C/O Luis Melendez
Medical students from rural backgrounds can help resolve the inequities of the Canadian healthcare system
While the Canada Health Act has always maintained that all Canadians should have equal access to healthcare, the unfortunate reality is that this ideal is far from the truth. Although many Canadian cities have sufficient doctors for their population, the same cannot be said for rural communities.
Comparatively studying the doctor-per-capita ratios between urban and rural communities exposes a harsh inequity. In fact, the country’s overall value for doctor-per-capita is one in 450 while rural areas average one doctor for every 3000 residents.
Clearly, there is a severe problem in our current healthcare system that needs to be resolved. Unfortunately, this statistic cannot be taken at face value and the snowball effect that is a result of this inequity must be studied as well.
Due to limited access to healthcare, individuals living in rural areas are more likely to have a significant disease burden. What this means is by the time someone in a rural community can see a doctor, their disease has progressed even further leading to higher rates of chronic disease and poorer mental health.
If you take a step back and really look at the problem, you notice that by allowing this population to go underserved, the Canadian healthcare system is essentially shooting itself in the foot. They are manifesting a sicker and more expensive population, in concordance with their healthcare needs.
By now, I’ve hopefully illustrated the dire need for a solution. My proposition? Increase medical school admissions for students with a rural background.
Studies have shown that when students who come from rural communities are admitted into medical schools and ultimately become physicians, they are more likely to practice in rural areas. Unsurprisingly, medical schools that have noticed and applied this phenomenon in their admissions strategies have seen benefits.
The Oregon Health & Science University School of Medicine visits undergraduate students in rural areas who have an interest in healthcare and guides them through the admissions and financial aid processes. By providing guidance to students from a rural background and linking them to residencies in rural areas, OHSU has proven successful in filling the gap.
This is especially impactful when you consider that over 50% of medical residents in the United States end up practicing in the state they trained in.
It’s undeniable that one possesses an innate connection to the community that they grow up in. This connection to serving rural communities is one that is best understood by students who have lived there and have the drive to give back to those exact areas.
The medical community should look to advance the practice of culturally competent care — care that meets the cultural and social needs of diverse communities. Where better to start than the medical schools themselves?
Other plans, such as incentivizing doctors to practice in rural areas with higher salaries have proven expensive. Rather, medical schools should commit to leveraging the passion that already exists in so many students that have a better understanding and connection with Canada’s rural areas.
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.
By Elisa Do, Contributor
“How many of you are thinking of pursuing a career in health care?”
Since my first day at McMaster, I have — on several occasions — been asked this same question by various professors.
Every time, the classroom flooded with hands in the air. And it was safe to say that none of us were surprised.
Health care encompasses a growing range of professions that have become increasingly popular in our world today. This popularity arises from various circumstances, but it is especially due to the growing number of aged “baby boomers.” As folks of that generation age, the number of individuals seeking healthcare also increases. Thus, leading to greater needs for healthcare professionals, and further emphasis on the field’s importance. Considering this, many children are being taught the benefits of building a career within health care, and more specifically, the benefits of becoming a physician. Physicians are known to have high paying salaries, receive a high level of respect, and face considerable job demands.
However, working in health care is meant to be attractive beyond these practical values. To work in healthcare means providing for others; it means caring for complete strangers. And that, to me, is something meaningful.
Unfortunately, when thinking about the opportunities that healthcare can offer, folks tend to brush aside other crucial professions within the field. One of which include the profession of nursing. Nurses are often viewed as inferior to physicians and portrayed as mere subordinates within the media. They are thought to hold fewer skills, when in truth, they simply hold an extremely valuable set of different skills.
When I think about the time I spent in the hospital with my family, I think about the warm smiles of the nurses. I remember their patience, and their acts of kindness that brought my family comfort. That is not to say that the doctors were not helpful during our difficult times, but the level of intimacy was not the same. I remember the way they cheered my family on, and I remember thinking to myself, “I have to give back to this community someday. I have to bring kindness to other families the way that they did for me today.” In the short amount of time that the hospital became my home, those nurses touched me and my family in a way that will last a lifetime.
When I think about the time I spent in the hospital with my family, I think about the warm smiles of the nurses. I remember their patience, and their acts of kindness that brought my family comfort. That is not to say that the doctors were not helpful during our difficult times, but the level of intimacy was not the same. I remember the way they cheered my family on, and I remember thinking to myself, “I have to give back to this community someday. I have to bring kindness to other families the way that they did for me today.” In the short amount of time that the hospital became my home, those nurses touched me and my family in a way that will last a lifetime.
Nurses are not only caregivers, but they can also be involved in treating injuries, administering and managing medications and performing basic life support. Many of their responsibilities are those typically associated with the roles of doctors.
But even with all the responsibilities that nurses carry, many still regard nurses as “assistants” to physicians. Nurses are often thought to be less significant in the hospital as many forget that health care requires a team effort. If you want to provide care for strangers, and wish to have those strangers put faith in you, it takes a lot more than diagnosing conditions or performing surgery. It requires providing emotional and psychological support for patients and their families, maintaining a safe environment for everyone, and taking unique approaches when providing care for each individual.
In an integrative review done by several members of the Department of Nursing Science at the University of Turku, the perceptions of nursing that young people carry were found to inaccurately reflect the profession’s actual responsibilities. In fact, these perceptions have not changed in the last ten years. Nursing was described with poor working conditions, difficult shift work, and low social status. Along with the many stereotypes regarding nurses — such as gender roles and sexualization — found in the media today, many folks fail to further consider the educational requirements and intellectual demands that nurses face.
Before coming to McMaster, I had intended on applying for the undergraduate nursing program. Although I eventually changed my application choices as I discovered more regarding my interests, the nursing program still stands to me as an exceptional pathway into doing amazing work.
However, when I had initially introduced my family and friends to the idea of me becoming a nurse, I was presented with questions such as: “Why would you want to be a nurse? Why wouldn’t you want to be a doctor?” Hearing these questions not only felt insulting to my values, but more so insulting to the professions themselves, as if all there was to a career was the monetary benefit, or the accepted social status.
And I know doctors and nurses are not the only jobs being misconstrued. Understanding the responsibilities behind any profession takes more than a simple Google search or hearing salary ranges from friends.
Whether to choose medicine, nursing or any other health care pathway for that matter, should be a decision made based on what the individual seeks for their future. There are many wonderful reasons to become a physician, but I believe the spotlight of health care has been too concentrated on the title of ‘doctor’ rather than what the job really entails. It’s time we shift this spotlight and highlight the importance of other contributing members of the healthcare team; it’s time we take a closer look at what it really means to “pursue a career in health care.”
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By Monica Takahashi
Applying to medical school is a strenuous and stressful process. In Ontario, you can choose to apply to six different schools, each of them with their own challenges. Arguably one of the biggest obstacles that applicants have to overcome when applying to medical school is the overwhelming cost.
Before even looking at the fees associated with the actual application, you have to consider the fees from the largest hurdle that med-hopeful students face: the Medical College Admission Test. Writing this test alone will put you out $315 USD. That fee is not including the review books, practice problems, practice tests, and preparation courses that you might need to be successful. So already, before you even register to the Ontario Medical School Application Services, you will have had to pay, on average, at least a few thousand dollars. Four out of the six medical schools in Ontario require at least one component of the MCAT, so if you choose to save substantial money by not writing this test, you will be at a significant disadvantage.
Now let’s look at the fees associated with OMSAS. The best way to increase your chances of getting an interview is to apply to as many schools as possible; it’s simple statistics. And yet, not everyone is able to afford this. Each school will cost anywhere from $100 to $125 to apply, plus a standard $220 OMSAS application service fee. This is excluding the fee that some universities charge their students for transcript requests.
Here at McMaster University, we’re lucky we don’t have to worry about this transcript fee, however small. So in a “best case scenario” where you apply to all six medical schools, you will have to pay at least $920, not including the possible transcript-request fee. Do you see the issue there? How can the best case scenario be the one where students are forced to pay just under $1000?
The high price of medical school applications fosters an environment where wealthy parents are able to give their children every resource possible, so they are successful entering medical school, become rich, and can then send their children to medical school. And so the cycle of wealth continues.
If you are paying so much for a service meant to merely submit your application, it’s reasonable to assume that this service will make the submission process as stress-free as possible, right? This was not the case for the 2018-2019 application cycle.
The application for this cycle was due on Oct. 1, 2018 at 4:30 p.m. Around 3:00 p.m. on the day of the deadline, OMSAS malfunctioned. It was so bad, in fact, that OMSAS had to extend the application deadline to 11:59.
https://twitter.com/RREnoorani/status/1046862579157602304
[spacer height="20px"]Imagine finishing your application, going to press submit, and the software just refusing to cooperate. Frankly, this is extremely disappointing for such an expensive service. Students are already at a disadvantage having to pay such hefty fees, and having the stress of being unable to submit their application on-time is a little insulting.
https://twitter.com/lindy_zh/status/1046908638550532096
[spacer height="20px"]In the end, the application was extended until Oct. 3, 2018. You know what the worst part is? When I went back to OMSAS News to verify the times, all of the posts associated with OMSAS system issues had been deleted.
Thankfully, I saved a screenshot of the OMSAS news post made the day of the application deadline. I find it incredibly insulting that, after such a catastrophic event, OMSAS chose to cover its tail and hide any sign of issues. “Out of sight, out of mind”, right? Wrong. Hundreds of students who were made to suffer through this error will remember.
[spacer height="20px"]I understand that sometimes things go wrong and systems malfunction. The problem arises when rather than owning up to your mistakes, you try to hide as if the problem had never occurred.
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