Growing up, I was always one of the whitest kids in my class. My appearance — conservative clothing, blonde hair, blue eyes — was a source of embarrassment through middle school, but by high school, I recognized it also gave me advantages. For one, no one could imagine I might misbehave. And while my family didn’t necessarily look like everyone else’s, it was different in other ways, too. Many of my friends knew that they'd have to get full-time jobs when they graduated from high school; some would have to start paying rent June 1st if they wanted to continue living in their parents’ house. By contrast, my family was willing to let me live at home while I went to college.
My mom couldn't help me with tuition, but I'd started saving when I was 13, the same week that I took a job at a local mom and pop shop, paying cash from the till because I wasn't legally old enough to work. My babysitting jobs only earned me a couple of dollars an hour, so the fact that I was coming home at the end of the week with one or two 20s seemed incredible. I'd allow myself to spend the smaller bills on things I needed or wanted — I’d often pay with a stack of $1 bills when shopping for "new" clothes at the thrift store. But there were so many of us buying things that way, working for tips or accepting payment in cash in order to skip the legalities. No one ever commented or complained. The big bills, the 10s and 20s, went into a metal tin on my desk. The top of the tin showed a sleepy bear wearing a nightshirt, and inside I had several thousand dollars saved to pay for my ticket to a better life. I'd spent some of my savings to buy an inexpensive used car but I never lost sight of my main goal. I'd seen what could happen if you married in your teens without a career to support yourself and your kids, and I had a different path mapped out for myself. I was lucky that my mom was going to let me live at home, and feed me along with the rest of the family so that all the money I earned could go to my education.
In the fall of my senior year, my chemistry teacher asked me where I was headed after graduation. She looked horrified when I said that I was going to the local community college and then planned to transfer to the nearby state college. She explained that I couldn't get into medical school unless I got a degree from a good university. "You could go to Stanford if you wanted," she told me. I’d heard of Stanford, but going there seemed less likely than winning the lottery or learning to fly. A few days later, she told me that she'd gotten permission from my mom and was taking me to visit her alma mater, a private liberal arts university within driving distance of my home, and from which I'd have a reasonable chance of getting into medical school. She'd introduce me to the head of the biology department and we'd have a tour.
The biology building was astonishing. Glass and brick with a metal-topped dome. Even the floors were beautiful. The head of the biology department said I'd need to submit an application but he'd see what he could do about some scholarship money. My teacher and I walked past the well-tended trees, fountains, and perennials that bordered University Hall. I wished I could stop and explore the huge stone building with its heavy wooden doors — but my teacher was on a mission and there wasn't time. Years of getting what I needed by being sweet, smart, and charming had prepared me well for this day; I didn’t even realize at the time that I was interviewing before I'd submitted an application. As soon as I completed the paperwork, I was accepted. Now, the only problem was money.
I applied for dozens of scholarships. A local bank gave me my first. I went to a brief ceremony at the bank building where they served flat pink cookies from the grocery store. I was a Sam Walton Walmart Scholar, which necessitated an early morning visit to their staff meeting. I felt guilty as the employees, who had never had a chance to go to college themselves, applauded me. The biology department at the university gave me a scholarship, too, and I also qualified for the university's need-based grant. Then I received an endowed scholarship from the university and had to look up what that even meant (in practice, it meant that every year I went to a big dinner for the scholarship recipients and donors. I ate my meal with a very sweet and very wealthy old lady whose donation was the "endowed" part of what was paying for a huge chunk of my tuition).
I didn't have all of the money I needed until a few weeks before I graduated from high school, the valedictorian headed to a private university. Once I arrived at my new school, still living at home to save money and commuting every day, I realized that the dramatic differences between my home life and my university life went well beyond the beautiful buildings and grounds. My fellow undergrads had a completely foreign set of experiences and assumptions. My time outside of class was spent working and helping my family, but the other pre-med students didn’t need to work. They seemed to have so many connections and opportunities. They had family and friends who could hook them up with unusual volunteer projects that showcased their brilliant problem-solving and leadership skills. They were given summer research jobs usually only open to grad students, and went on medical mission trips for which their parents shelled out huge amounts of money. I knew their applications would be as full as their photo albums and phone contact lists.
I did what I could with my own resources; I volunteered at the hospital, but they only let me carry mail and stuff folders with educational pamphlets — worthy tasks, to be sure, but not activities that demonstrated my potential. I also volunteered where I did have connections, at an elementary school that needed tutors, and at a local history museum. I couldn't afford prep classes for the MCAT, so I bought a big book and studied on my own for months. My classmates compared notes from private tutors and week-long intensives, and I despaired of ever being able to compete. Thankfully, the months of studying paid off and I ended up doing so well on the MCAT, I was able to get a summer job tutoring others who were preparing for the test.
Every year I scrambled for tuition money. I worked as much as possible, using up all my work study hours long before the end of the year, but my boss wrangled an hourly position for me instead. It didn't pay as well as work study, but it was a steady job that was compatible with my school schedule. Still, I was thousands of dollars short my senior year, so the history department (my second major) awarded me both of their scholarships that year. I cried when they told me.
Suffice to say, my undergraduate experience was financially harrowing — but it still didn’t prepare me for the expense of applying to medical school. My fellow pre-med students spent thousands of dollars applying to multiple medical schools and flying all over the country for interviews. I only applied to the one within driving distance of my home. People told me I was crazy, and that there was no way I'd get in if I applied to only one school. But I didn't have any other choice.
I was offered an interview.
To prepare, I decided to buy an actual new outfit. I'd seen my female professors wearing pant suits so I knew that was my desired look, but the discount department store near my house, the only place I knew to go, had nothing that looked quite right. I finally decided to buy a black wool jacket and wore it with a plain blouse and slacks that I already owned. When I arrived at the interview, everyone else was wearing nice black suits that fit perfectly and professional-looking footwear I’d never seen at Payless. Where did they even find those? I went into the bathroom and was sick. I looked like the Country Mouse in a room full of City Mice. They all acted important and chatted about all the important things they had done. I told myself that the worst thing that could happen was that I wouldn't get in, and if I ran away, I definitely wouldn't get in. On the other hand, if I pulled myself together and did my best, I'd still have a chance. I looked like the poor country cousin — but I decided I would use that to my advantage. I told the admissions committee about the life experiences that drove my desire to become a physician. I said (honestly) that I wanted to help kids in situations like mine. When I got too nervous, I looked over the interviewer's shoulder at the back wall, hoping to appear more thoughtful than panic-stricken.
I survived, and when I got back to the chaos and noise of our crowded family home, I had an intense sense of returning to where I belonged. Medical school, with all those fancy people in fancy suits, was definitely not going to have a place for someone like me. I figured I'd find something else to do with my life, something close to home, where I was supposed to be.
Weeks later, I came home from school to find my mom and Linda, our mail carrier waiting for me. Linda had been our mail carrier for a long time and she'd seen mailboxes full of scholarship applications go out four years previously. She had said then that I gave her hope. I didn't know how long they'd been waiting … but my mom was holding a big envelope. Little envelopes are rejection letters. Big envelopes … could it be? My mom admitted later that she and Linda had held it up to the light and pressed the envelope down against the pages inside until they'd been able to make out a word: “Congratulations.”
Congratulations. An acceptance letter. To the only medical school I'd been able to apply to. Somehow I was actually going to be a doctor.
I beat the odds by becoming a physician. Only 5% of medical students in the United States come from the 20% of households in the lowest income bracket, and three quarters hail from the highest quintile. Once I was in medical school, too, everything seemed a little harder for me than everyone else. I'd never had great medical care and, during the first semester of medical school, I was diagnosed with both asthma and a goiter (enlarged thyroid and low thyroid hormone). Thankfully, the school helped me find a doctor to sort it out — I didn’t know where to find good medical care myself. That same year, I also learned that my terrible headaches were called migraines and could be treated (until then, I’d just pushed through, every step causing explosions of fireworks in my head). My doctor suggested taking some time off school to get my medical situation stabilized, but I couldn’t afford it. Instead, I scraped through my first semester in status migrainosus (a continuous migraine), triggered by the fumes in anatomy lab and eventually controlled with medications that left me lightheaded. My thyroid hormone levels reached a normal range sometime during my second semester.
As I’d done throughout undergrad, I commuted using the car I'd bought as a teenager; when it started to literally fall apart, I used duct tape and bailing wire to hold it together. When it didn’t hold, I took a city bus with a transfer that required a 20-minute wait at a stop without a shelter. I didn't have a good coat for the winter; I was often cold and miserable. In short, I just didn't have the same buffer that my classmates had, and for a long time, I couldn’t figure out what I’d missed, how they seemed to know the secret to a comfortable life while I floundered. When it came time to apply for residency, I found myself with the same problem I’d had applying to medical school (and my solution was the same: apply few places).
The most unbelievable part of my story is that, in reality, I came from a position of relative privilege. My mom had a bachelor's degree, played public radio in the kitchen, and filled our house with used books, which meant that I spoke like an educated person from an educated family (though to this day, I can code-switch when I realize that a patient I'm seeing is from a community similar to mine). My family could afford to feed and shelter me an extra four years while I earned my bachelor's, and valued my education enough to do it. And though my university did so much for me to make sure I could attend, it would be disingenuous not to mention its diversity problems. The majority of the students are wealthy and white; even in 2021, only 4% of the student body identifies as Black/African American. Would the administration and faculty have been as eager to help if I'd had darker skin? I benefited from my privilege, and left behind most of the students from my high school, who were trapped in a very different set of options.
Now, my oldest child is in middle school, and I'm realizing more than ever that privilege has less to do with money than I thought previously. We’re not millionaires, but I can use my connections to give my son opportunities. He isn't working, as I was at his age. Instead, he's developing his abilities and enjoying experiences that build toward his future. He assumes that he can pursue his interests, whatever that entails. When he is older, I'll help him find a job that will look good on his applications. He's had excellent medical care his entire life and he knows how to dress, and he doesn't feel inferior because his parent is in a profession that is respected by people of all income levels. He lives in a bubble of inherited confidence provided by my education.
To improve the diversity of medical schools, we need to better understand the challenges and barriers faced by young people with intersectional disadvantages. We need to be providing opportunities, mentors, and connections — and we need to start way before medical school, in middle school and high school. We need to either stop caring if someone went to the "right" university, or help students from underprivileged backgrounds access the universities preferred by medical schools. We need to make the application process affordable, perhaps with a sliding scale application fee, and we need grants to pay for everything from the MCAT to flights and hotel rooms. Finally, we need to provide students coming from underprivileged backgrounds with extra support as they work to catch up after a lifetime of less.
I was blessed to attend a medical school that saw the value in my experiences, even if I lacked the connections and was too busy working and helping my family to do all of the amazing things my classmates had done. I was blessed to have a family that valued my education. And if my chemistry teacher hadn't stepped in, I wouldn't have known that no one had ever been admitted to medical school from the state college until I learned the hard way.
Countless studies have shown that diversity benefits everyone — so why are we starting to work on the “diversity problem” after it’s full blown when we should be addressing it before it develops? Diversity work should start sooner — and it should start now.
What was your medical journey like? Did you come from a family of clinicians — or were you the first? Tell us about your barriers and how you overcame them in the comments.
Robin Dickinson, MD is a board-certified family physician who teaches clinical skills to first-year students at Rocky Vista University. She created the first pre-medical curriculum for kids, hosts a podcast for young people who want to be physicians, consults neurodiverse families and individuals, and founded the only free clinic and the first DPC practice in her hometown. You can find her at robindickinsonmd. Dr. Dickinson is a 2021–2022 Doximity Op-Med Fellow.
Illustration by Jennifer Bogartz