New Legislation Threatens DEI in Med School While Research Reveals Socioeconomic Disparity in Acceptance Rates

Recent research highlights a trend within the medical profession: a significant socioeconomic disparity in the acceptance rates to MD-PhD programs. While physician-scientists play a vital role in bridging research and clinical practice, ensuring diversity among them has emerged as a critical factor for fostering biomedical innovation and achieving equitable health care, the study authors note.¹

A stark contrast was found in acceptance rates based on household income. While 50.3% of applicants from households earning more than $200,000 annually were accepted, only 29.9% of applicants from households earning less than $50,000 annually received acceptance offers.

The publication of these findings came just before the introduction of legislature in the US House of Representatives that aims to ban diversity, equity, and inclusion (DEI) practices in medical schools.² If passed, federal funding would be eliminated from medical schools “that force students or faculty to adopt specific beliefs, discriminate based on race or ethnicity, or have diversity, equity, and inclusion offices or any functional equivalent,” as stated by the office of Rep Gregory Murphy, MD (R, North Carolina), who introduced the bill.

The study, conducted by researchers utilizing data from the Association of American Medical Colleges, aimed to investigate trends in application and acceptance rates to MD-PhD programs based on family income.¹ The findings, published in JAMA Network Open, revealed disparities among applicants from different socioeconomic backgrounds.

Between 2014 and 2019, more than 10,000 students applied to MD-PhD programs in the US. Among these applicants, 45.3% were accepted into at least 1 MD-PhD program. The gender distribution was close to equal, with women making up 43.1% of applicants. In comparison, the distribution across ethnicities was more distinguishable, with the majority of applicants identifying as White (52.1%), followed by Asian (23.3%) and then those who were multiracial (8.4%).

The analysis demonstrated a stark contrast in acceptance rates across all years based on household income. Whereas 50.3% of applicants from households earning more than $200,000 annually were accepted, only 29.9% of applicants from households earning less than $50,000 annually received acceptance letters.

The study investigators noted that a key finding of their data analysis showed that low-income applicants remained significantly less likely to be accepted into an MD-PhD program when compared with their affluent peers even after adjusting for applicant test scores and prior publications.

“In the fully adjusted model, applicants from household income less than $50,000 were 16% less likely than their peers to be accepted into an MD-PhD program (adjusted relative risk, 0.84; 95% CI, 0.79-0.90),” investigators wrote.

Applicants with a reported annual household income of less than $50,000 decreased each year from 28.36% in 2014 to 25.14% in 2019 (annual percent change [APC], −0.57%; 95% CI, −0.94% to −0.21%; P = .01). No significant change was observed for other income categories, but the percentage of accepted students reporting household income greater than $200,000 increased annually. The acceptance rate of 16.10% among those in the higher earning category who applied in 2014 increased to 20.87% in 2019 (APC, 0.90%; 95% CI, 0.08%-1.72%; P = .03).

“These findings suggest that MD-PhD admission committees may select applicants based on characteristics more associated with privilege than merit, which may include undergraduate institution prestige, exposure to a high-impact mentor, and having a parent with a doctoral degree,” they wrote.

Even after adjusting for factors like race, ethnicity, academic performance, and research experience, applicants from low-income households remained significantly less likely to be accepted into MD-PhD programs compared with their wealthier counterparts. This suggests systemic biases in the selection process that may favor applicants from more privileged backgrounds, according to the study authors.

The gradual correlation of disparity that increased throughout the study period aligns with previous findings suggesting an encompassing socioeconomic inequity in medical profession access, researchers noted.

“The decline in low-income applicants is noteworthy and may be due to the significant financial investment in pre–MD-PhD preparation, including research years and the cost of the increasing time to independent physician-scientist career,” they wrote.

Furthermore, the study highlighted a concerning trend over the years. The percentage of applicants from households earning less than $50,000 annually decreased annually, while the percentage of accepted students from households earning over $200,000 annually increased steadily.

Despite the insights provided by this study, investigators acknowledged certain limitations. Childhood income may not entirely capture wealth and opportunity, as it can be influenced by geographical factors and other unmeasured variables. Consequently, the results might underestimate the extent of socioeconomic disparity. Additionally, the analysis did not account for characteristics specific to MD-PhD programs, such as program prestige, inclusion in the Medical Scientist Training Program, and overall National Institutes of Health funding for medical schools. The impact of these factors on admission equity remains unclear, the researchers stated.

The findings of this study underscore the urgent need for action to promote diversity and equity in the physician-scientist workforce. By addressing systemic biases and adopting holistic admissions approaches, MD-PhD programs can ensure that talented individuals from all socioeconomic backgrounds have equal opportunities to contribute to biomedical innovation and advance patient care.

“Diversity in the physician-scientist workforce is critical for innovation in the biomedical sciences and patient care,” the authors concluded. “To promote socioeconomic equity in MD-PhD program admission, program directors and admissions officers should rely on holistic measures such as grit, resilience, and distance traveled, in addition to traditional academic metrics.”

References

1. Nguyen M, Cavazos JE, Venkataraman S, et al. Socioeconomic diversity in admissions to MD-PhD programs, 2014-2019. JAMA Netw Open. 2024;7(3):e241951. doi:10.1001/jamanetworkopen.2024.1951

2. Murphy introduces bill to ban DEI in medicine. News release. US Congressman Gregory F. Murphy, MD. March 19, 2024. Accessed March 20, 2024. https://murphy.house.gov/media/press-releases/murphy-introduces-bill-ban-dei-medicine