Rachel attended our University of Cambridge Summer School in 2020, and is now studying medicine at university. She unpacks the lack of socioeconomic diversity within the medical profession and what can be done to improve access.

The NHS workforce is more diverse than at any other point in its history. Unfortunately, it ignores the fact that just 4% of doctors come from a working-class background. This is a stark misrepresentation of the general population, highlighting the social disparities that persist within the medical profession. The fact is: the medical profession has deep-rooted inequalities.

As a working class, widening participation medical student from an ethnic minority background, I’ll be part of this 4%. Applying to medicine wasn’t easy. It’s not easy for anyone, but the struggles are exacerbated when you come from a poorer background. I had no connections into medicine and neither of my parents went to university. Contrast this with the majority of my peers at medical school who were mostly white, fed opportunities through their background of privilege, and didn’t face financial barriers.

These difficulties continue throughout medical school. Medicine is notorious for long hours of studying, and we’re told to build our portfolios with leadership, teamwork and research experience – already taking up a huge chunk of our time.

But some face additional hardships, such as working part time jobs just to make ends meet; leaving medical school with over £100,000 worth of debt (like myself); undertaking unpaid internships to get experience; and having limited elective choices due to financial difficulties, while others can comfortably afford to head to countries like Dubai, Australia and the USA.

The list goes on. It’s not a surprise there’s a lack of representation of students from these backgrounds in the profession, as it’s incredibly challenging to get into and complete the medical degree itself. People are deterred from applying, and there’s hardly anyone like yourself when you get there.

Beyond medical school, the press headlines in the last year echo the burnout junior doctors are experiencing in the UK. The pressures only seem to build as time goes on, and the bottleneck in speciality applications makes it even more competitive for students to succeed in the areas they want.

This doesn’t even take into account the number of things we have to do for these applications. I’m aspiring to apply for ophthalmology, and there’s a huge list of things we should complete to maximise the quality of our applications, totalling to a minimum of £2,000. For example, I must do the following:

  • Part 1 FRCOphth Exam: £615. A theory exam to assess understanding within ophthalmology before applying.
  • Refraction certificate: £710, assessing some of my clinical skills.[5]
  • Courses including basic surgical skills, basic science, conferences and workshops – totalling well above £1000.

Cost is a major barrier. I’ve grown up with little to no money, but it’s led me to have the drive and determination to take on whatever I can to impress both academically and on a personal level. These courses and exams are a sunk cost, which there is no avoiding, but I wish there was greater support for students and doctors to overcome these hurdles. There are conferences I would love to attend, but some cost hundreds of pounds – which is unaffordable as a student.

So, how do we address this?

We need to improve diversity and access into medicine. It starts with aiding the applicants through summer schools and access programmes – like the one I attended, run by the Sutton Trust. We also need mentoring services so students from disadvantaged backgrounds can receive more guided support like their peers. I’ve created my own guide for widening access students to give them direct access to free resources to aid them with their application. Often, these free and discounted services are poorly advertised, and we’re left feeling like we have no choice but to pay for expensive tutoring resources and work experience opportunities.

Throughout medical school, we need more financial support. Medical equipment is expensive, and sharing limited resources from the clinical skills department is a limitation. More teaching is also needed on strengthening portfolios early on in medical school – I’m entering fourth year and we’ve been told nothing to date, despite the fact I know of its importance through my own research.

A diverse medical workforce is essential for addressing the varied needs of a diverse patient population. Doctors from different socioeconomic backgrounds and ethnicities bring unique perspectives into the social determinants of health and allow us to represent the tapestry of communities across the UK. Medical schools need to work to diversify their intake in order to address this and make these students feel more welcomed into their environments.

By fostering a more inclusive environment, the NHS can better reflect the society it serves and uphold its commitment to equality and diversity.‌

The opinions of guest authors do not necessarily reflect the opinions of the Sutton Trust.