Fewer first-generation students are finishing medical school, study finds

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A new study of 256,513 U.S. medical students over a 13-year period has revealed a troubling trend: fewer first-generation students are entering medical school, and those who do are significantly more likely to leave before graduation.

Published in JAMA Network Open, the study evaluated allopathic U.S. medical school matriculants from 2002 to 2015 and found that first-generation students made up just 7.1% of incoming classes by the end of the study period — down from 8.7% in 2002. These findings point to a deepening divide between socioeconomic background and the opportunity to hold a stable career in medicine.

A pipeline shrinking at both ends

Researchers used data from the Association of American Medical Colleges’ (AAMC’s) Matriculating Student Questionnaire and Graduation Questionnaire. First-generation students — those whose parents did not complete a bachelor’s degree — were significantly underrepresented among matriculants and faced greater risks of attrition.

Among students who did not graduate, 10.6% were first-generation compared with just 6.8% among those who graduated. After adjusting for income, race and other variables, the odds of not graduating were 56% higher for first-generation students.

“These findings suggest that policies to recruit and retain socioeconomically diverse individuals are needed to improve both the educational environment for future physicians and health care for all in the U.S.,” the study’s authors wrote.

Intersecting risks

The study also identified the compounded risks for students who were not only first-generation, but also low-income or underrepresented in medicine (URIM). Students with all three identities had more than twice the odds of attrition compared to their peers.

Low-income students had a 71% higher likelihood of not completing their degree, and URIM students had a 107% higher likelihood. Students who fell into all three categories were 2.51 times more likely to leave medical school before graduating.

Wealth gaps widening

The socioeconomic profile of the medical student body continued to skew toward wealthier backgrounds. In 2015, more than a quarter of non-first-generation students came from families in the top 5% of U.S. household income, compared with just 0.8% of first-generation students.

Meanwhile, the proportion of first-generation students from the lowest income quintile grew from 13.3% in 2002 to 17.1% in 2015. These students also reported significantly higher levels of educational debt at graduation — a gap that widened over time.

Implications for the workforce

Despite the well-documented benefits of a socioeconomically diverse physician workforce, the data shows little improvement in closing the gap. The graduation rate for first-generation students was 2.1% lower overall, and fewer entered high-paying specialties.

The authors argue that first-generation students often reflect the lived experience of the patient populations they will serve, offering a potential bridge to more equitable health care delivery.

A call for structural reform

The findings come as many institutions grapple with how to improve diversity pipelines and support systems. The authors call for more targeted interventions, including mentorship, financial aid, and systemic reforms that acknowledge the barriers first-generation students face.

“First-generation students are an often overlooked and invisible minority among diversity discussions, although they bring a much-needed perspective to medicine,” the authors wrote.

They concluded that the “results indicate a pressing need for intentional investment in recruiting and retaining these students, with the goal of diversifying the physician workforce to better reflect the communities we serve.”