Growing up poor presented extra hurdles in medical school for Rochester native, UMR grad
Brian Nguyen has experienced first-hand the impact of attending medical school without the benefits his affluent peers take for granted.
ROCHESTER — Brian Nguyen never thought about attending medical school as a child. Growing up the child of Vietnamese war refugees with a low socioeconomic status in Rochester, even going to college seemed out of reach.
“Around the age of 17 or 18, I thought I would be dead or in prison or something by the age of 25,” he said. “College was like a Hail Mary.”
Not only did he attend college, Nguyen is set to graduate from medical school on May 6, 2022, and will begin his anesthesiology residency soon after.
This is a major feat for anyone, but particularly someone like Nguyen who had the deck stacked against him as a Vietnamese man from a low socioeconomic status without any familial connections to medicine.
Nguyen said he knew he had the ability to get into college, but he “didn’t know if I could survive this system.”
“I’ve heard horror stories,” Nguyen said. “It's easier for me to hang out with people I'm used to, and to be associated with the culture I've known for most of my life than to brave the wilderness and to dive out into the deep end into pursuing dreams.”
Despite these thoughts, Nguyen enrolled in college at the University of Minnesota Rochester and graduated in three years, with help from college courses completed while in high school. He didn’t want to go to medical school at first – he planned on becoming a pharmacist, “because it’s easier.”
Ultimately, he decided to listen to his heart, and mentors, and began applying to medical schools.
Nguyen undoubtedly was challenged in college, but not as much by the curriculum. He had to work through a myriad of personal obstacles, from social and emotional issues at home to his family’s health and lack of education and resources.
But the biggest hurdle was overcoming years of structural racism and getting into medical school.
For some, getting into medical school is all but written in stone. About one in five medical students have a parent who is a physician, a relationship medical school admissions have historically favored because of the students’ access to money and shadowing experiences.
Nguyen doesn’t have that relationship. He also comes from a family with a lower socioeconomic status. Never mind any success he enjoyed at college, Nguyen already had two strikes against him: no connection to medicine and no ties to money.
Medical schools have started diversifying their student body in an attempt to provide better and more equal care to future patients. However, according to research by the University of Minnesota Medical School, schools looking to diversify direct their attention to racial, ethnic and gender diversity and rarely even mention socioeconomic diversity, which the research refers to as “a less visible form of diversity.”
Nguyen arguably did benefit from the medical school's racial diversifying measures, but he said administrators "just clumped us into races." He described a system that determined what medical college admission test, or MCAT, score a student needed to earn acceptance based on their race.
Dimple Patel, the associate dean of admissions at the University of Minnesota Twin Cities medical school, described the school’s use of holistic review, a concept created by the Association of American Medical Colleges to “help medical schools consider more factors in the selection process above and beyond academic metrics,” she said, with the idea that a school would admit students with diverse backgrounds, not only those who scored highly on tests.
“The three major tenants of holistic review are the consideration of a candidate's academic metrics, their experiences and their attributes in the context of each person's own lived journey and the influences of things around them,” Patel said. “In doing it, your result, hopefully, is a more diverse class in terms of identity and in terms of thought representation and geographic distribution.”
This admissions process has diversified UMN’s Twin Cities medical school – 35% of students are multicultural and 18% are identified as “underrepresented in medicine,” according to the school’s website , but there is more to be done, especially socioeconomically.
Ana Núñez, the vice dean of diversity, equity and inclusion at University of Minnesota Medical School, said the importance of diversifying the medical school is less about checking a box to boast about the level of diversity the school is able to achieve, and more a focus on diversifying the pool of future physicians available.
“As physicians, we talk about doing no harm, and I would submit that that kind of implies that we do good,” she said. “Being able to do good means we understand some of the questions and what the issues are that patients across our populations face, and their health care and their scientific needs, so far as solutions for things. It also means attending to the health inequities that exist and putting that on our to-do list.
“In order to get the right perspective, in terms of what the problems are and maybe the right innovations towards the solution, we need to have diverse voices at the table," Núñez added. "If we don't include diverse members, especially historically excluded racial ethnic groups, we're never really going to get the right questions and therefore never the right answers.”
The same can be said for diversifying socioeconomically. For example, affluent people who routinely underwent a yearly checkup have a vastly different experience than those who didn’t receive this care, maybe because of the cost or accessibility.
Núñez and Patel both expressed that the UMN medical school is looking at addressing socioeconomic inequalities, but it’s a more difficult area to target.
Patel shared that it’s important for those in medical school admissions, like herself, to make an effort to reach communities that have been left out of the conversation. She’s working to meet individuals where they are to engage and learn how the admissions process can benefit those with non-affluent backgrounds.
Patel is also abundantly aware of the privileged group that medicine still attracts. She mentioned the idea of expanding the holistic review process to capture the “diversity that sometimes is unseen and goes unrecognized.”
“Learning a little bit more about the gaps in care when you don't have a diverse workforce when it comes to socioeconomic background is important for us to know,” she continued. “Access to medical education should truly be accessible to everyone. And right now, I think our data shows that it's not, despite our efforts, so finding out where we can fill that gap is really important.”
It will take time for UMN, and universities across the country, to completely and truly diversify its medical school. Until then, students like Nguyen will continue to feel isolated, as he described it.
“There’s a reason why we can't relate to so many people in our class. It's because we're not even the same damn bracket in medical school,” Nguyen said. “There's not many people that I could relate to because they're focused on other things. I've heard people complaining about not being allowed into country clubs because their parents make like $600,000, as opposed to a million. I'm like, ‘Oh, cool, cool story, bro.’”