A few weeks ago, I was writing up one of this website’s guides on the medicine application. The guide was about work experience, a pretty basic topic to most of you I’m sure. Yet, I thought it was important to add a small disclaimer – an acknowledgement of a common problem. It’s harder to get work experience if you don’t know any medical professionals.
That probably seems obvious, right? Sure, James (whose mum is a Midwife) is going to be able to shadow an obstetrician easier than Rachael (whose parents are supermarket workers) is going to be able to find some GP work experience. Isn’t that just the luck of the draw? Why should that matter to a medical school? The answer is, unfortunately, it’s much more complicated than what we see on the surface.
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‘It’s all about who you know’
It’s easier to see the problem with inequality in medicine if we zoom out to the large scale. Instead of thinking about individuals, let’s think about communities. By and large, people like to stick to their own. We make friends and form relationships with our neighbours, our peers, our work colleagues. That’s why it’d be weird if you heard that a chip shop worker from Birmingham married a millionaire from London; the pair have crossed several social barriers for that relationship to happen. It’s to the point where it sounds more like a soppy romance on TV than a real-life couple.
So what are those social barriers? Well, here’s the rub – there’s a lot of them. How much you earn, race and identity, the types of job you have, level of education, even where you grew up! It’s not just down to your own factors – your parents’ social situations will also affect your own choices and opportunities. It’s important to note that a lot of these barriers, like race and parental income, are completely out of control of the people they affect.
Suddenly the problem becomes clear. People who have fewer resources and links are made to have a harder time with the medicine application than those who are well connected and well-off. That means one thing: a small group of people, usually rich, from private school, and in the past white males, make up a disproportionate amount of medical students. They’re also more likely to be accepted into medicine courses. We live In a country filled with people from a diverse range of backgrounds. Should we really be prioritising one group’s dreams of becoming doctors over others?
Breaking the mould
Of course, it’s not all doom and gloom. There are still people who manage to push through barriers and reach their dreams of going into medicine. We call this social mobility and it’s an important measure of how equal a society is. The idea is the more people from disadvantaged backgrounds can manage to build high achieving careers like medicine, the more society is based on merit rather than good fortune.
Medical schools understand that healthcare needs to represent the needs of all groups of people fairly. As a result, ‘widening participation’ schemes, aimed at broadening the range of applicants to medicine have been launched across most medical schools. They aim to increase social mobility and access to medical school. Since 2014, the Medical Schools Council (a group of the heads of UK medical schools) has also been keeping track of data about student admissions and entry into medicine, in the hope of showing their progress. As a result, there’s been big improvements in the number of applications from women and people of colour. In fact, in 2017 women made up around 60% of 1st-year medical students, compared to 40% of the gents. It should be noted though, that women still have a much smaller presence in certain specialties, likely affected by societal expectations of motherhood and part-time working.
Two steps forward…
It’d be nice to think these improvements mean that medicine has become truly representative of the UK population. Alas, that’s not the case. While the ethnic and social makeup of medical students is getting closer to the UK average, barriers around income and class stubbornly remain. A massive 80% of medical students come from a core 20% of UK schools. No surprise, those schools are disproportionately made up of private institutions, grammar schools, and state schools in well-off areas. Probably more depressing is that half of schools in the UK have never produced a single medical applicant (not even an application!) in recent years.
I want to make clear that these issues around class and finances are just as relevant to marginalised groups as to the majority white British population. Yes, medical schools are becoming more diverse and that’s great. But when medicine as a degree is still only open to those who are well-off, that’s not truly representative of any core group in society. It’s a half measure. That’s made even more damning when you learn that women and people from ethnic minorities are statistically less well-off than their white counterparts. This would mean that, if anything, becoming a doctor for many non-white people has gone from near-impossible to a steep uphill battle, and the odds aren’t much different for poor white people either. To be truly representative of the UK, you need both social AND economic justice. They are deeply intertwined.
Fighting Inequality in Medicine
So how do we go about improving inequality in medicine applications? It’s no easy task, and there’s no clear answer. The MSC’s data has given us some good pointers though. Firstly, disadvantaged students just aren’t applying to medicine in the same numbers that advantaged students are. Some people call this an ‘aspiration deficit’. While I think it’s true that many working-class people are told from an early age to forget about university, I think suggesting it’s a lack of desire to learn is just pushing old stereotypes. Instead, people have real worries about the cost of living on student maintenance loans, poor local education infrastructure and a lack of support to help disadvantaged applicants along a complex application process.
Early data shows that the widening participation initiatives are working to help level the playing field (by reducing A-level requirements, supporting applicants with summer schools etc.) but changes aren’t happening quick enough. Part of that is a lack of awareness about these initiatives, so make sure to check them out! Still, universities and the Department of Education need to continue to help those most in need. Here are just some of the ideas that have been floated to improve inequality in medicine:
– Increasing the size of widening participation university places
– Using more evidence-based measures for WP programmes to ensure the system is not abused
– Pushing more funding to support medical students from poor backgrounds, especially during the NHS bursary years
– Ring-fenced job opportunities for WP medical students, ensuring financial support if required
– Increased med school outreach programmes, so local kids know about their medical schools nearby.
– Removing competitive entry for standalone foundation year medicine courses.
There is significant inequality in medicine applications linked to social and economic injustice
Social mobility in medicine is increasing slowly
We need to speed up the progress, especially for those who are financially disadvantaged
Regardless of the statistics, those who strive can become doctors regardless of background. Remember the WP initiatives!