In an undergraduate introductory chemistry lecture at Stanford University, a friend and I, both Black freshmen who graduated near the top of our college-preparatory Catholic high schools’ classes, sat feeling unprepared for the presented material.
“It’s like I missed the actual introduction before this class,” my friend said, processing the disillusionment of our first lecture. I could relate: The material felt completely new, and it was taught so quickly that it seemed to build on knowledge I did not have. I had taken honors chemistry in high school and chose not to take the advanced placement (AP) course only to avoid overloading my schedule. Sitting in that lecture hall, I started regretting that choice.
While AP classes are often described as an opportunity to earn college credit by placing out of introductory courses, they also prepare pre-medical students for the rigor of university-level classes. A College Board study found that students who took AP classes in high school performed better in intermediate college courses within the same field. AP courses are also designed to introduce college-level concepts at a slower pace. I passed on that opportunity in chemistry only because no one told me how helpful it would be.
My friend, who always knew he wanted to be a doctor, decided to withdraw from the course and pursue it the following year when he felt he could be more successful. I applauded his bravery for identifying what he needed. I decided to stick it out, stumbling through the problem sets and exams. By some miracle, I did fine, and so did my friend. But not everyone does.
A 2008 Stanford University study found that half the students who come from racial or ethnic minoritized groups drop out, compared with only 17% of others. One of the significant factors they noted was discouragement due to chemistry class difficulty. There are droves of smart future physicians from minoritized groups who abandon their dreams because they believe they cannot succeed. Their fears are confirmed through educational experiences that confirm their lack of preparation.
Our stories have a happy ending. We both graduated from medical school and are currently training in our chosen specialties: adolescent medicine for me and emergency medicine for him. Yet I am still disappointed that our high school education, even at institutions of privilege, did not adequately prepare us for the next level. Despite our stated interest in medicine, we were not warned about the difficulty of college chemistry or advised to take specific AP courses. This missed opportunity for us is often nonexistent for other minoritized students, who predominantly attend schools where advanced courses are not even offered.
There are many Black and Brown students whose stories that do not end as well as ours and whose talents do not materialize into the physicians we desperately need, especially when there is a predicted shortage of 54,100 to 139,000 physicians by 2033. The United States needs people with the proper education and training to meet this growing need. A diverse medical workforce allows physicians to reflect the various backgrounds of patients and help bridge cultural, socioeconomic and racial barriers.
Preparation for pre-medical success begins long before a student starts college. As long as there are racial or ethnic inequities in educational opportunities, students are set on unequal paths toward medicine. Public schools are increasingly segregated by income and race, and these changes have negative impacts on STEM education for students from lower socioeconomic status backgrounds.
A report by Change the Equation demonstrates that at every educational level, students in high-poverty schools have less access to science laboratories, regular science activities and teachers with adequate resources. At the high school level, high-poverty schools also have less availability of statistics, physics and advanced calculus courses. The report concludes that “as a result, students in such schools suffer disadvantage upon disadvantage over the course of their schooling, and they face dim prospects for rewarding STEM careers.”
Poverty rates in the U.S. among Black and Latinx people are 18.8% and 15.7%, respectively, and are more than twice as high as white people. Therefore, limited access to STEM education in high-poverty schools disproportionately affects racial and ethnic minoritized groups. It is no surprise that between educational inequities and the high cost of applying to medical school, only 24% of medical students come from the lower three quintiles of parental income.
Increasing diversity in medicine must start with equitable educational opportunities. All students, regardless of race or family income, need access to early and quality experiences in math and science. From this early exposure, they will not only learn that careers in STEM are possible but also feel prepared to thrive in them. Funding needs to be diverted to high-poverty public schools so that students and teachers have the resources to effectively learn and teach. As physicians, we can advocate for allocation to these areas of need so that future generations of physicians can be more diverse.
Currently, many medical schools aim to support the path to medicine for minoritized groups through programs for high school or college students to encourage careers in medicine. These programs provide students valuable exposure to the medical field, where many can meet a physician who looks like them. Minoritized physicians often credit these early experiences for their interest in medicine.
While these programs provide valuable exposure to healthcare careers, they must also address existing educational inequities. By incorporating supplementary experiences, they can build on their participants’ school curriculum. For example, program organizers can develop labs or activities that demonstrate how chemistry and physics are foundational to biology and medicine while reinforcing grade-level appropriate content.
Students also need structures to help them bridge the gap between the STEM careers they desire and the education they have been given. Some universities have summer programs to support incoming students in their academic and social transition to college. In 2012, Stanford University started Leland Scholars, a four-week, funded pre-enrollment program focused on first-generation college and low-income students from under-resourced high schools. The participants complete a research project together, participate in writing and STEM courses, and have access to community and advising throughout their college experience. More colleges and universities should offer these programs so that students can succeed in pre-medical coursework, regardless of background.
Any student can succeed with the right support. The lack of racial, ethnic and socioeconomic diversity in medicine reflects the unequal opportunities in our society. Calls for increasing diversity in medicine must be matched with advocacy for quality math and science education and supplementary opportunities for the students who need it most.
A first-generation college student from a public high school should have the same educational access as a private school student with college-educated parents, like me and my friend. Our success navigating pre-medical coursework was made possible by the education we received, even with its shortcomings. More Black and Brown students can become doctors if they’re provided the same opportunities. Because demographics should not determine the path to medicine.