Physics taught us that the current follows the “path of least resistance.” Hopeful healthcare professionals apply this heuristic as they follow the path to their health professions schools, not wanting to jeopardize their future by going off the beaten path or forging their own path. Perhaps some anxiety is warranted, given recent admissions statistics. According to the American Association of Medical Colleges (AAMC), the number of applicants in the 2020-2021 application cycle rose by nearly 18% to over 60,000 applicants, with only 22,666 applicants matriculating into a medical school.1
While that particular increase in competitiveness may be temporary and attributed to the COVID-19 pandemic canceling gap year activities, admissions have maintained a level of competitiveness that can erroneously cause students, particularly those without access to formal advising, to ascribe to the notion that there is only one direct, successful path to medical school. As I look back on my own pre-med journey without rose-tinted glasses, I admit that I used to hold this view not simply out of ignorance, but fear: fear of failure pervaded my every move, from registering for classes to selecting extracurricular activities. This fear could have been assuaged by a mentor who shared my experience, but as a Black, low income woman, there were few and far between, since less than 3% of U.S. doctors are Black women.2
Though I acknowledge the privilege I held as a student with an active health career advising office, compared to my more privileged peers, I lacked the social capital to understand what it meant when the advisors stressed that there was no pre-med track. To me, with the prerequisites, MCAT, volunteering, and employment burden I carried to support myself, a “track” seemed to be the structure I very much needed to navigate this unknown territory. And that same “track” appeared to prevent me from exploring my passion for community engagement and social justice, which directly tied to my reasons for studying medicine in the first place. I interpreted this as meaning that if I took time for my interests, then I would be seen as an uncompetitive candidate.
After eventually connecting with mentors from similar backgrounds, I finally understood what the advisors meant: I began using my autonomy as a student to incorporate community engagement and social justice into my pre-med journey, rather than seeing them as mutually exclusive concepts. However, my experience was not a path of least resistance: I faced multiple challenges, such as searching intensely for mentorship while keeping my grades up, volunteering, and working multiple on-campus jobs. Danielle Sawyer and Brittany Gratreak, two doctorate of medicine and philosophy candidates from the University of Arizona College of Medicine who identify as first generation and low income (FGLi), further validate my experiences. Sawyer and Bratreak stated that, due to financial and social barriers and a decreased access to guidance and mentorship resources, FGLi students have less time for accomplishments that enhance their application compared to their more privileged peers.3 Similarly, students who are historically underrepresented in medicine report receiving inadequate advice and fewer institutional opportunities.4 While it is not clear how much of an impact these hurdles have on their admissions odds, if there is a lack of diversity in the medical student community, this shortcoming can have consequences for human health. In other words, growing evidence demonstrates that patients cared for by diverse healthcare teams tend to have improved health outcomes.5
It is an interesting paradox: while qualified FGLi and underrepresented in medicine (URM) students should be celebrated for their diversity and contribution to the healthcare industry, they are likely to believe that they have to fit a certain mold to be successful. Although AAMC reports a high percentage of matriculating URM students in 2021, how many more are weeded out by the egregious amount of social and financial capital needed for the profession?1 I argue that the feeling that they cannot have success in the field, better known as imposter syndrome, creates a self-fulfilling prophecy that can deflect even more qualified FGLi and URM candidates. This toxic combination of socioeconomic barriers, lack of mentors that come from similar backgrounds, and imposter syndrome, is a threat to the goal of increasing diversity as a means to improve health and reduce health disparities.
Medical schools see the value in diversity as they work to increase the number of students from underrepresented and/or disadvantaged backgrounds, but admitting these students is a downstream act. There is a need for upstream interventions at the institutional level, such as longitudinal pipeline programs, to ensure that these students are not leaving the field simply because of a perceived inability to accomplish their goals or belong there. In addition to pipeline programs, well-funded support systems are needed to retain these students in medical school. Currently, there are models led by student-run non profit organizations, such as Prescribe it Forward and The MV3 Foundation, that promote accessible mentorship as a resource to address barriers and gaps in access.
Mentorship can empower these students to forge their own path, regardless if doing so makes the journey to medicine more circuitous and challenging compared to the “path of least resistance.” While change can be challenging to implement, it will take a push from current medical students, physicians, and administration to hold ourselves accountable to this investment in diversity. Without it, who knows how many future change-makers of medicine are out there, doubting their place in a profession where they rightfully belong?
- Boyle, Patrick. “Medical School Applicants and Enrollments Hit Record Highs; Underrepresented Minorities Lead the Surge.” AAMC, 8 Dec. 2021,
https://www.aamc.org/news-insights/medical-school-applicants-and-enrollments-hit-record-highs-underrep resented-minorities-lead-surge. - “Figure 20. Percentage of Physicians by Sex and Race/Ethnicity, 2018.” AAMC, https://www.aamc.org/data-reports/workforce/interactive-data/figure-20-percentage-physicians-sex-and-ra ce/ethnicity-2018.
- Sawyer, Danielle L, and Brittany DK Gratreak. “Medical Schools Must Do More to Open the Door to First Generation and Low Income Students.” The BMJ, British Medical Journal Publishing Group, 18 May 2022, https://www.bmj.com/content/377/bmj.o1246.
- 4 Freeman, Brandi Kaye, et al. “Understanding the Leaky Pipeline: Perceived Barriers to Pursuing a Career in Medicine or Dentistry among Underrepresented-in-Medicine Undergraduate Students.” Latest TOC RSS, Wolters Kluwer, 1 July 2016. https://www.ingentaconnect.com/content/wk/acm/2016/00000091/00000007/art00029.
- Gomez, L.E., and Patrick Bernet. “Diversity Improves Performance and Outcomes.” Journal of the National Medical Association, Elsevier, 11 Feb. 2019. https://www.sciencedirect.com/science/article/abs/pii/S0027968418303584.
