In early 2018, the Twitter hashtag #mypathtomedicine took off, with the aim of inspiring young students considering a career in medicine and encouraging them that they needn’t fit a certain stereotype.
At a time of significant staff shortages in the NHS, we should be doing all we can to make sure the profession is accessible to everyone who might want to enter it. While much of the focus has been on improving gender and ethnic diversity of the NHS workforce, an area that can be neglected is the socio-economic background of staff, and of doctors in particular.
I’m sure most people can imagine the classic ‘well-spoken, privately educated, pinstriped-suit-wearing doctor’ and although improving the social diversity of the medical workforce has been a focus for the government over the past ten years, data suggests little has changed. The 2012 government report Fair access to professional careers showed medicine had made little progress in widening access to those from disadvantaged backgrounds, and appeared to have little interest in doing so. In 2015 the BMA highlighted that although there was increasing diversity in gender, ethnicity and age, there continued to be minimal improvement in social diversity. A year later the Social Mobility Commission found that only 4 per cent of doctors came from working class backgrounds, behind other groups considered to be ones of privilege, such as lawyers and journalists at 6 and 11 per cent respectively.
There are clear benefits of improving the diversity of the medical workforce. It would allow doctors to be more representative of the populations they serve, enabling patients to feel they can better connect with their doctor and believe their doctor has a holistic understanding of them as a person. Research in Scotland has shown that general practitioners from less affluent backgrounds are more likely to work in practices serving the most deprived communities, while other research suggests those from low socio-economic backgrounds are more likely to apply for specialties where there are particular shortages, such as general practice or mental health. Being at a diverse medical school has also been shown to positively affect medical students’ attitudes to diversity-related issues and possibly their future care of minority groups.
So why is social diversity still poor within medicine?
Research suggests that pupils from disadvantaged backgrounds are less likely to apply to medical school as they consider it to be for ‘posh’ students and underestimate their chances of getting in. Research from the education sector has also shown that ‘36 per cent of children from as young as seven years old, base their career aspirations on people they know. For those who didn't, 45 per cent stated that TV, film and radio were the biggest factors influencing their choice.’ Undertaking a long academic course has clear financial implications, both putting pupils off applying and preventing some who do from completing their studies. In addition, whatever measure is used for determining socioeconomic status, those from disadvantaged backgrounds are less likely to gain an offer for medicine than those of a higher socioeconomic group, suggesting application processes might favour those from privileged backgrounds.
What is being done to address this issue?
The good news is that a few steps are being taken to improve the socioeconomic diversity of the medical workforce.
The Medical Schools Council Selection Alliance was set up in 2015 with a focus of widening access to medical education and leading on the changes discussed below. The number of ‘access’ or ‘gateway’ courses at medical schools across the UK has increased from 2 in 2002 to 17 in 2019. These courses attract significantly higher proportions of students from deprived areas or those with parents who do not have a higher education qualification. Summer schools, outreach programmes and other measures particularly aimed at regions of low school engagement with universities are also increasingly being used. There have also been steps towards more inclusive selection processes at medical schools, moving away from relying solely on academic achievement. Studies have suggested that aptitude or situational judgement tests have a less adverse impact on those from disadvantaged backgrounds compared with traditional interviewing and personal statements, which can be heavily coached and benefit from having access to family networks or resources. However, although all UK medical schools now use an admissions test as part of their selection process, there remains no strong evidence that changes in admissions processes have had much of an impact on diversity.
Lack of data to monitor improvements in the area has hampered progress, though this is being addressed through the newly established UK medical education database and the UK medical admissions cohort study, both of which aim to collect data that could help monitor change.
There have been some changes, including a relative increase of 28 per cent between 2007 and 2016 of medical students whose parents do not have higher education qualifications. Yet there has been little overall change in entrants to medicine from lower socioeconomic groups, and entrants from the most deprived areas have only increased by 5 per cent in these 9 years.
As the government aims to award planned new medical school places to universities who can show evidence for plans to widen participation, it is hoped this will provide further motivation for universities to fully engage in widening participation. And with better data now available to all, there should be progress in knowing what measures can achieve this. The NHS People Plan is due for publication in spring 2020 and is expected to make renewed commitments to diversity in the NHS workforce. It is unclear yet whether the proposed measures will also increase socio-economic diversity. Even so, to make a real impact, change and engagement is needed at all stages of education to ensure a truly diverse workforce and its potential positive effect on the population’s health.
The following resources may be useful for anyone considering a career in medicine.
Generation Medics – this resource offers support for medical school applicants and aspiring doctors and holds conferences throughout the year.
MyBigCareer – this charity aims to break down barriers to social mobility and provides mentoring and work experience schemes for medicine.
The Social Mobility Foundation – this UK charity aims to give practical support to people from lower socio-economic backgrounds, including mentoring, workshops and internships.
Medic Mentor – this website provides resources for medical students and also runs courses for prospective students.