In many ways, medicine represents an intersection of myriad disciplines, requiring practitioners to possess an extensive curriculum that stretches across the likes of biochemistry, pharmacology, psychology, and sociology. Altogether, a variety of knowledge ensures that physicians are able not only to treat patients for their immediate cause of visiting the clinic, but also to act as a source of support for addressing troubles adjacent to biomedical disease, such as the emotional and social distress of illness. Though curriculum updates have been implemented to reflect the constantly changing face of medicine, it remains a struggle to reflect the diverse intersectionalities from which patients are drawn in the physical faces of medical practitioners.
The importance of diversity in medicine cannot be understated. Not only has diversity been reported to better educate future physicians and enhance comfort for patients of all backgrounds, but patients themselves also feel more comfortable when treated by physicians with similar lived experience. Patients may feel more at ease discussing their symptoms, or perceive a more trustworthy or intimate connection with their physician. Trust, a value espoused within the Hippocratic Oath, is something that should be cultivated—in fact, greater physician-patient trust is reflective of superior health outcomes. As diversity is something that is predicted only to swell in Canada, there are measurable benefits to ensuring that medical admissions reflect this increasing heterogeneity.
The unfortunate reality is that health care in Canada does not appropriately reflect all aspects of human diversity. The median neighborhood household income of applicants to McMaster School of Medicine, for example, is $98,816—already almost $30,000 higher than the overall Canadian median—and this disparity only grows for medical school admittees. There are significant financial barriers to application, including but not limited to the $320 Medical College Admissions Test (MCAT) fee, which would deter individuals from lower socioeconomic backgrounds, without even touching on the costs often undertaken to improve exam performance.
One study found that the average first-year medical student spends over $2,300 on preparation material alone for the MCAT, with a total economic loss of $6,357 when accounting for time taken from working to study. Compounded with hidden expenditures, such as the cost of travel to interviews or numerous application processing fees, it is unsurprising that the financial demographic from which physicians are drawn is not representative of their patients’ demographics. Perceptions of medicine as an elitist profession do little to persuade students from disadvantaged socioeconomic backgrounds to embark on the long journey to a medical degree.
The aforementioned barriers may directly cause unequal downstream effects. Medical students are significantly less likely to be of Black or Indigenous origin, possibly attributable to larger structural issues that obstruct equality in admission processes. This disparate admissions process creates a vicious cycle that sustains a history of underservice in these communities. It has been well documented that physicians are more likely to practice in locations where patients reflect their personal background, and thus there are direct public health benefits to be reaped from placing a greater emphasis on recruiting from rural backgrounds.
Even among those in medical school, not all are equal. Though much has been done in recent years to promote a greater representation of women in medicine (and indeed, the overall physician population is projected to be evenly split between men and women by 2030), there remain gender gaps in pay, leadership, and specialty. Women are more likely to match into obstetrics & gynecology and family medicine, but less so for specialties such as radiology or surgery. Not only are women less represented in higher-paying specialties, but they also earn less for any given specialty, even when accounting for different working hours—for instance, up to 40 percent less in cardiology. Attention has been drawn to a “hidden curriculum” that surreptitiously guides medical students to pursue differential careers by gender, calling for policies and awareness training to end the perpetuation of implicit biases.
Though progress has been made over recent decades to increase the diversity of our physicians, much work remains before justice can be achieved across race, gender, ethnicity, and income. Healthcare is a service accessed by all irrespective of background—thus, it is necessary that our healers themselves are cleansed of prejudice before we may properly begin the healing process for the structural inequalities that plague our society.
