From the time he was a child, Dennis Brown always had dreams of someday becoming a surgeon. Back then, he would insist on being the neighborhood doctor, pretending to operate on his classmates during playtime at school.
“A lot of people say they want to be a doctor because it’s almost the expected thing to say,” he says. “But I really saw myself in the emergency room, wanting to help people. It’s something that I used to think about all of the time.”
But three years after graduating from college, Brown, 25, has made a decision that has even baffled his parents: he’s opted to remain in the working world and not attend medical school, putting his plans of becoming a physician on hold—perhaps indefinitely.
“I have so many loans from my undergraduate years, and the cost of medical school is simply too much,” Brown says matter-of-factly. “I’m not trying to be in debt for the rest of my life. I want to get married someday and not saddle my family with that kind of pressure.”
The first in his family to go to college, Brown is already burdened with nearly $40,000 in loans from his undergraduate years. Adding more debt on top of the interest that he already owes isn’t something that the Cleveland native is able to stomach.
“If I had the money, I would have tons of other options,” he says. “But I have to be sensible about my financial situation. I don’t want to be in debt for the rest of my life.”
Brown’s sentiments may partially explain why the percentage of African-American students enrolled in medical schools across the country has fallen steadily over the last decade while enrollment for Hispanic and Asian students has dramatically soared. In 2004, for example, African-American students represented about 7.4 percent of all of the students enrolled in medical schools, compared to just 7 percent in 2011.
The numbers are telling, according to a new report released by Columbia University’s Mailman School of Public Health and published in the journal PLOS. The report suggests that the reason for the decline in Black enrollment in medical schools can be attributed to the rising educational costs. While Asian students, according to the report, are overrepresented in medical schools by 75 percent, African-American students are underrepresented by 100 percent.
Blacks—more so than their White, Asian and Latino counterparts—enter the application process already anticipating shouldering more than $150,000 in debt once they graduate from medical school. As a result, many, like Brown, decide to reconsider their options, much to the chagrin of their most dedicated supporters.
“The finding that Black medical students had significantly higher anticipated debt than Asian students has implications for understanding differential enrollment among many groups in U.S. medical schools,” notes Dr. Sandro Galea, senior author of the study and chairman of the Department of Epidemiology at the Mailman School of Public Health at Columbia.
“Our work suggests that the burden of medical student debt is substantial and that the distribution of debt across race and ethnicity is disproportionate,” Galea says. “With Black students reporting higher debt burdens than their counterparts from other racial and ethnic backgrounds, it is plausible that this disproportionate debt burden may play a role in the relative decline in medical school attendance among Black students.”
Galea and co-researcher Dr. Abdulrahman El-Sayed analyzed data from a sample of more than 2 percent of students enrolled at 111 accredited medical schools in the country during the 2010-2011 academic year. Of the 2,355 students who were included in the sample, 65 percent of White students anticipated debt greater than the $150,000 financial threshold, while a greater percentage of Black students—77.3 percent—anticipated owing more than $150,000. Asian students, at 50 percent, expected the lowest levels of debt, followed by Latinos at 57.2 percent. The results were weighted by race and class year.
The report suggests that Asian and Latino students who hail from immigrant families “may be less comfortable with the American norm of educational loan utilization than non-immigrant families,” says El-Sayed, who points out that their parents “may be more willing to offset the costs of their children’s graduate education.”
Many African-Americans, particularly those who are low-income and first-generation, may not have family members who are able to assist them in paying for a medical degree.
If the findings in the report are indeed true—that anticipated debt is forcing African-Americans to reconsider enrolling in medical school—the implications for the future of the medical profession are great.
“This is deeply concerning because we want to make sure that the field is diverse,” says El-Sayed. “What we have learned is that African-Americans have the added financial burden of trying to figure out how they will pay for medical school after they’ve gotten in, and that seems really unjust.”
“This is something we expected, but it really bore out in the data,” he adds.
A national survey commissioned of 2011 graduates of medical schools revealed, for example, that the average amount of debt was about $205,000, with West Virginia School of Osteopathic Medicine topping the list with the average student enrolled there owing almost $243,000.
Dr. Marc Nivet, the chief diversity officer at the Association of American Medical Colleges, believes that cost may indeed be a factor in the dramatic decline of African-Americans in medical schools, but he says that it is not the only reason why Blacks decide not to enroll.
African-American males, in particular, are enrolling in medical school at a lesser rate than their Black female counterparts, says Nivet. Today, there are 100 fewer African-American males in medical school than in 1980 and 180 fewer male applicants.
“This is a pipeline issue,” Nivet says. “There is something happening with African-American males, and we have to do more research to find out what is going on.”
For now, Brown has taken a job at a pharmaceutical company in Chicago where he earns a decent living, though he often wonders about his dream of someday becoming a doctor. As the years progress forward, however, he knows that it’s less likely that he will give up his daytime job to attend medical school on a full-time basis.
“I have tons of bills to pay, and I can’t think about the possibility of taking on additional financial debt at this time, so I think I’ve come to terms with my situation,” he says. “It’s unfortunate, but that’s just the way it is.”
“Who knows?” he continues. “Maybe I will someday hit the lottery or have someone leave me an inheritance. But until then, the idea of drowning in more debt is something that’s just out of the question for me.”
Jamal Watson can be reached at [email protected].