When Joseph Finkler goes to work as an emergency-room physician at St. Paul’s Hospital, he knows he will come across patients from all walks of life. He knows that his downtown emergency room is just as likely to see a wealthy stockbroker as it is a sex-trade worker.
When Finkler goes to work at his other job as associate dean of admissions in the UBC faculty of medicine, he doesn’t see the same kind of diversity. According to him, many UBC med students have more in common with Yaletown than with the Downtown Eastside.
Finkler wants to make UBC the first university in Canada to address the fact that a disproportionately large number of medical students are wealthy city dwellers.
“We definitely have a racially diverse class,” he tells the Georgia Straight over lunch at an Earls restaurant near Vancouver General Hospital. “You can’t name a culture that’s not represented here. I think that socioeconomic diversity may not be represented, and that’s an issue that exists [in medical schools] all across Canada.”
Dealing with topics such as class and money can be touchy, especially with regard to university admissions, but a growing number of people in the medical profession feel these issues can no longer be ignored. The Association of Faculties of Medicine of Canada, the Association of American Medical Colleges, and the Liaison Committee on Medical Education have all discussed the need to make medical schools more socioeconomically diverse. In March, the Canadian Federation of Medical Students lobbied Parliament to raise awareness of the need to have doctors who better reflect the population at large.
“Socioeconomic diversity matters for patients,” CFMS president Tyler Johnston says in a phone interview with the Straight. “People who are from rural and more diverse economic backgrounds tend to treat patients from their own backgrounds. If we don’t have a health work force that mirrors society, you’re going to have segments of society that are left out of care.”
In 2001, CFMS researchers found that 29.1 percent of medical students came from a household with an income greater than $120,000, while just 4.9 percent of Canadian households earned that much. As well, only 15.4 percent of medical students came from a family with a household income of less than $40,000, an income bracket that includes nearly 40 percent of the general population.
Finkler says that the lack of socioeconomic diversity occurs not because of any inherent bias on the part of UBC or other universities. Instead, he says it’s a naturally occurring phenomenon.
According to Finkler, people from wealthier backgrounds tend to receive more support from their family. They are also more likely to have family members in the medical field, making it seem like an achievable goal. Students from upper-class backgrounds may also have the financial support to pursue volunteer projects and other extracurricular activities that adjudicators look for on medical-school applications.
“The selection committee didn’t try to create this homogeneity,” Finkler explains. “It happened for predictable reasons. We want to change that and possibly approach it with new techniques.”
Those new techniques may include outreach programs that encourage students from rural and disadvantaged areas to consider a career in medicine. Finkler hopes to find current UBC medical students who are willing to visit high schools across B.C. to talk about careers in medicine. Ideally, he wants to find students from rural and/or lower-income backgrounds and have them visit schools to show students that a career in medicine can be within their reach.
He says part of his mandate is simply a form of “myth-busting”. Many young people from underrepresented groups see medical schools as unreachable ivory towers, ones that don’t value their life experience.
“You might hear someone say, ”˜I’ll never get into medicine because you have to do all this volunteering, and I have to work on my dad’s farm.’ I have to tell you those activities have value. No, they don’t sound exotic, but we value them. People just don’t believe we do.”
Not surprisingly, it partly comes down to money. The CFMS notes that across Canada, medical-school tuition has risen steadily since the 1990s, something that creates a significant barrier to entering the medical profession. Finkler hopes to work with UBC’s Student Financial Assistance and Awards office to remove financial barriers to attending medical school.
He notes that his plan to increase socioeconomic diversity is still in the very early stages, but he hopes to implement some initiatives this fall.
It could be argued that a medical student’s socioeconomic background shouldn’t matter one way or the other. After all, if you need to have your appendix taken out, you don’t care whether your surgeon is the scion of a billionaire or the offspring of a farmer so long as he or she does a good job of patching you up.
Finkler agrees that technical skill is a critical part of being a doctor, but it’s not the only part. There is a huge social aspect to medicine that’s often overlooked.
“The delivery of care is a mixture of technical skills, knowledge, communication, intelligence, and collaboration,” he says. “To do that you have to be in tune with the community, and it doesn’t hurt to have people from a broad range.”
Boosting socioeconomic diversity in medical schools can have additional benefits. For one, it can enrich the classroom experience for all medical students. “It’s good to have diversity in a class, or the group opinion might drift to a common denominator. If the common denominator comes from a certain socioeconomic strata, your opinions might shift that way.”
More importantly, increased diversity could help deal with the continuing shortage of doctors in rural areas. In 2002, an article in the Canadian Medical Association Journal noted that only 10.8 percent of first-year medical students came from rural areas, where 22.4 percent of the population resides.
“Many doctors in Canada come from upper socioeconomic groups and are primarily urban,” says Dr. John Wootton, president of the Society of Rural Physicians of Canada, by phone from Shawville, Quebec. “The conclusion that follows from that is that many of those students, not having been exposed to rural areas in their younger years, lack information to make decisions about their future practice. By default, they tend to choose to practise in cities.”
Seeking out students from poor and rural areas may help fill the gap. Both U.S. and Canadian studies have shown that growing up in a rural community is the factor most strongly associated with choosing rural practice. A 2005 report by the Society of Rural Physicians of Canada found that a medical student with rural roots is two-and-a-half times more likely to practise in a rural area upon graduation.
There are signs that this approach can work. Australian universities decided to tackle the issue of diversity in medical schools, and have made major inroads. In 1989, only 10 percent of medical students in Australia were from rural areas. A decade later, that number was roughly 25 percent, thanks in part to financial incentive programs.
Wootton says that one of the best ways to increase the number of doctors in rural areas is to increase access to education in rural areas. He cites UBC’s Northern Medical Program, carried out in conjunction with the University of Northern British Columbia in Prince George, as an example of attracting promising rural students by taking education to them. A similar program exists in partnership with the University of Victoria, and one will be launched at UBC’s Okanagan campus in Kelowna in 2011.
A common myth is that students need to complete their undergraduate studies at UBC in order to eventually make their way into that university’s faculty of medicine. Finkler wants to reassure students that this is not the case, and that they can take the necessary prerequisites at colleges and universities closer to home.
And if his outreach program inspires students from lower socioeconomic backgrounds to attend schools other than UBC, he’s fine with that. To him, the initiative is about serving the community and helping students unlock the potential in themselves.
“People should have access to be whatever their potential suggests that they could be,” he says. “We want a social project of mentoring and guiding high-school students. We want to go out and say, ”˜Look at me—this is what I’ve done, and you can do it too. And we’ll show you how.’ ”