Do current 'unwritten requirements' select for the wealthy?

[Spinach Dip]

short answer: yes.
Working as a tutor has put me in contact with a large number of very interesting pre-meds. One of these cases I related here before (in a thread which was closed far before its time): http://forums.studentdoctor.net/threads/this-is-who-you-are-competing-against.1181975/

It has become apparent to me that the path we call "pre-med" is nothing more than a game wherein one puts in the minimum amount of effort to check off boxes of activities which meet (and rarely exceed) a predetermined set of precise expectations. Gotta have research. Gotta shadow. Gotta work at a summer camp for deaf kids. Gotta volunteer at some hospital. Etcetera.

I'm not here to debate one activity or another. Nor will I waste my breath to remind you yet again that the vast majority of premeds are doing these things solely to impress adcoms and not because they are intrinsically good people. I write this to bring up the fact that there is one massive advantage that a certain subsection of the premed population has which the other subsection can never obtain. And that is this:

A parent who is independently wealthy and knows the rules of the game from before their child even begins playing.

This, more than anything else, is the best indicator of success in this little game we play.




Let's talk about shadowing.

I loved shadowing. Of all the premed activities I took part in, shadowing was undoubtedly my favorite and the one where I learned the most.

However, I had a hell of a time finding a single physician who would allow me to shadow. Perhaps this has to do with the fact that hundreds of other premeds at my university were all asking the exact same doctors? Most among my classmates had shadowed 0-1 physicians by graduation. A couple lucky ones shadowed 2. Many of these gigs lasted only 1 or 2 days.

There were also a couple who had shadowed more than 2. These were, in every case, children of physicians. Some admitted to being in pseudo-exchange programs between physician parents ("If my son shadows you, I'll let your daughter shadow me.").

You can see similar things in research where a lab manager will add authors who did little-to-nothing to help the research. Of course it's immoral and nobody will admit to it, but everyone knows it happens.

And those who are born into rich non-medical, non-research families? Go on a mission trip to Nigeria for a couple weeks, courtesy of dad's wallet.

The really serious ones don't even wait for college to start. Billy just started highschool? Better get him volunteering NOW so he can have double the hours everyone else has when it comes time to apply to med school in 8 years.




The outcome

This has been on my mind a long time, but I choose to make this thread now because of a statistic I heard only recently: Apparently, only ~1000 african americans applied to med schools last year (2 years ago? 3? Whatever.), which makes them ~2% of all applicants. Yet, they are the largest minority in this country, making up 12% of the population. Most distressingly, this number has been decreasing.

I, for one, am not surprised.

The pre-med game benefits those who can volunteer their summers in Zimbabwe instead of work at starbucks because they are struggling to make rent. It benefits those who begin amassing ECs from day 1 of freshman year.

It benefits those who know there is a game to play.




I don't even blame adcoms (eh, not much). With 30-100 people applying for every single seat they have, they are living in a dream-like sellers market where they can disqualify any number of people for any trait they desire, and still have dozens begging for every spot. Of course they would select the most qualified applicants. Who wouldn't? But they have (through selecting those check-box activities that anyone on this site can name) selected for starting classes which are overall whiter and richer than the average.




In his book Excellent Sheep, author William Deresiewicz refers to this problem as "Hereditary Meritocracy". He says that Americans like to believe their society is a meritocracy, where individuals are judged solely on their individual efforts and accomplishments, but the real America we live in is anything but. It's not just limited to college life, but even private highschools and elementary schools where teachers actually care about the fate of their children (rather than get them in and out the doors assembly-line style) can have a massive effect on a child's future. Putting your child into sports can get them scholarships (or even admittance) into better universities.

In America, everyone is equal (in theory). It just so happens that those born to 1%ers have more chances to do things with their equality than, say, those born into families who think having 9 credit cards is a viable long-term financial strategy.




In summary, here is a quote I saved from somewhere (was it this website? Either way, google scholar is not helping me find its source). If true, it would mean the proportion of med students from low-SES backgrounds has fallen by 63% over 31 years.....I wonder where it stands now, 10 years later.....


"Unfortunately, one group that did not benefit from this expansion was students of lower socioeconomic status (SES). In 1971, 27% of students came from families in the lowest two quintiles (lowest 40%) of household incomes nationally.[6] By 1987, this important segment of medical school enrollees had dropped to 15%, and, by 2004, it was only 10%.[34] Similarly, in 1974, 66% of students came from the top two quintiles (top 40%) of household incomes, but these percentages increased to 70% in 1987 and to 75% by 2004.[7,34]"

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[deleted480308]

One of the reasons I work so hard is to give my kids an edge over other kids.

 

[MaxPlancker]

Certainly. I know many examples of students' whose family wealth, connections, positions have provided significant advantages. Perhaps the biggest problem for those outside of that minority is simply knowing of opportunities. Sure, one may have to ask more times to get into a lab, shadow, etc, but with persistence and good planning, those opportunities are not tremendously difficult to indulge for most people. Yet, one must have the knowledge of opportunities to pursue them; looking back, when I first entered college I was so "naive". I didn't realise undergrads could do research, that you had to even have volunteer experience as a pre-med, etc. That is why it is often very beneficial to seek out mentors who have been through what you are going through; however, I imagine many segments of society do not have ready access to those mentors which is another obstacle.

Also, I would like to point out that children coming from wealthier families often tend to have better developed social skills for settings such as interviews. There are many intangibles that come with status.

With regard to the stat about African Americans (NOT trying to shift nor start a debate about Affirmative Action or URMs), a big problem IMHO is that immigrant/foreign Africans detract from the more support that African Americans should receive. I've interviewed at many schools and 9 times out of 10, the black applicant would be African (not African American). Many of these immigrant families have the same mentality as other immigrant races such as Asians and are more successful/well-to-do than people may realize.

In the end, the advantage will always be there (or at least for a very long time). Life is a cumulative game and the successes of your ancestors or lack thereof do, whether desired or not, play a significant role in the following generations.

 

[The Knife & Gun Club]

I consider myself a 5%er (not in the 1% but financially comfortable enough to not have to work during undergrad), so I'm probably part of the "problem" more than the solution...but anyway...heres my take

yes, being wealthy does help with these "unwritten requirements" but this is not unique to medicine. For literally any profession imaginable, having wealthy parents helps. Lawyer, doctor, business, entrepreneur, software design, anything. Being able to intern unpaid, having your own car, or having more time to devote to studies because your not working part time are all advantages in any field. Maybe it is more noticeable in a field like medicine where the entry requirements are so clearly defined, but it is certainly not unique.

My point is, while it sucks, it's the society we live in. And I think you'd be hard pressed to find a society where having wealthy parents isn't a leg up in life. This problem has exited for as long as humans have, and we've yet to find a good way to remedy it.

 

[CoomassieBlue57]

shor

Let's talk about shadowing.

I loved shadowing. Of all the premed activities I took part in, shadowing was undoubtedly my favorite and the one where I learned the most.

However, I had a hell of a time finding a single physician who would allow me to shadow. Perhaps this has to do with the fact that hundreds of other premeds at my university were all asking the exact same doctors? Most among my classmates had shadowed 0-1 physicians by graduation. A couple lucky ones shadowed 2. Many of these gigs lasted only 1 or 2 days.

There were also a couple who had shadowed more than 2. These were, in every case, children of physicians. Some admitted to being in pseudo-exchange programs between physician parents ("If my son shadows you, I'll let your daughter shadow me.").

You sound like an entitled millennial, as if it is you're right as a premed student to shadow a physician. Does having a physician parent help get in the door... yes. But I would argue that my shadowing experience (I worked hard to obtain the several opportunities I had) were more valuable than a student who shadowed a parent or a parent's friend.

No parent or family member helped me. I don't have any family working in the medical field. Every physician I shadowed, I made a personal connection with them before I had the opportunity to observe them. These physicians went the extra mile for me, because they knew I cared about the opportunity to shadow them. This is what many premeds fail to realize.

How would you feel, as a physician, if you allowed some random premed to shadow you from a cold call, only to never be seen again just so they could put a check mark next to their application. The physicians I shadowed gave this exact reason why they rarely allow premeds to shadow them (there are ways to circumvent the administrative bs in most cases, even if they tell you otherwise). It is the ones that show initiative and drive that they want to help.

Oh look, putting effort into your application is too difficult, so instead you're going to complain how the system is rigged.

 

[JessebenBenjamin]

9 times out of 10, the black applicant would be African (not African American).

I also noticed this. Very weird.

 

[Mansamusa]

I'm not as concerned about the unwritten requirements (which are difficult, but possible to overcome) as I am about the immense financial burden non-wealthy students need to take on.

Without parental support, you need to go in double the median about of debt to pay for school. The schism gets wider and wider as interest accrues, so we start out at a huge disadvantage and I can very well end up with a lower take home pay than my parents, who didn't go to college, until my mid-50s or unable to pay depending on how the system changes. $320K-350K for med school + $60K of capitalized interest + $75-200K for residency is outrageous

I'm still at the point where I am 50/50 about whether or not I want to start med school next year. Being trapped in a job that may be completely different than what I envisioned, under a rapidly changing healthcare system, while swimming in debt that is impossible to pay off is my worst nightmare. I intend on loving the career, but you can't really know until it's too late and then there is no getting out.

The financial costs of applying to med school and getting MDs is where wealthy students get the biggest advantage

 

[eteshoe]

With regard to the stat about African Americans (NOT trying to shift nor start a debate about Affirmative Action or URMs), a big problem IMHO is that immigrant/foreign Africans detract from the more support that African Americans should receive. I've interviewed at many schools and 9 times out of 10, the black applicant would be African (not African American). Many of these immigrant families have the same mentality as other immigrant races such as Asians and are more successful/well-to-do than people may realize.

Just wanted to point out that many African immigrants have a good enough family/community network to understand the "game" being played. They parents aren't the well to do people in most cases - they're just strategic enough to push the right child to succeed.

My parents are doing ok, but they sacrificed a hell of a lot to get me opportunities to compete against the more advantaged kids (be that wealth, networking, etc). So yes you learn the game from another angle and you learn to push yourself as well (typical immigrant mindset) so that the next generation can be more advantaged. I push myself despite the whole 'URM advantage' thing because I don't 'just' want to get into the program - I want to crush the competition and forge my way to my goals. One cannot do that simply putting in just enough work to slide into the next level.

In many immigrant cases, especially if the kids are born outside of the US, the benefits of living in the US are not seen until the kids' kids are born. And this the reason why you see Africans on the interview trail IMO.

 

[Lannister]

My parents are the 1% (it's kind of strange to say that because I always assumed the 1% were extremely wealthy people, which we're really not). My mom went to graduate school but is a homemaker, and my dad, our sole source of income, never finished college. Neither of them know anything about medical school at all. In my experience, having wealthy parents obviously helped. I got to go to a great school with lots of opportunities for pre-meds, I've done extensive international traveling, I could have taken an mcat prep class if I wanted to, etc. But in my opinion, having parents in the medical field would be SO much more of an advantage than just having wealthy parents. Having connections would've made it so much easier to find shadowing and research opportunities. And just having your parents understand what you're going through would be so helpful. I mean, my parents spent most of my college years trying to convince me to go to med school in the Caribbean.

Sent from my HTC6535LVW using SDN mobile

 

[MaxPlancker]

Just wanted to point out that many African immigrants have a good enough family/community network to understand the "game" being played. They parents aren't the well to do people in most cases - they're just strategic enough to push the right child to succeed.

My parents are doing ok, but they sacrificed a hell of a lot to get me opportunities to compete against the more advantaged kids (be that wealth, networking, etc). So yes you learn the game from another angle and you learn to push yourself as well (typical immigrant mindset) so that the next generation can be more advantaged. I push myself despite the whole 'URM advantage' thing because I don't 'just' want to get into the program - I want to crush the competition and forge my way to my goals. One cannot do that simply putting in just enough work to slide into the next level.

In many immigrant cases, especially if the kids are born outside of the US, the benefits of living in the US are not seen until the kids' kids are born. And this the reason why you see Africans on the interview trail IMO.

Agreed I think it is primarily the mentality/strategy.

 

[longleat11]

Chalk this up in the "no duh" column. Coming from money is an advantage. This is true in most aspects of life, not just medicine.

 

[Lucca]

I would say the parental advantage thing is important in both college and medical admissions but much much much more important in college admissions. We're immigrants. We didn't know anything about anything when it came to higher education. I got good grades, I liked school so my parents assumed I would want to go to college but it wasn't a given and most of our family friends (also immigrants) had kids who did not go to college or at least did not straight out of high school. I was the first one to actually go to a 4 year university if I remember correctly. That game is a lot more opaque and distanced than, say, med admissions. There are a million and one resources at many colleges to help you navigate the process, including other students so the parental advantage is less pronounced.

 

[Terror Billy]

Nepotism is very prevalent in the pre-med game and I don't think this is a millennial complaint by the OP. I know for a fact fellow pre-meds who have parents as doctors talk about how over break they're going to "rack up hours" shadowing their parents friends. As getting into medical school has become so much more competitive people have resorted to whatever it takes to make themselves stand out...

 

[DokterMom]

Haven't read all the way through yet, so just based on Spinach's post:

Unfortunately, you're right @Spinach Dip -- But when schools try to correct for the advantage the wealthy and 'in the know' are born with, there's an outcry against "affirmative action" and the "preferential treatment" given to URMs and low SES applicants. This seems to be a 'no win' for those who weren't born lucky.

But please don't let it sour your outlook. Because that in itself often is perceived as "seems to have a chip on his shoulder", which further diminishes your chances.

 

[Hospitalized]

Life selects for the wealthy. This isn't a medical school specific thing.

 

[The Knife & Gun Club]

Wouldnt it be really easy to break into law if your parent was a lawyer? Much easier to break into banking if your parent was a banker?

What is being described here isn't unique to medicine or some horrible slight on America's poor...it's just the way the world works.

5000 years ago it was a hell of a lot easier to become a carpenter, sailer, or mason (or even a proto-doctor/medicine man) if your parent had the same profession.

 

[SurgeonOfLife]

I wholeheartedly agree with the title of this thread. As others have suggested, it's just how things work in society and is probably a natural law of society itself.

And when I was on the interview trail, what I strikingly noticed was that even though people say they are amazed to see someone without many opportunities get this far, who'd you rather have a part of your class as an admissions committee member? - One that had an amazing year staying abroad over in China helping orphans and able to do that with the monetary support of their parents or one that worked hard and got lucky enough to find a awesome physician to shadow? Someone that got to fly over to Egypt and participate in protests in Cairo during the Arab Spring or someone that had to work every summer in a menial job to pay for school?

 

[DokterMom]

You sound like an entitled millennial, as if it is you're right as a premed student to shadow a physician. Does having a physician parent help get in the door... yes.

[snipped for brevity]

Oh look, putting effort into your application is too difficult, so instead you're going to complain how the system is rigged.

The self-righteous anger and "I did it without any help - Why can't you?" attitude are part of the problem, and in my opinion, an increasingly large part of the problem.

It was easier to see the disadvantage (and easier for the public to accept correcting adjustments) when discrimination was overt and sanctioned by law and custom. But this 'faux meritocracy' we're in now -- (To quote Spinach again: "In his book Excellent Sheep, author William Deresiewicz refers to this problem as "Hereditary Meritocracy". He says that Americans like to believe their society is a meritocracy, where individuals are judged solely on their individual efforts and accomplishments, but the real America we live in is anything but.") This faux meritocracy is even more pernicious because those few disadvantaged applicants who learn to play and master the game provide the appearance that the playing field is level, when clearly it isn't.

To master the game, you first have to know there IS a game. Then seek out the rules. Then learn to play. And for disadvantaged applicants, there are obstacles at every step.

Most HS students know that you need good grades to get into college. So many work to get good grades, and succeed as far as that goes. But they often don't know that those grades need to be in honors or AP classes, so are bested by the kids who have this knowledge. And they may not know how ECs contribute to the "well-rounded" applicants who score the "best" spots, and/or may not have the funds to pursue "club" sports at a level that attracts athletic scholarships. They know they need to take the SAT/ACT tests, but don't necessarily know that multiple retakes are the norm for wealthy kids or have the money to do that even if they do know. And those college admissions tests are themselves biased in favor of well-educated households. A student's vocabulary and reading comprehension are hugely enhanced by having well-educated parents who are native English speakers.

The kinds of 'grooming' that advantaged students get goes on for YEARS, decades even before medical school. If the STUDENT is the one who has to find out that there's a game and what the rules are, then they're already way behind...

The disadvantaged desperately need mentors.

 

[Terror Billy]

The self-righteous anger and "I did it without any help - Why can't you?" attitude are part of the problem, and in my opinion, an increasingly large part of the problem.

It was easier to see the disadvantage (and easier for the public to accept correcting adjustments) when discrimination was overt and sanctioned by law and custom. But this 'faux meritocracy' we're in now -- (To quote Spinach again: "In his book Excellent Sheep, author William Deresiewicz refers to this problem as "Hereditary Meritocracy". He says that Americans like to believe their society is a meritocracy, where individuals are judged solely on their individual efforts and accomplishments, but the real America we live in is anything but.") This faux meritocracy is even more pernicious because those few disadvantaged applicants who learn to play and master the game provide the appearance that the playing field is level, when clearly it isn't.

To master the game, you first have to know there IS a game. Then seek out the rules. Then learn to play. And for disadvantaged applicants, there are obstacles at every step.

Most HS students know that you need good grades to get into college. So many work to get good grades, and succeed as far as that goes. But they often don't know that those grades need to be in honors or AP classes, so are bested by the kids who have this knowledge. And they may not know how ECs contribute to the "well-rounded" applicants who score the "best" spots, and/or may not have the funds to pursue "club" sports at a level that attracts athletic scholarships. They know they need to take the SAT/ACT tests, but don't necessarily know that multiple retakes are the norm for wealthy kids or have the money to do that even if they do know. And those college admissions tests are themselves biased in favor of well-educated households. A student's vocabulary and reading comprehension are hugely enhanced by having well-educated parents who are native English speakers.

The kinds of 'grooming' that advantaged students get goes on for YEARS, decades even before medical school. If the STUDENT is the one who has to find out that there's a game and what the rules are, then they're already way behind...

The disadvantaged desperately need mentors.

If I could super-like this I would!

 

[SurgeonOfLife]

^^Also thank you DokterMom. I became a re-applicant almost a year ago to date and you gave me advice/insight in another thread that helped me tremendously this cycle. Now I'm going to med school! You seem to have a fundamental and real understanding of the topic covered in this thread and others like it. Thank you.

 

[GrapesofRath]

By and large the points being made here are valid and Im not sure how anybody can argue against them past a point really. Wealth is an advantage that cant be "corrected" for by any admissions commitee in any admissions process.

The problem any low income person makes(who isnt a URM) is that there will always be applicants who come from very poor backgrounds who manage to do everything, ace school, have top ECs etc. That's just how good the applicant pool is. So in many ways an ADCOMs response to a poor applicant talking about "I didnt have time to develop my ECs because I was working 30+ hours a week" or "I had all these other commitments and my GPA is lower becuase of that is" would be "well our app pool has people who come from poor backgrounds who did all that you couldnt do". Its an unfair standard, but that's going to be the response youll always get. Nothing you can really do about it.

Regardless of what people will admit publicly and I dont want to start a URM flame war, a significant part of why Affirmative Action for URMs exists and has the influence it does is because of external pressures and the benefit it provides individually to each medical school. These dont exist for taking on applicants from poorer backgrounds to nearly the extent who arent URMs. Frankly schools just like all of us do what's in their best interest.

Schools at the end of the day are very risk averse and terrified of attrition/losing medical students. The best way to protect against this is to take on applicants who a) can show they know what they are getting into b) who have academic credentials that prove historically they are very low risk. Applicants from low family income backgrounds can have the same "desire for medicine" or "academic capabilities" but it can be harder to prove this and unfortunately without external pressure to accept such applicants like there are for URMs/legacies, theyll always be at a disadvantage. Unfortunately, there is no great solution here or a fix coming anytime soon; no point tip-toeing around the subject but the applicant who can best highlight how they have overcome the struggles theyve faced in life in their application will be at an advantage.

 

[terra330]

Having a parent physician is definitely helpful, but even within that subset, some people have advantages over others. My dad's a FMG (born in India and went to med school there), so while he was able to hook me up with good shadowing experiences, he didn't really know how the game is played for getting into med school here. I also frequently got asked whether I'm going into medicine because he's a doctor or whether or not he's making me pursue the career.

 

[CoomassieBlue57]

The self-righteous anger and "I did it without any help - Why can't you?" attitude are part of the problem, and in my opinion, an increasingly large part of the problem.

It was easier to see the disadvantage...

You're correct that there is a socioeconomic advantage over the poor and/or uneducated for many prestigious professions. I never denied it in my argument. What I am saying is that I see a repeated theme on SDN complaining about how unfair the clinical experience portion of the application is for many aspiring physicians. I see it time and time again, "shadowing is a requirement ADCOM's look for, but it's so unfair because I can't find any doctors to shadow". Developing relationships with doctors and truly seeing what the professions entails is far more valuable than just checking a portion off of an application for shadowing a doctor a total of four hours once (how OP described).

There were also a couple who had shadowed more than 2. These were, in every case, children of physicians. Some admitted to being in pseudo-exchange programs between physician parents ("If my son shadows you, I'll let your daughter shadow me.").

This is what I took issue to. I had several opportunities to shadow a variety of physicians. I CREATED THIS OPPORTUNITY. Not mommy or daddy. Not my undergraduate institution. Not anyone else. It was ME. I worked for it because I don't expect anyone else hand me anything.

He says that Americans like to believe their society is a meritocracy, where individuals are judged solely on their individual efforts and accomplishments, but the real America we live in is anything but.

Intriguing quote, and I'm sure it's applicable to many other situations, but were talking about the medical school application process where the whole point of the personal statement, activities, and whatnot are to highlight efforts and accomplishments. OP brings up some fantastic, yet disturbing realizations about disadvantages, but his views on shadowing are incorrect. There is a mentality of entitlement with many millennials as demonstrated with the shadowing example.

The disadvantaged desperately need mentors.

Agree. I wouldn't necessarily call myself disadvantaged, but I had much to learn about the medical school application process. I found my mentor (one of the physicians I shadowed) through MY efforts. To reiterate, I set up my own opportunities. Nonetheless, their are those that have the mentality that I have to succeed though their efforts but need direction before doing so.

I know many medical schools are trying to get their students out into the community by going to going to grade schools and high schools in disadvantaged areas. Are any of these grade school students going to become doctors? Who knows, but it provides an opportunity to ask questions and gain guidance. This is great, and I hope to be involved with helping others understand the process.

 

[DrHart]

Great post spinach! I also agree with @terra330 but would expand it a little. Having a physician parent - or even just being middle or upper middle class does not necessarily confer an advantage if, like DokterMom says, the student is the one who has to find out the game and the rules. I think it puts you just as far behind as others. Moreover, if you give it a go but haven't been playing the game long enough, it might be easy to be perceived as a privileged kid who hasn't done enough with his/her time/life, when in fact you just started playing the game late (whereas others have been playing since grade school).

Sometimes I feel like theres a strong narrative associated with being white, middle class, and growing up in the suburbs. I wouldn't really emphasize it though because I know it gives off the whole "woe is me and my middle class/white privilege" sour vibe. But everyone's situation is different, as are the opportunities available to them, regardless of race, family income, or cultural background.

 

[medic86]

You sound like an entitled millennial, as if it is you're right as a premed student to shadow a physician. Does having a physician parent help get in the door... yes. But I would argue that my shadowing experience (I worked hard to obtain the several opportunities I had) were more valuable than a student who shadowed a parent or a parent's friend.

No parent or family member helped me. I don't have any family working in the medical field. Every physician I shadowed, I made a personal connection with them before I had the opportunity to observe them. These physicians went the extra mile for me, because they knew I cared about the opportunity to shadow them. This is what many premeds fail to realize.

How would you feel, as a physician, if you allowed some random premed to shadow you from a cold call, only to never be seen again just so they could put a check mark next to their application. The physicians I shadowed gave this exact reason why they rarely allow premeds to shadow them (there are ways to circumvent the administrative bs in most cases, even if they tell you otherwise). It is the ones that show initiative and drive that they want to help.

Oh look, putting effort into your application is too difficult, so instead you're going to complain how the system is rigged.

Haha. You might need to take a chill pill, dude.

You sound pissed (and obsessed with saying "ME" in all caps), and I can't think of any good reason why.

*shrugs*

 

[eteshoe]

...I also notice something I like to refer to as "nth Generation Syndrome"; A pretty significant number of students from wealthy backgrounds end up wasting all of their opportunities and end up living a lower middle class lifestyle once their parents cut them off, while there are a ton of poorer students right there to replace them. This is especially common amongst "millenials", but you can see it all over the place; immigrants come to America--> work hard for success--> have kids--> work hard for success--> repeat "n" amount of times--> eventually you get a generation who feels entitled and that work ethic disappears. Whether it is the 1st or 10th generation doesn't matter, it eventually happens.

EDIT: This is obviously n=1, but the richest student in my graduating class got rejected from medical and dental school for the past 2 cycles, and has "played the game" since day 1 of freshman year.

Very interesting theory.

 

[Goro]

While I often disagree with Spinach's views on ECs, to give him credit, he is someone who life has given some very hard knocks, and so the "entitled' crack is uncalled for.

At the worst, he's a tad naïve.

You sound like an entitled millennial, as if it is you're right as a premed student to shadow a physician. Does having a physician parent help get in the door... yes. But I would argue that my shadowing experience (I worked hard to obtain the several opportunities I had) were more valuable than a student who shadowed a parent or a parent's friend.

No parent or family member helped me. I don't have any family working in the medical field. Every physician I shadowed, I made a personal connection with them before I had the opportunity to observe them. These physicians went the extra mile for me, because they knew I cared about the opportunity to shadow them. This is what many premeds fail to realize.

How would you feel, as a physician, if you allowed some random premed to shadow you from a cold call, only to never be seen again just so they could put a check mark next to their application. The physicians I shadowed gave this exact reason why they rarely allow premeds to shadow them (there are ways to circumvent the administrative bs in most cases, even if they tell you otherwise). It is the ones that show initiative and drive that they want to help.

Oh look, putting effort into your application is too difficult, so instead you're going to complain how the system is rigged.

 

[KungFuPanda123]

This is what I took issue to. I had several opportunities to shadow a variety of physicians. I CREATED THIS OPPORTUNITY. Not mommy or daddy. Not my undergraduate institution. Not anyone else. It was ME. I worked for it because I don't expect anyone else hand me anything.

Have you ever thought that the summation of your childhood/adolescent/adult experiences gave you the motivation/empowerment to seek out and create these opportunities for yourself? It's very easy to say that _______ was all due to my hard work and effort, without considering what ultimately led to those opportunities.

Many people don't consider the fact that even learning "hard work ethic" comes from a certain upbringing - model parents, motivating teachers, good peers in school, etc. Even more interesting is that even more people don't consider the fact that although all those positive environmental factors correlate with creating amazing qualities such as "hard work ethic," not everyone benefits from these things equally (and not everyone gets hurt from the lack of these things equally). We all know plenty of rich screw-ups who have great parents, go to a great school, have smart friends, etc. We also know of plenty of people who are true rags to riches stories. Look at John D. Rockefeller and Andrew Carnegie.

People like JDF and Carnegie could easily say (and did say) that they created every opportunity for themselves and that people need to get off their asses and work hard and become successful like they did. But having this mentality and then pressing it on others as though this method is a one-size-fits-all method for success is incredibly toxic. Hard work and being smart alone don't get you to where you need to be; you need other factors to be on your side as well; let's look at luck specifically as one of these factors (others include things like good parents being present, not getting hit by a car at a young age paralyzing you, etc.), since luck is something that absolutely no one has control over.

Let's look at 2 students who are failing high school chemistry; both students have a 50% in the class. Both decide to study REALLY, REALLY hard for their test that is coming up in a few days (they decide not to procrastinate, because they are promising themselves that they will work hard in order to succeed). They both study the same amount of time, and while they both study all the main material, they end up focusing on mastering different things that should show up on the test. Test day is here, and both students take the exam. All the things that student A focused on end up showing up on the test, and he ends up getting a 90% on the exam. All of the things that student B focused on don't show up on the test, and he ends up getting a 65% on the test (still a big improvement from a 50%, but not representative of his hard work). Student A sees the fruits of his labor and sees how working hard will lead him to success, and decides to work hard in his other classes too. Student B sees that even though he worked hard he still got a failing score, and he sees no reason to try anymore since trying doesn't make a difference. He keeps studying the same amount in his other classes as he was already doing. Where do you think each student is now 10 years down the road? It's easily possible that both students are both f-ups somewhere. But it wouldn't be surprising if student A ended up somewhere better in life than student B. And how did he get there, and what would he tell people was his secret? He'd say it was "working hard."

So while working hard is the secret ingredient in success, outside factors that are beyond our control play a big role too; luck being just one of these factors (and the one factor that I like talking about, since we have 0 control over it). Should student A 10 years down the road beat down on people who haven't gotten to the same level of success as him and say that they just "didn't work as hard?" He could... I mean, student B clearly didn't work as hard over those 10 years as student A, right? But no - in my opinion, he shouldn't. That beats down on people like Student B who worked just as hard as student A on that one fateful day. It marginalizes people like student B who really did want to work hard in life but were given a poor hand 1 too many times and fell off the deep end as a result.

So please don't attribute every little thing that you do to just YOUR hard work and YOUR success and the opportunities that YOU sought out. Nothing that you have accomplished is a result of just you. Luck played a role, and so did every other thing outside of just yourself such as your peers, friends, family upbringing, presence of younger/older siblings, country you were born in, presence of 4 functional limbs, lack of any debilitating diseases, etc.. Of course, YOU probably did play a gigantic role in your success, but discounting the positive benefits from an infinite number of sources sounds incredibly selfish and self-righteous. Reading the extent to which you attributed your success to just YOU made me a bit sick in the stomach.

This isn't necessarily presented at you CoomassieBlue57, but I do like this comic a lot:
http://digitalsynopsis.com/inspiration/privileged-kids-on-a-plate-pencilsword-toby-morris/
It shows a lot about the flip in mentality that happens to people from 2 different backgrounds over the many years of our lives.

 

[CoomassieBlue57]

While I often disagree with Spinach's views on ECs, to give him credit, he is someone who life has given some very hard knocks, and so the "entitled' crack is uncalled for.

At the worst, he's a tad naïve.

Fair enough. It comes off as if I was attacking Spinach, but my intent was to debate the idea that shadowing is only available to rich physician parents, or to those who had random luck.

 

[KungFuPanda123]

1. I find that the harder I work, the luckier I get.

2. Who studies only parts of their recommended study materials?

3. It's called grit, I think you should watch the Ted talk on it.

4. Do you happen to be a genderfluid something kin as well as ableist?

1. Obviously hard work plays the biggest role; I am not refuting that. The harder you work, the better your odds of success. That being said, luck does play a role. Easy example: 2 twin applicants for the same job; the employer has to choose one. 50-50 chance of success despite having an amazing application. Luck. How do you improve your odds? You work hard and have a slightly better application to push the odds in your favor.

2. No one. Re-read what I wrote. I said that both students studied the whole material. However, each one did focus on certain parts more than other parts. We all do this when we study; we try and focus on certain things that we think will end up showing up on the exam while not studying as much on things that seem more superfluous. Sometimes, it's the luck of the draw for what ends up being tested more on the exam.
Easy example: 3 questions on a test on stoichiometry/ideal-gas-laws. Either 2/3 questions on stoichiometry or 2/3 questions on ideal-gas-laws. Depending on which topic is your strong suit, you'll do better on 1 version of the test or the other. Obviously, at the high school chemistry level, I would argue that it's simple enough that you should just know both topics like the back of your hand - they're easy topics right? Well, then let's turn it into a medical school exam on the renal system. You're not going to understand everything, so you better try your best to learn everything and hope that the odds end up in your favor to an extent (i.e. the parts of the renal system that you understand the best show up on the exam to a greater extent).

3. I know what grit is. I was a high school chemistry teacher. I tried to teach my students grit as best I could.
Although it might sound like I'm trying to come up with excuses for people who fail in life, that is not my primary focus here. I'm trying to give reasons for why we should avoid ****ting on people who are failing and assuming that all our successes are a result of only our own hard work.

4. I'm not sure what you're trying to say here. I am a male and have always identified as male. I am not on board with discriminating against people with disabilities, and I'm not making it their primary attribute. Maybe you want to expand on this a bit so that I can respond?

 

[Ochemphd]

.

 

[NotYou20]

Undoubtedly. One thing you didn't touch on is that those of us from normal families usually have to work during college. 20 hours per week spent working could instead be spent doing meaningful research and having more time to study.
Work can certainly help an application, but grades are much harder to change. It's easier to take a gap year to work and make up that deficiency. In the case of people with borderline stats, that time, if used well, could really boost one's stats. In my case, working also made going to office hours almost impossible.

And for those who grew up poor, the damage has been done before they even get too high school. Lack of role models, a culture that tends to not see much value in education, changes in genetic expression, and bad schools are a few of the factors that would lower anyone's grades in high school and college relative to what they could do if coming from a different environment.

 

[Ochemphd]

.

 

[whatever5]

Life selects for the wealthy, dude.

 

[aalamruad]

short answer: yes.
Working as a tutor has put me in contact with a large number of very interesting pre-meds. One of these cases I related here before (in a thread which was closed far before its time): http://forums.studentdoctor.net/threads/this-is-who-you-are-competing-against.1181975/

It has become apparent to me that the path we call "pre-med" is nothing more than a game wherein one puts in the minimum amount of effort to check off boxes of activities which meet (and rarely exceed) a predetermined set of precise expectations. Gotta have research. Gotta shadow. Gotta work at a summer camp for deaf kids. Gotta volunteer at some hospital. Etcetera.

I'm not here to debate one activity or another. Nor will I waste my breath to remind you yet again that the vast majority of premeds are doing these things solely to impress adcoms and not because they are intrinsically good people. I write this to bring up the fact that there is one massive advantage that a certain subsection of the premed population has which the other subsection can never obtain. And that is this:

A parent who is independently wealthy and knows the rules of the game from before their child even begins playing.

This, more than anything else, is the best indicator of success in this little game we play.




Let's talk about shadowing.

I loved shadowing. Of all the premed activities I took part in, shadowing was undoubtedly my favorite and the one where I learned the most.

However, I had a hell of a time finding a single physician who would allow me to shadow. Perhaps this has to do with the fact that hundreds of other premeds at my university were all asking the exact same doctors? Most among my classmates had shadowed 0-1 physicians by graduation. A couple lucky ones shadowed 2. Many of these gigs lasted only 1 or 2 days.

There were also a couple who had shadowed more than 2. These were, in every case, children of physicians. Some admitted to being in pseudo-exchange programs between physician parents ("If my son shadows you, I'll let your daughter shadow me.").

You can see similar things in research where a lab manager will add authors who did little-to-nothing to help the research. Of course it's immoral and nobody will admit to it, but everyone knows it happens.

And those who are born into rich non-medical, non-research families? Go on a mission trip to Nigeria for a couple weeks, courtesy of dad's wallet.

The really serious ones don't even wait for college to start. Billy just started highschool? Better get him volunteering NOW so he can have double the hours everyone else has when it comes time to apply to med school in 8 years.




The outcome

This has been on my mind a long time, but I choose to make this thread now because of a statistic I heard only recently: Apparently, only ~1000 african americans applied to med schools last year (2 years ago? 3? Whatever.), which makes them ~2% of all applicants. Yet, they are the largest minority in this country, making up 12% of the population. Most distressingly, this number has been decreasing.

I, for one, am not surprised.

The pre-med game benefits those who can volunteer their summers in Zimbabwe instead of work at starbucks because they are struggling to make rent. It benefits those who begin amassing ECs from day 1 of freshman year.

It benefits those who know there is a game to play.




I don't even blame adcoms (eh, not much). With 30-100 people applying for every single seat they have, they are living in a dream-like sellers market where they can disqualify any number of people for any trait they desire, and still have dozens begging for every spot. Of course they would select the most qualified applicants. Who wouldn't? But they have (through selecting those check-box activities that anyone on this site can name) selected for starting classes which are overall whiter and richer than the average.




In his book Excellent Sheep, author William Deresiewicz refers to this problem as "Hereditary Meritocracy". He says that Americans like to believe their society is a meritocracy, where individuals are judged solely on their individual efforts and accomplishments, but the real America we live in is anything but. It's not just limited to college life, but even private highschools and elementary schools where teachers actually care about the fate of their children (rather than get them in and out the doors assembly-line style) can have a massive effect on a child's future. Putting your child into sports can get them scholarships (or even admittance) into better universities.

In America, everyone is equal (in theory). It just so happens that those born to 1%ers have more chances to do things with their equality than, say, those born into families who think having 9 credit cards is a viable long-term financial strategy.




In summary, here is a quote I saved from somewhere (was it this website? Either way, google scholar is not helping me find its source). If true, it would mean the proportion of med students from low-SES backgrounds has fallen by 63% over 31 years.....I wonder where it stands now, 10 years later.....


"Unfortunately, one group that did not benefit from this expansion was students of lower socioeconomic status (SES). In 1971, 27% of students came from families in the lowest two quintiles (lowest 40%) of household incomes nationally.[6] By 1987, this important segment of medical school enrollees had dropped to 15%, and, by 2004, it was only 10%.[34] Similarly, in 1974, 66% of students came from the top two quintiles (top 40%) of household incomes, but these percentages increased to 70% in 1987 and to 75% by 2004.[7,34]"

Why did you need such a long post to make the most obvious claim ever?

 

[NicksMD]

Love this post OP it's so true.

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[The Knife & Gun Club]

I'd just like to throw in there that it by no means means children of doctors or from wealthy families cant be good doctors. OP seems to imply that everyone in those categories are prestige chasing brats who've had everything handed to them on a silver platter.

I still worked hard and had to overcome a bunch of crap, as do most people, and it sucks to be categorically dismissed simply as having everything handed to me.

As with everything there are shades of gray, not just black and white

 

[NicksMD]

Also in reference to my last post I respect that everyone works hard! It's undeniable though that many are placed in a better position. This is a great discussion, even if you have opposite views.


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[KungFuPanda123]

I may have copped a little bit of an attitude there so my apologies, I breezed through the post since I'm at work so it came off as whiny at first. On a serious note, obviously success isn't guaranteed to anybody. That's why everyone is obligated to work as hard as they can, because your "luck" will tend to be better in an overwhelming majority of cases. You can use outlying samples such as someone focusing on the wrong concepts for a test and getting a full 25% lower score or having to essentially flip a coin for two applicants, but that is way too extreme to be relevant to the wealth= opportunity discussion of this thread.

As for the grit, I just mentioned it because isn't the essence of "grit" not giving up no matter how difficult things get? I can tell a few stories about my own life where most reasonable people would give up and these situations are definitely much more of a punch in the gut than getting a low test score.

The genderfluid comment was a reference to the Social Justice Warriors of the world who think that everybody should have the same opportunities and strengths/ weaknesses as everyone else, and that any characteristic that gives someone an inherent "edge" over another individual is to be viewed negatively. I referenced it because of the comment about having 4 functional limbs; When I said ableist it actually refers to discrimination against able bodied people by those who are disabled for one reason or another, and as a result, holding something against someone because of an advantage they were born with. I had to make the reference because at a glance it seemed like you were comparing being able bodied to being born into a wealthy family.

Overall I didn't mean to offend, so my apologies. For some lighthearted reading about "Affirmative action/ accommodations gone too far", do a quick google search of "Tumblr Social Justice Warriors", and I think you'll start to get where I was coming from.

Ah, yea I know what you are getting at. I guess my main point was that all those little small "wins" or "losses" can add up and snowball. My examples were definitely very extreme; I just wanted to simplify it as much as possible so as to write less.

Ohhhhh, I thought that being an ableist was discriminating against disabled person as a regular person. I was just trying to say that being born able-bodied is just as uncontrollable as being born into a wealthy family and can have its own deleterious effects (e.g. having non-functional limbs would automatically disqualify you from most medical schools as part of their "technical standards")

Thank you for your response!

 

[bananafish94]

It's not just the unwritten requirements, it's also the written requirements. Wealthy people can spend more time studying for classes, can afford things like prep classes for the MCAT, etc. Hell, in my state some poor people can't even go to college anymore because state grants to low-income students aren't being funded in the midst of the budget crisis. There will always be people who start at a higher level in any situation.

 

[futuredoc71]

My parents are the 1% (it's kind of strange to say that because I always assumed the 1% were extremely wealthy people, which we're really not). My mom went to graduate school but is a homemaker, and my dad, our sole source of income, never finished college. Neither of them know anything about medical school at all. In my experience, having wealthy parents obviously helped. I got to go to a great school with lots of opportunities for pre-meds, I've done extensive international traveling, I could have taken an mcat prep class if I wanted to, etc. But in my opinion, having parents in the medical field would be SO much more of an advantage than just having wealthy parents. Having connections would've made it so much easier to find shadowing and research opportunities. And just having your parents understand what you're going through would be so helpful. I mean, my parents spent most of my college years trying to convince me to go to med school in the Caribbean.

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we are twins. my parents are the exact same way. had to figure everything out on my own.

 

[Lannister]

Love this post OP it's so true. View attachment 201220


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I think most wealthy people will acknowledge that they had a significant advantage. However, when you've grown up in a wealthy family and lived in a community with people of the same socioeconomic status, it's hard to really grasp how well-off you are. Obviously I know my family lives a comfortable live, but I've never considered us wealthy, and it was pretty shocking to find out that my parents' income puts them in the 1%, because I don't feel rich. I think that comes from having grown up around other wealthy people, so that it seemed like literally everyone else was just as well-off as I was and could afford the same things. It's still really hard for me to even believe that there are many, many people who live in houses like that second one.

 

[KungFuPanda123]

I think most wealthy people will acknowledge that they had a significant advantage. However, when you've grown up in a wealthy family and lived in a community with people of the same socioeconomic status, it's hard to really grasp how well-off you are. Obviously I know my family lives a comfortable live, but I've never considered us wealthy, and it was pretty shocking to find out that my parents' income puts them in the 1%, because I don't feel rich. I think that comes from having grown up around other wealthy people, so that it seemed like literally everyone else was just as well-off as I was and could afford the same things. It's still really hard for me to even believe that there are many, many people who live in houses like that second one.

Much respect for your humility. That being said, I hope that you never let anyone attribute all of your success to your socioeconomic background (not that you ever did) because you definitely worked hard to get to where you are now - no matter what sort of benefits you had growing up.

 

[medic86]

I think most wealthy people will acknowledge that they had a significant advantage. However, when you've grown up in a wealthy family and lived in a community with people of the same socioeconomic status, it's hard to really grasp how well-off you are. Obviously I know my family lives a comfortable live, but I've never considered us wealthy, and it was pretty shocking to find out that my parents' income puts them in the 1%, because I don't feel rich. I think that comes from having grown up around other wealthy people, so that it seemed like literally everyone else was just as well-off as I was and could afford the same things. It's still really hard for me to even believe that there are many, many people who live in houses like that second one.

Did you grow up in a town where there were places you knew you shouldn't go, even during the day time?

If so, you should have an idea of how well-off you are.

 

[Lannister]

Did you grow up in a town where there were places you knew you shouldn't go, even during the day time?

If so, you should have an idea of how well-off you are.

I did not. I would feel safe anywhere in my town and in the surrounding towns, day or night.

Edit: the only reason I ever feel threatened at night when I'm in my hometown is because I am super paranoid that I'm going to be attacked by a wild animal, and we live in a very forest-y area with lots of raccoons and opossums.

 

[medic86]

I did not. I would feel safe anywhere in my town and in the surrounding towns, day or night.

Edit: the only reason I ever feel threatened at night when I'm in my hometown is because I am super paranoid that I'm going to be attacked by a wild animal, and we live in a very forest-y area with lots of raccoons and opossums.

Hahaha. Those opossums only look deadly!

"Breaking news: premed murdered by pack of wild opossums"

 

[Lannister]

Hahaha. Those opossums only look deadly!

"Breaking news: premed murdered by pack of wild opossums"

Hahah it sounds funny but I once thought my mom and sister were being attacked by wolves and it was absolutely horrifying. They were walking with my dog and cat a street over from my house. My mom called me in a panic asking if wolves ate cats. Then all of a sudden she started screaming and wouldn't respond to me. I went out on the balcony and I could hear them screaming bloody murder. I legitimately thought they were being attacked so I called the cops. Luckily they were fine and no cats were eaten.

 

[DokterMom]

And for those who grew up poor, the damage has been done before they even get too high school. Lack of role models, a culture that tends to not see much value in education, changes in genetic expression, and bad schools are a few of the factors that would lower anyone's grades in high school and college relative to what they could do if coming from a different environment.

Very, very true. Not to mention the utter lack of available, relatable role models.

As for the grit, I just mentioned it because isn't the essence of "grit" not giving up no matter how difficult things get? I can tell a few stories about my own life where most reasonable people would give up and these situations are definitely much more of a punch in the gut than getting a low test score.

Grit and resiliency are very important and should never be underestimated or under-appreciated. But in order to maintain those characteristics, you need to actually believe they can make a difference -- that success is actually even possible if you don't give up --- Too often, disadvantaged people lose that fundamental hope early, early in the process -- or never even feel it to begin with. Or they set the 'success' bar far too low because it's all they've ever seen.

 

[Ochemphd]

.

 

[Petrichor1]

• The millennial 'woe is me attitude': This is all because we are born in the century of social media. Ppl who I went to college with, that had similar competency or preparedness as me are now flying through Ibiza and what have you posting exotic foods and business trips. It hardly takes me a second before I start wondering what I did wrong that I am not nearly as successful. Yes, they work very hard but if I had the same network as them, I wouldn't be far away (high school environment was enough to prove this suspicion). Due to the openness and flauntiness with which my colleagues share their life now, it is very evident of the background they came from. The sad part is that because our school systems have always allowed us poor and rich to be in the same proximity, we have bought in the delusion that our lives should be similar if only academics are compared, or that we should be superior if we were smarter. It isn't true and when you learn about a kid who was just average or nearly below average in hs, get a consulting job straight out of college, you just know that the game was quite different from the very beginning. This is NOT A MILLENIAL thing. If we had facebook in the 1950s or whatever, we all would have had the same type of harrowing thinking and our concentration wouldn't be on the work we are given but what others are doing.
• Shadowing: Take it from someone who has tried for 2 consecutive years to try getting shadowing and has each and every time been denied. This is a crucial part of the application, not for the sake of the application, but to form our opinions of what doctors do and where things can be done differently. It is unfair-simple and pure as that, but I don't consider it a right so I don't care. You think I just tried? Nay, I cold called, sent emails, and got referred to several manager voice message boxes only to be ignored and never responded back to. Thankfully, I am creative and instead drive an hour for volunteering to get this. Meanwhile, plenty of friends who have parents in the 'know' have things set during the last minute to fill their hours. We all know that.

Basically, don't complain. I have met a variety of people, from low to high. Both types have offended me purposely and have never had the spine to apologize. Rich or poor, I want medical admissions to choose individuals that know how to treat people right. I know that as someone not with monetary back-up, I am in the grave situation of sacrificing my education and thus distancing my chances as the more years I am out of school the more my academic potential is up for questioning. However, what's done is done...no point in putting the finger on the masses the system favors and neither do I think the system should fill its seats with only low SES. Hopefully, when I become a physician, I will help someone under my circumstance. That is all I can do and that is all I want to do.

The world is a lot harsher than this Spinach, just keep up the good work and when you cross this barrier in your life, I know your merit will be your torch.