Luz (not her real name) could be a great doctor. A Latina student from Arizona, she graduated at the top of her high school class and has always aspired to give back to her community.
But ultimately, she decided against medical school for one reason: chemistry. It’s not that she isn’t smart enough for chemistry — far from it. She just hates it, finding it dull and unrewarding. Most of what students learn in college chemistry does not appear to be necessary for becoming a good clinician, and Luz is now considering law school.
The recent Supreme Court ruling on affirmative action is almost certain to decrease the already depressing number of doctors from racially underrepresented backgrounds. Today, only 6.9% of physicians are Hispanic, 5.7% are Black, and 0.3% are American Indian or Alaska Native. This is in spite of research showing that a diverse health care workforce can improve access to care, patient experience, and health outcomes, particularly for patients of color.
Because of the ruling, influential individuals and organizations are committing to alternative ways of maintaining and improving racial diversity within health care. Supporting mentorship programs, accounting for socioeconomic status in admissions, and, as I and others have written before, passing anti-poverty legislation will help. But these strategies miss a crucial factor that discourages many promising students, especially students of underrepresented backgrounds, from becoming doctors: pre-med requirements.
I spent the past three years as an in-house pre-med college tutor at Harvard, closely advising students through their pre-med journeys. To apply to most U.S. medical schools, students must generally complete one year each of biology, general chemistry, organic chemistry, physics, and related lab work. Some medical schools have additional requirements. These requirements were first recommended for medical school admission more than a century ago.
Luz is not the only student I worked with who decided against medical school because of the requirements. David, a Black student from Maryland who loved the sciences in high school, dropped his pre-med focus after realizing that the pre-med courses incentivized rote memorization and added a lot of undue stress. “You put a lot in and don’t get a lot out,” he told me. He’s starting a consulting job this fall.
It’s one thing if we were losing potential doctors because of requirements that were necessary to become a good clinician, but they don’t seem to be. In college, I worked as a faculty teaching assistant who taught organic chemistry, a famously brutal course that often discourages students from pursuing a career in medicine. I (perhaps weirdly) loved my time both taking the course and teaching its content.
But I’ve made it to my final year of medical school without having to use anything I learned (or taught) in organic chemistry to deliver patient care. Evidence also shows that mastery of the pre-med requirements, which is usually demonstrated by performance on the Medical College Admissions Test (MCAT), is not predictive of the clinical performance of young doctors. In one study, the MCAT scores of first-year doctors were not associated with their patient care and medical expertise, professionalism, and interpersonal skills as evaluated by their program directors. Older research concluded the same.
For decades, reformers have called for change to the pre-med requirements. These include shifting the status quo to a pre-med curriculum that includes mentored scholarship; self-directed educational plans that foster lifelong learning; more scientifically and clinically relevant classes such as introductory anatomy; and courses on the social, political, and economic contexts that affect patients. Others have more specifically focused on removing the heavy emphasis on the natural sciences.
From my vantage point as a former pre-med student and recent adviser, students would welcome most of these changes. Perhaps starting small, such as removing the mandatory laboratory time for pre-med courses less applicable to medicine, such as physics and organic chemistry, could jumpstart the process. Alternatively, requiring one semester, instead of two, of certain basic science courses could work. Once it becomes clear that these changes don’t result in less-prepared medical students (and doctors), colleges and medical schools could then consider replacing courses entirely, while giving the Association of American Medical Colleges (AAMC) time to revise the MCAT accordingly.
And that would have ripple effects throughout the U.S. health care system. These courses likely discourage students because of what Luz and David told me, but also because many underprivileged students feel intimidated by classmates who have taken rigorous science courses with labs at better resourced high schools. Some may also feel uncomfortable with the cutthroat competition that often erupts in these courses. This discomfort for minority students is likely only compounded by the fact that very few of their classmates look like them.
Black and Hispanic students, who are less likely to have parents with a college or medical degree, may also fail to understand that pre-med courses are not a true reflection of what it means to be a doctor. Discouraged by their lack of enjoyment and success in the subject, they may decide to drop out of the pipeline altogether.
Because of these reasons and more, we lose the doctors the U.S. desperately needs. This happens even though students who discontinue their pre-med journey appear to have the same scholastic ability as those who continue.
Partly because of pre-med requirements, less than one in six students who begin college every fall with the intention of becoming a doctor will end up applying to medical school. Less than half will get in. Students from backgrounds underrepresented in medicine will disproportionately fall off the pre-med track simply because of the prerequisite courses.
At the end of the day, Luz will inevitably become an excellent lawyer, maybe one who advocates for patients without access to health care. And David, if he chooses, will ensure innovative therapeutics are accessible to underserved communities in the U.S. and abroad. But on the day each decided to leave the path to medicine, the U.S. lost a sorely needed doctor.
David Velasquez is a medical student at Harvard.