraduate debt, in the first place. This influences who goes to medical school and what communities they eventually choose to serve.

One structure that could increase access to medical education is offering students the opportunity to swap their loans for an income share agreement (ISA). A number of fields, including many trades, offer students the opportunity to participate in an ISA, in which an investor takes on the student’s debt in exchange for a set percentage of their income in the future. While the default rate on medical school loans is actually quite low, offering students the option of an ISA could encourage a greater number of low-income students to pursue medical education.

More Students Than Matches

After completing their basic medical education, students spend several years as resident, essentially trainees practicing under close supervision. Like everything else about medical education, residencies are highly competitive; medical students rank residency programs and are matched through a national placement algorithm based on specialty, location, and other factors. Where students match for residency has a major impact on where they choose to practice later in life – but there are a number of problems with this system.

First, despite a national physician shortage, thousands of students aren’t matched with a residency each year. There just aren’t enough slots, even though the country is in desperate need of those doctors and many of the students who fail to match have great potential. Offering alternative paths to licensure, such as allowing graduates to practice under physicians in underserved areas, could increase the supply of doctors and give smart, eager students a chance to utilize their knowledge and training.

Distribution Issues

In addition to students failing to match with residencies, those who do match tend to be clustered in specific areas. Residencies are often based at teaching hospitals, which are in turn often in major cities or expensive suburbs. This is exacerbating the physician shortage in rural areas since students who are trained in well-equipped urban hospitals may feel unprepared to be one of a few doctors on call in a low-income, rural community. Medical residencies need to be redistributed or new residencies created in areas with major shortages and students need support and encouragement to pursue those areas.

Diversifying The Field

Finally, most industries reflect their leadership in terms of make-up. If a field is dominated by men at the upper levels, then men are most likely to enter the industry. The same divisions occur along racial lines. At the rate things are going right now, medicine won’t reach racial or gender parity for many decades, and that has a lot to do with who is in charge of medical schools.

Because of changes at the undergraduate level, more than 50% of medical school students are now female, which makes it seem like medical education is on the right track. That’s true in some regard, yet because of deeply rooted disparities, it will be 50 years until half of all doctors are women. Of long-term medical school deans, only 7% of deans serving more than 12 years are women.

For healthcare to adequately serve patients, it needs to better reflect those it serves and that means looking beyond grades. That’s only a small part of who these students are and what they’ll be capable of as medical professionals.

This article does not necessarily reflect the opinions of the editors or management of EconoTimes.