Unequal Treatment?

Medicine has long been recognised as one of the most difficult and competitive professions to access, particularly for those from the lowest socio-economic backgrounds. As the Government looks to train more doctors through the NHS Long Term Workforce Plan, the report Unequal Treatment? looks at access to medical school today, and how best to ensure that the thousands of extra medical school places envisaged will be accessible to students across the socio-economic spectrum.

Part 1, authored by Professor Katherine Woolf, Dr Asta Medisauskaite and Dr Shaun Boustani from UCL, is a detailed original analysis of national administrative data on medical school admissions from the UK Medical Education Database (UKMED). The work examines where and how improvements in widening participation have been achieved since 2012, what the new landscape of undergraduate medical school recruitment looks like and points to lessons that can be learned from some of the changes to medical school selection that have been implemented over the last decade.

Part 2, authored by the Sutton Trust, looks back on the last decade of widening participation in medicine, from barriers in schools through to the workplace. It also looks forward, at the opportunities to improve access coming up through the implementation of the NHS Long Term Workforce Plan.

Webinar on socio-economic diversity in the medical profession

Taking place on Thursday 6th March at 12PM, this webinar will discuss the findings in this research and how working class representation among doctors can be increased. Panelists will speak about their perspective on barriers to accessing careers in the healthcare and medical industries and what they think needs to happen to widen access to these profesisons.

The percentage of entrants to medical school from lower socio-economic backgrounds.

1.5x

How many times more likely independent school applicants are to receive an offer to study medicine.

56%

The proportion of medical school entrants from non-selective state schools.

Key Findings

Medical schools over time

Between 2012 and 2022, the number of young people applying to study medicine in England grew by 64%, from under 7,500 to over 12,000. At the same time, the number of students entering medical school grew by only 44%.
Students with the highest prior educational attainment and the highest Universities Clinical Aptitude Test (UCAT) scores, were the most likely to receive an offer to study medicine. UCAT score was found to be the strongest of these predictors.
Admissions processes currently vary considerably between medical schools. This complex system can be challenging for applicants to navigate, particularly those from less advantaged backgrounds, who may lack wider support

Access to medical school

By school type

Between 2012 and 2021, the proportion of medicine entrants from independent schools decreased, from 31% to 22% (compared to around 7% of students attending independent schools overall) while the proportion of non-selective state school entrants increased from 50% to 56%. This is a result of the absolute number of applicants from independent schools staying relatively stable, while numbers from non-selective state schools grew.
Even after adjusting statistically for their exam grades, socio-economic status and other demographic factors, independent school applicants had higher odds of receiving an offer than those from non-selective state schools.
Between 2012 and 2022, the majority (80%) of schools or colleges had fewer than five students applying to medicine per year. However, a very small number sent large numbers of applicants. Two percent of all institutions had on average 20 or more applicants per year and on averaged 85 applicants per year. 11 schools/colleges (<1%) averaged 20 or more entrants to medical school each year.

By parental occupation

In 2021, individuals from higher socio-economic backgrounds (based on their parent’s occupation) made up 75% of entrants to medical schools, while just 5% were from the lowest socio-economic group. While still very low, the proportion of those from lower socio-economic backgrounds has doubled since 2012.
The UCAT test may be a barrier for those from worse-off homes. Applicants from lower socio-economic backgrounds with the highest predicted A-level points achieved significantly lower UCAT scores than those from medium or higher socio-economic backgrounds
Looking at the interaction between socio-economic group and ethnicity, among students from the lowest socio-economic backgrounds almost two thirds (61%) were Asian and 15% were White. Conversely, in the highest socio-economic group, 31% were Asian and 52% were White

By neighbourhood (IMD)

The proportion of applicants living in the 20% most deprived neighbourhoods (by IMD)) grew considerably from 2012. By 2022, 20% of applicants lived in the most deprived and 25% in the least deprived or wealthiest areas.
Applicants from the most deprived areas were less likely than those from other areas to get an offer to study medicine largely because of lower attainment. However, those with similar grades and demographic backgrounds were more likely to get an offer and more likely to enter medical school compared to applicants from less deprived neighbourhoods.
Improvements in access by neighbourhood, alongside less progress by individual socio-economic background, potentially point to the limitations of place-based rather than individual-based widening access efforts with the possibility that applicants from better off families within more deprived neighbourhoods may have benefitted most from these widening access efforts.

Widening participation efforts

New medical schools

Between 2018 and 2021, six new medical schools admitted students for the first time – established in areas with relatively fewer doctors per person, with the specific remit to recruit both locally and from typically under-represented groups.
Although new medical schools had more balanced state/independent school intakes than established institutions, they still have considerable gaps between entrants from higher and lower socio-economic backgrounds, with only 7% of entrants to new medical schools from the lowest socio-economic group and two thirds (66%) from the highest.

Gateway courses

Gateway medical degree courses include an additional foundation year, with lower grade requirements for entry. These courses are designed to attract and admit applicants from under-represented backgrounds.
Just 4% of those entering a gateway course attended an independent school, compared to 28% of those entering a standard entry course.
Only 11% of all entrants to gateway courses were from the lowest socio-economic group, with 46% from the highest. While this is better than standard entry courses (4% and 73% respectively), gateway courses may need to do more to further access to those from lower socio-economic backgrounds.

Recommendations

For government

As the Government looks to expand the number of medical school places and medics trained in the UK, there is a major opportunity to improve socio-economic access to the profession.

To do so successfully:

Government should prioritise medical schools with a successful record on widening participation, both in initial access and in student outcomes, in any expansion of spaces. Those with a proven track record of success, with a focus on individual level measures (for example free school meal eligibility) should be prioritised for any new medical training places.
There should be a fair access review across the higher education sector, including access to medical schools. This should explore a sector-wide approach, with a focus on socio-economic disadvantage. Such a review should look at implementing stronger regulatory expectations and encouraging a clear and consistent approach to contextual offers.
Clearer information and support should be available for aspiring medics looking to navigate the application process. The identification of an agreed clearly advertised and accessible ‘one-stop shop’ for all medical school applicants would help simplify the information gathering process, ideally hosted by UCAS.
Medical apprenticeships, if continued, have the potential to open-up access to the medical profession by diversifying routes to entry, but to do so, they must be properly monitored and evaluated. It should not be assumed that medical degree apprentices will be from a wider range of socio-economic backgrounds than those on standard medical degrees, as higher and degree level apprenticeships are often highly socially selective.

Webinar on socio-economic diversity in the medical profession

Medical schools over time

Access to medical school

Widening participation efforts

For government

Related Research

A Class Act

Fair opportunity for all

Closing the attainment gap