The field of medicine lacks diversity because applying to medical school is inaccessible

CW: ableism, racism, classism

Coming into university, I thought I was going to be a doctor. I got accepted into health sciences and thought that health was something I wanted to pursue. While I am still passionate about health care, I’ve come to many realizations during my undergraduate degree — with one of them being that I am unable to apply to medical school due to my disabilities.

It’s hard to face the reality that some things might be unattainable for you when there is this mindset pushed that if you work hard enough, you can achieve anything. I agree that it’s good to work hard and set goals for yourself, but becoming a doctor is a bit more complicated than simply “working hard.”

It’s hard to face the reality that some things might be unattainable for you when there is this mindset pushed that if you work hard enough, you can achieve anything. I agree that it’s good to work hard and set goals for yourself, but becoming a doctor is a bit more complicated than simply “working hard.”

The first barrier I came across was the lack of accessibility surrounding the application process. For most Canadian medical schools, you have to write the Medical College Admission Test in order to apply. The MCAT is a multiple choice examination that covers a wide variety of subjects such as physics, chemistry and biology, and assesses your critical thinking and problem solving skills. 

Typically, the MCAT is a seven hour and 30 minute-long test where you are not allowed to access water or food except for during the scheduled breaks. To allow for things such as extra time, a separate testing area or even water or food during the testing period, you have to apply for accommodations.

Accommodations for the MCAT are known to be notoriously difficult to access according to many applicants. You need to submit a profile, your condition, history, a personal statement that talks about your experiences and a comprehensive evaluation by a qualified professional. The problem with this is that many people with disabilities may not always have a “proper” diagnosis since many conditions are hard to diagnose and may even take years — it took five years and several doctors to diagnose my rare knee condition. In addition, folks may face barriers in accessing healthcare services due to long wait times, racism, classism or other forms of discrimination. 

The Association of American Medical Colleges, which administers the MCAT, is known to be strict on accommodations. Even if you have extensive documentation for your disability, you may be denied accommodations. Many have shared such experiences on platforms such as Reddit, detailing the hardships of accessing accommodations. If you’re given accommodations, it could not be what you requested for. As a result, many people decide to “power through” instead of applying for an accommodation. In addition, up until 2015, MCAT accommodations used to be flagged for being administered in a non-standard setting, which could have an impact on your medical school applications.

Even amidst a pandemic, the MCAT is still running in-person — they have shortened the test from seven hours and 30 minutes with two 10 minute breaks and one 30 minute break to five hours and 45 minutes with three 10 minute breaks. It’s ironic that MCAT testing is in-person and could potentially put test takers at risk, while other standardized tests like the Law School Admission Test is online to accommodate for the pandemic. 

It’s ironic that MCAT testing is in-person and could potentially put test takers at risk, while other standardized tests like the Law School Admission Test is online to accommodate for the pandemic. 

Ableism isn’t the only barrier people face in applying to medical school. A recent study found that McMaster University Medical School applicants often come from upper-class families, with the median income of $98,816 being almost $30,000 higher than the average Canadian. From those who were accepted into McMaster, the median income was $105,959. This creates a huge disparity in healthcare: low-income patients will often lose out on the opportunity to have a physician that can empathize with their experiences or fully understand conditions that disproportionately affect low-income people. 

Applying to medical school is difficult, but low-income students have it even harder because the cost of applying to medical school is high. Maintaining a high grade point average requires hard work and lots of studying, but when you’re juggling two or three jobs on top of that, it can be exceedingly difficult. Not to mention that while low-income students often have to work jobs, students that are more well-off can spend their time doing volunteer work or extracurricular activities that can boost their resume. Upper-class students can also pay for MCAT prep courses to help boost their scores, which can cost up to $2000. If you’ve received a medical school interview, you may also need to book a bus, train or plane ticket for the in-person interview depending on where the school is located.

Another disparity that has been very visible this year is the lack of Black and Indigenous medical students in Canada. Very few Black students have been admitted to McMaster Medical School for the past five years and other Canadian medical schools historically haven’t done much better with admitting Black and Indigenous students either.

Very few Black students have been admitted to McMaster Medical School for the past five years and other Canadian medical schools historically haven’t done much better with admitting Black and Indigenous students either.

In the class of 2020, I was the only Black medical student in my class! And my class was super amazing but I think it could of been better. Sign our open letter to the McMaster MD program to make huge improvements towards diversity and inclusion! https://t.co/GCJChL9kk6

— Oluwatobi Olaiya (@tobiolaiya_) June 20, 2020

https://twitter.com/Alavian_S/status/1274457232680378373

Although there have been some changes, such as Queen’s University changing their accelerated medical school route so that it is reserved for Black and Indigenous students only, many people have criticized these changes, as Black and Indigenous students will be entering an environment that may not be supportive. 

Although I appreciate the approach Queen's has begun to take, I do wish more was addressed on how these Black and Indigenous students will be properly supported at a school that is known to have blatant issues with racism especially for undergrads: https://t.co/Xy5SR4DSHb https://t.co/tVcg1bOfm4

— Iku Nwosu, MD (@IkuNwosu) July 24, 2020

I’ve always found it ironic that medical school is inaccessible in many facets — the fact that people with disabilities, low-income individuals and Black and Indigenous folks are disadvantaged when applying highlights the lack of doctors who belong to these identities. The best doctors that I’ve had are ones that can empathize with my experiences. But if the majority of doctors are abled, upper-class and not Black or Indigenous, you alienate a large group of people. 

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By: Kaiwen Song

MCAT? Thank God that’s done! Autobiographical sketch? Just needs another look. Supplementary essays? Completed and edited! Now I just pray that my reference letters arrive on time.

This September, many of my peers and I applied to medical school through the Ontario Medical Schools Application System. In addition to the full application, OMSAS requires that three physical copies of completed reference letters be received by Oct. 1 — not sent by, not postmarked on, but received. Although many medical schools understand the variability of mail delivery times and use Oct. 1 as a flexible deadline, certain schools don’t. The University of Toronto medical school this year is notable for declaring on its FAQ page that if a reference letter arrives at OMSAS even just one day after the deadline, the corresponding application will not proceed to file review.

As you can imagine, the weeks leading up to the deadline were a very stressful time. In addition to taking the MCAT, completing our autobiographical sketch, and writing our supplementary essays, we also had to take all the necessary steps to ensure that our reference letters arrive on time. Unfortunately, as students, we can only do so much. We begin by asking our potential referees early to provide them with plenty of time to write it, as well as for the letters to arrive at OMSAS safely before Oct. 1 through the postal system.

As the deadline approaches, we start to send carefully worded reminders to our referees — forceful enough to express the reference letter’s importance, but restrained enough to not offend. Although we understand that our referees lead busy professional and personal lives and require time to complete the letter, we can’t help but feel uneasy since our entire applications are on the line. At the time, it felt supremely unnerving and frustrating – all of our hard work can be undone by something outside of our control.

Upon further reflection, I am surprised to say that I actually believe that the University of Toronto medical school’s strict deadline is fair. If the deadline was flexible, up to what point should reference letters to accepted? One week after the deadline? One month? There must be a clear deadline to ensure that all applications are processed in a timely manner, and Oct. 1 seems perfectly reasonable.

That being said, I would like to advocate for the change from physical reference letters being mailed in to electronic references sent through email. The biggest source of stress regarding references was the unpredictability of the postal system. Reference writers could send the letter weeks before the due date, but there’s still the chance that it could arrive later than the deadline, especially if the letter is coming from another province or country. If a letter is lost in the mail, students have no way of determining whether that occurred, and there may not be enough time after this discovery to ask for another letter. All of these issues can be addressed by switching to an electronic system, such as the one used by the United States’ undergraduate college application system. Students are asked to input their referees’ email addresses into the system, and their referees will receive a secure link in which to comment on the student’s suitability for their applied program. As soon as the reference letter is submitted, the student will receive notification of its completion.

An electronic system for receiving reference letters will streamline the process, reduce the anxiety of students at a very tumultuous time in their lives, and ensure that all applications can begin to be processed in a timely manner. As anyone can tell you, applying to medical school is hard enough already. Let’s not make it harder than it has to be.

Photo Credit: Ontario Universities' Application Centre

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Palika Kohli
Student Health Education Centre

Last summer I had what I’ve now termed my “mid-undergraduate-crisis.” Until then, I hadn’t realized how stressful figuring out my future could be. It was always a vague haze, far away from my present, and I gave it an equally vague, hazy title that would somehow sound concrete. I realized that not only the path I had always imagined myself taking was one of many, but also that I basically knew nothing about that initial path in the first place.

It was all very confused. I switched my projected career path about three times, gave my parents conniptions and took the mandatory trip to Europe to “figure myself out.”

How I determined my future path might not be how you choose to consider yours. But what I realized is that it’s never too early to think about your future. The worst that can happen is that you’ll change your mind.

And if you don’t know where to start, here are some tips and resources that I have found to be pretty useful.