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Doctor Nepotism

To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art. – Hippocratic Oath

I come from a family with physicians in it. If I randomly sample my class, I’m sure at least 30-40% of my peers have family members who are medical doctors, whether they be parents, brothers, sisters, uncles, cousins. It’s a common finding all across the country.

Medical students tend to come from families with doctors in it.

The reason for this is probably because children of physicians are more likely to get an exposure into the medical field. Their parents probably encourage their kids to consider this profession. When they do decide to apply to medical school, they are told what all the right things to do are to bolster their application. As a result, a large portion of medical classes are made up of students in upper-middle class.

There’s nothing wrong with a kid wanting to be a doctor like mom or dad. What’s concerning is that there is an over representation of students from better-off families and an under representation of students from lower socioeconomic classes. When graduation rolls around, doctors will be less likely to go to under served communities and help those who have the least access to health care.

It’s a moral dilemma that I have thought about often. I wonder if it would have been better if my spot was given to someone from a rural community, a lower socioeconomic class, an aboriginal reserve? We try to fix this problem by giving preferential treatment (or affirmative action) to those we want to attract in the admissions process. In theory it should help, in reality I wonder if it makes a difference.

Is there a good solution to making medical schools more diverse to include more than just upper-middle class students from privileged families?

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  1. Med School Odyssey
    Med School Odyssey April 16, 2011

    The real solution to all of this is to break the monopoly on medical training that is maintained by the American Medical Association. You want diversity of background? Expand class sizes and stop rejecting 25,000 applicants every year. End the preferential admission to people that have family members that are doctors – adcoms need to stop accepting “My parents are doctors” as a valid reason to apply to medical school.

    This particular subject really tends to piss me off since I run across hordes of pre-meds that have no business practicing medicine but will probably get in because they can tell an admissions officer that their parents are doctors. Makes me sort of angry.

    • medaholic
      medaholic April 17, 2011

      @Med School Odyssey

      1) As far as I know, there’s no preferential admission for people who have family members who are doctors, at least not in Canada. As mentioned in my post, I believe why a lot of kids who have doctors in their family end up going on to do med school is because a) better resources, coming from better backgrounds, more focus on education etc and b) more exposure into the field, able to volunteer/ do research etc.

      At least at my school, having family members that are doctors have zero weight in the admissions committee.

      2) Expanding class size is another topic all together. Each spot has funding associated with it dictated by government. The reason why thousands of applicants are rejected each year is because demand far surpasses supply. And the supply is limited by resources each province allocates to the schools. Taxpayers subsidize medical education, and class size will change from year to year due to budgets.

    • Hideyuki
      Hideyuki February 7, 2012

      With all of this thconolegy being created, when will integrity – over talent – be the most demanded character trait? Food for thought.

  2. Josh
    Josh April 17, 2011

    I’m fairly sure that the AMA has little to no role in medical training, which also goes for the CMA. “My parents are doctors” is not any kind of valid reason to apply to medical school that would be taken seriously by admissions committees and preferential admissions do not exist in Canada.

    • Med School Odyssey
      Med School Odyssey April 17, 2011

      None of the preference is formal – but what the original article mentioned about nepotism is exactly correct.


      As far as limits on class sizes, I’d forgotten that the poster was Canadian. But in the US, the AMA absolutely does control medical training. New schools cannot be opened without the blessing of the state branch of the AMA. Class sizes also cannot be expanded without their permission either.

      As far as I’m concerned, the medical profession has basically become a guild. If you have a family member that’s a doctor, your chances of getting into the guild are a lot higher. As long as the supply of medical training is restricted by the AMA, you’ll never be able to eradicate nepotism from the admissions process.

  3. medrunner
    medrunner April 18, 2011

    Hey Medaholic,
    It’s funny that you would post this as UBC is currently going through an interesting “change”.
    Last year the new Dean Dr. Joseph Finkler openly admitted to a problem regarding SES and medical school admissions and indicated that UBC would be making an effort to combat this issue. This past month he released a statement through the UBC Senate that simply stated the school does not measure SES on any applications and did not mention whether or not this would be addressed, even though in his original article he mentions that he would like the school to show some changes as early as this fall. I understand that it is a difficult task, and change will take time… but it was just disappointing to see nothing done this year, if anything UBC took a bit of a step backwards with their latest rule changes. Anyways, just thought I’d post this up here for you and your readers.

    • medaholic
      medaholic April 18, 2011

      Thanks for the article. I think the problem isn’t going to be corrected at the medical school admissions level, or at least it’s very hard too. A solution like offering scholarships to inner-city kids or disadvantaged groups early (say in elementary school) and mentoring and encouraging them to pursue a medical field might be more effective. However, doing that requires long term effort that no one is willing to undertake.

  4. Michael
    Michael April 19, 2011

    Perhaps medical schools could have separate pools of applicants based on their economic status – similar to how some schools in Canada dedicate a certain number of slots to Aboriginal students.

    Then again, its really hard for people to define the boundaries between upper and lower class. I mean, you can have a rich family who simply refuses to support their kid’s educational endeavors while at the same time, a poor family that decides to pool all their resources on their children’s success.

  5. Heidi
    Heidi July 22, 2011

    In my opinion, it is concerning how your socioeconomic class decides whether you going to become successful or not. It would be easy dedicating a certain number of slots for lower class people as a short term solution but it would not work long term.

    just my five cents

    // Heidi

    • medaholic
      medaholic July 22, 2011

      Interestingly enough, dedicating a few spots for lower SES is quite hard. How would you decide who is disadvantaged? Unfortunately the problem starts many years before applying to medical school. It starts in our primary school education, whether people have to work part-time jobs, whether they are able to afford secondary school, etc…

  6. Edward Sanders
    Edward Sanders August 30, 2011

    “There’s nothing wrong with a kid wanting to be a doctor like mom or dad. What’s concerning is that there is an over representation of students from better-off families and an under representation of students from lower socioeconomic classes.”

    Unfortunately, this is a trend with higher education ingeneral, not simply with medical school. Medical school, however, rarely provides the opportunity for assistantships, unlike most PhD programs in science. And as medical school is an enormously expensive proposition, it’s not surprising that children of well-off doctor’s families (as I am myself) are more likely to attend medical school. There is also the “apple doesn;t fall far from the tree” phenomenon. The question is, how could we equitably rpovide the opportunity to go to medical school to a broader socioeconmic spectrum without compromising the quality of the education?

  7. Bryce
    Bryce February 14, 2012

    I have to agree with Edward about this is the trend with higher education in general. Yes families with more money have a better opportunity to go to a better school but there are a lot of grants, loans and scholarships available today that can help someone who comes for a lower income household be able to attend the school of their choice.

  8. Pearlie Farnan
    Pearlie Farnan April 18, 2012

    Medical students from rural backgrounds tend to practise in rural areas. The problem is that no medical schools are in the north and there are so many barriers for rural and northern students to attend a university in the south

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