Researchers at Yale University did a study of prospective students applying to MD/PhD programs. It found (as if this is news) that these programs do not attract a wide diversity of students, especially from lower-income backgrounds.
Between 2014 and 2019, applicants from families with higher household incomes were accepted at increasingly higher rates, a trend not found among other income brackets.
Yale researchers lament the lack of diversity in MD PhD programs, which is decreasing slightly.
“We know that diversity in the medical field leads to more effective and equitable health care for patients,” she said. “And the different perspectives that diversity brings also boosts biomedical innovation and productivity.”
To assess whether the sky is falling it is important to back up and look at exactly what study authors are talking about. Everyone knows what an MD is, it’s a medical doctor or doctor of medicine. When I was a child virtually all physicians seemed to be middle-aged white men. I’m related to quite a few physicians who fall into that category. In the past 20 years if not more, it is increasingly common for women to enroll in medical school. Today the ratio of men to women is about equal. Medical schools are also much more diverse than when I was a child.
So what is an MD/PhD then? Well the PhD is a research degree. It’s a degree used mostly in academic medicine. An MD/PhD is far more costly and rigorous a program than just a medical degree. It’s achieving two doctorates, each of which is a huge accomplishment. Positions that require MD/PhDs are most likely lower-paying research jobs than physicians who treats patients. Physicians who work in academic medicine often have given up earning a larger salary in return for one that brings them more joy. More on that Yale researchers have to say:
First, fewer prospective students from low-income families applied to M.D.-Ph.D. programs over the study period, the researchers found. Between 2014 and 2019, the percentage of applicants reporting less than $50,000 in household income decreased from 28.4% to 25.1%.
Throughout the same time period, individuals from affluent families made up a greater proportion of accepted students. In 2014, 16.1% of applicants accepted into at least one M.D.-Ph.D. program came from households that reported more than $200,000 in income, a rate that steadily increased to 20.9% in 2019.
An MD/PhD would take much more time to earn and substantially higher. What this means in a nutshell is that lower-income households are either less interested in spending years longer in school to earn a lower salary or they cannot afford to spend years longer in school to earn a lower salary. Another way of saying this is that an academic program that involves earning two doctorates is something of a luxury good. In addition, acceptance rates for lower-income students have declined over time slightly. That could be the result of two things: 1) fewer students applied for the positions creating a less competitive applicant pool, 2) lower-income students didn’t have as much time or resources to prepare.
Across all years assessed, 29.9% of applicants with incomes under $50,000 were accepted in M.D.-Ph.D. programs. That rate rose steadily across higher income brackets, peaking at 50.3% for applicants with incomes greater than $200,000.
Officials worry that some applicants are being evaluated on privilege rather than merit. Suggestions how to recruit more lower income students are something that should worry patients.
…programs should consider more holistic measures of capability in addition to traditional academic accomplishments, the researchers said… Programs should also not penalize low-income applicants for activities that might be more necessary for them than those with greater financial resources, such as having jobs rather than research positions, they added.
In other words, don’t look at applicants’ grades and academic career – all things that make them better doctors. Look at how tough it was for them to get here. There is something to be said for grit and perseverance but there is also something to be said for mastering the medical knowledge.
More from Yale: In the nation’s M.D.-Ph.D. programs, the socioeconomic gap widens
More from JAMA: Socioeconomic Diversity in Admissions to MD-PhD Programs