Diversity — Undergrad Costs Harms Financial Diversity

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In the last two articles on impact of finances and financial diversity in medical school we’ve covered several topics:

  • The AAMC and the TDMSAS have recognized a correlation with MCAT & GPA and parental finances (this also includes other factors, such as parental education, household size, etc). Therefore, both agencies encourage medical schools to consider socioeconomic class (SES) within their holistic review of applicants. SES effects all ethnic groups and both genders, though some groups are more likely to have more applicants applying and designated SES.
  • We have noted that despite SES consideration, there hasn’t really been an appreciable change in the number of SES designated accepted medical students — calling into question the myth perpetuated by some that SES students are unfavorably gobbling up seats.
  • We also covered the obvious caveat to aggregated data, you can’t say much about an individual, all we can do is speak of trends.

Today, in this last installment, the last idea: undergraduate education is growing prohibitively more expensive, therefore it’s a moot point to later hope for SES applicants to flood the application gates.

The key to understanding what cost of living in a temporal sense is something called the Consumer Price Index (CPI) — it gives us a barometer of how much more stuff costs now than before on every day items. A rough explanation of CPI versus time is: a flat CPI trend would mean your money is worth just as much now as before, positive slopped CPI would then mean you can buy less of that item you’re using as an index, while if the CPI slooped down it would tell us we’re somehow getting more bang for our buck.  So, looking the graph below as an example:

This graph tells us that overall day to day items costs more than before, they were practically giving away houses in the early-mid 80’s, housing wasn’t a get rich scheme yet in the early-mid 90’s, and now housing is rather un-affordable, though there was a “crash” in prices that hurt you if you owned a house after 2008 (aka housing bubble). And the future of housing prices is unknown, you’d need a good risk analyst to give you a good prediction; but it looks like CPI will continue to rise regardless. That was a very long winded way to say stuff costs too much.

Now back to college stuff, undergraduate education costs are surging. In fact, the rising costs of college greatly dwarf the rising CPI and even the housing price increase we saw in the 2008 bubble.

Credit: Carpe Diem
Credit: Carpe Diem as referenced in a citation on BubbleBubble

The graph above demonstrates that while in general housing is pretty expensive, it’s eclipsed by the burgeoning tuition rates compared to CPI. Overall, undergraduate education is becoming less and less affordable to those with more meager financial support, and it’s likely the only mediation for these groups is either to qualify for more grants and scholarships or to take out additional loans. It’s also interesting to note that in the same period of time, there was a 4x raise in the cost of housing and medical school (when adjusted for inflation 2011 dollars), but during that same period undergraduate education rose by 10x.

Census Bureau data 1967-2011. Graph credit to Advisor Perspectives. Note that the top two quintiles are new additions, previously we restricted conversation to 1st-4th quintiles.
Census Bureau data 1967-2011. Graph credit to Advisor Perspectives. Note that the top two quintiles are new additions, previously we restricted conversation to 1st-4th quintiles — the first four quintiles are the same values as cited in previous articles.

This graph tells us what we already should of ascertained by now: some slivers of society are enjoying a better rate of average income growth given the same period of time, and there is a growing gap between the top quintiles an the lowers. Though, to get a more accurate picture we’d have to include the rate of inflation as in the graph below:

Adjusted for inflation (2012). Census Bureau data  1967-2012. Credit source Advisor Perspectives.
Adjusted for inflation (2012). Census Bureau data 1967-2012. Credit source Advisor Perspectives.

When we look at the data, and it’s adjusted for inflation, we get a more accurate financial picture. All the quintiles, with the exception of a slight creep up in the top two quintiles, all of them were more or less in line of each other from 1967 until about 1984. After 1984, the top 5% (the dash line) left all the other quintiles in the dust– though “top” quintile did see a steady increase. All the other quintiles pretty much make as much in 2012 as they did in 1965.  Now, if we look at this self reported household income survey from Berkeley, we can get a snap shot of one college (though it is scant evidence with n =1). I chose Berkeley simply because they were transparent with their data, there was no other reason other than it being a premed generating university:

Self reported income survey from the University of Berkeley.
Self reported income survey from the University of Berkeley.

From a snapshot of Berkeley alone, we can see that in fall of 2010 about 27% of the class claimed parental finances of $80,001-$150,000, 20% claimed $150,000+. While 53% claimed $80,000 and below –not allowing for us to figure how many actually got in from the lowest quintiles. In terms of who’s usually in medical school (the top and 2nd quintiles as displayed above),  the 53% Berkeley group would easily consume the bottom till the third quintile and still have enough breathing room to also constitute some of the top quintile. Whereas, the other 47% of Berkeley would be high flying into the top quintile with no reservation. From the start some undergraduate institutions already contain an unusually high family income, especially considering that the average family income is around $65,000. Therefore, unless a dis-appropriate amount of low financial quintile applicants are applying in waves, medical schools are somewhat destined to select from crowds who could afford to be at some universities anyways.

Unfortunately, there isn’t much medical schools can do to stop the undergraduate education finance bubble. Furthermore if college continues to become less affordable, medical schools will likely keep having difficulties recruiting SES applicants (regardless of race) in the first place. While offering pipelines and grants is a good start, to make a real dent in the problem college has to become more affordable — unless someone can explain to me why my 4 year medical school bill would be less than a 4 year degree from Columbia in Fine Art (Columbia tuition is ~$56K per year).

I would like to thank Jesse Columbo for pointing me towards sources. He’s an astute financial analyst, contributor for Forbes; and also given credit by the London Times for predicting the US housing crash in 2008. His articles make for a good sobering read, he’s currently leading the scoop on the education bubble as well, click here to read more of his work:



Diversity — Financial Diversity and GPA

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In the last article I focused on diversity and applicants’ socioeconomic status (SES) correlation with the MCAT. This time we will discuss SES and the overall GPA. Gleaning information from the last article we’ve already discussed the following:

  • The AAMC and the TMDSAS both have found a trend, the higher the students’ family income bracket the higher their mean MCAT score.
2012 EO-1 Applicants' who's parents less than bachelor degree, EO-2 applicants' parents with at least bachelor and unskilled labor as a profession. EO-3, EO-4, and EO-5 all represent bachelors, masters, or doctorate degrees with executive or professional positions.
2012 EO-1 Applicants’ who’s parents less than bachelor degree, EO-2 applicants’ parents with at least bachelor and unskilled labor as a profession. EO-3, EO-4, and EO-5 all represent bachelors, masters, or doctorate degrees with executive or professional positions.
  • Just over 75% of the accepted medical students come from families in the upper two quintiles (income brackets).
  • Less than 10% of the accepted medical students will come from families in the lower two quintiles (income brackets).



The average median income for applicants' parents was $57,000 in 1987, it is now $100,000.
The average median income for applicants’ parents was $57,000 in 1987, it is now $100,000.
  • This trend has been pervasive, but not for the lack trying from the AAMC and medical schools continual attempt at intervention with the introduction of SES consideration & holistic interviews.

-We also most mind the logical caveats in the data:

  • Averages don’t equate to a snapshot of any one applicant; SES isn’t fate, either in a positive or negative light.
  • Not qualifying for SES status necessarily guarantee both familial support financial and emotionally. I was in this boat, long story short in college I never qualified for SES consideration because of my parents income that I never tapped into. Regardless, I slaved away like everyone else healthy GPA and MCAT score, fund my ability to work for free (volunteering), applications etc. 
  • We can’t use these numbers to correlate with who works harder, and there will be variations in applicants regardless of SES that would appear within any pool.

This time we will examine the talking point data presented by the AMCAS and TMCAS to examine the following questions:

  1. Is there any correlation with SES and GPA?
  2. How is SES related to ethnicity? *We will look at the TMDSAS because of their unambiguous preferences for consideration of SES.

This time we’ll focus on the Texas equivalent of the AAMC, the TDMSAS applicant joint study talking points and data. For the applicants and accepted, the TDMSAS broke down SES into three categories: parental education & relationship, household (wealth, household size), and hometown (inner city and rural etc.) considerations. For our conversation, we will limit our time to talk about the applicants. Lastly, those who scored more points ranked higher on the SES scale, the higher your SES rating the higher your grade ranging from SES A-D — getting an A wasn’t a good thing.

1. Is there any correlation with SES and GPA? By graphing the aggregated data supplied to us by the X, we get a graph like so:

Data take from report, and graphed with Sigma Plot.
Average GPA versus Year. Data take from report, and graphed with Sigma Plot. TDMCAS assigned SES A – high qualifying SES classification, whereas SES D is on the other side of the spectrum with no (for intents and purposes) SES qualification.

In general, since they’ve started to consider SES there are several short term trends. Overall, over the years everyone has gotten higher GPAs however those with less SES (higher parental income and education etc.) consideration fared better in their overall GPA.  The average  currently shows a trend of groups SES B & C besting (higher incomes) always trumping group SES A (most SES consideration by points). Interestingly, the lowest effected by SES had the most variability in scores, however note that this group always either floats near the performance of groups SES B & C, this group also has the highest average GPA overall.  In other words, there is a correlation with GPAs and SES status.

2. How is SES related to ethnicity? *We will look at the TMDSAS because of their unambiguous preferences for consideration of SES.

*2008 Estimations to nearest whole percent.*Other races not included because values not given, so values may not total to 100% Percent of Total Applicant Pool SES-A (4% of Applicant Pool) SES-B (~10% of Applicant Pool) SES-C (~25% of Applicant Pool) SES-D (~remaining 61% of Applicant Pool)
White/Caucasian American 50% 28% 41% 52% 56%
Asian/Pacific Islander 23% 17% 17% 20% 26%
African American 7% 17% 11% 8% 3%
Latino American 13% 30% 20% 11% 7%

From the chart above we can see that the lowest SES, SES-A, only made up a measly 4% of the applicants in the 2008 cycle whereas the the top two categories (low SES score) made up over 75% of the applicant pool. Caucasian Americans (a mixture of ethnic groups) are the most likely to be in the upper two brackets, however note there are certainly Caucasian Americans qualifying for SES status — in fact, just over 1 in 4 of those with the highest rating of SES were in Caucasian Americans in the TMDSAS — as a whole this is a diverse group economically.  Asians are listed as a conglomerate, from Chinese, Vietnamese to Pakistani, therefore it’s really hard to say much about “Asians” because it’s too broad of an ethnic category. Never the less, all we can really say is that Asians are also a diverse group, and should not be excluded from the SES conversation — in the lowest income bracket (SES-A) by percent alone Asian Americans  qualified as much as African American applicants. African Americans and Latino Americans (another conglomeration) have the least applicants by percentage applying in the upper two (low SES scores) groups C & D, with only 3% and 7% of African American and Latino American applicants’ families qualifying for SES-D respectively. In other words, SES is a multi-racial issue and all races would likely benefit from its application. 

In conclusion, the AAMC and the TMDSAS both recognize that there is a correlation between SES status and academic performance (MCAT & GPA). The AAMC also acknowledges that there is currently a disparity, or lack of diversity, in terms of the financial backgrounds of their applicant pool — this lack of diversity in the applicant pool eventually translates to financial skew of matriculates towards the upper income brackets (and parental education). In response to this reality, the SES is considered by medical colleges as a purview of legitimate holistic review. However, despite genuine efforts to diversify in this area, there hasn’t been much change in the financial portrait of students — in the next, and hopefully final article on the issue, we will discuss some reasons possibly why.

No matter if you agree or not, data is data; and it happens to be the data medical schools take under consideration.

A Day in the Life of a Tutor

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I love Los Angeles, I was born and raised there. But, it’s no secret that some parts of non-gentrified parts of East Los Angeles aren’t exactly for the feint of heart, this is especially true for the neighborhood I was driving to. In my destination neighborhood, there had been a recent spat of racial violence of gangs targeting certain minorities (even students). It probably didn’t help that I was on their “do not enter” list because of this. I knew my boss didn’t really like me, I had wondered deep down if she knew this dangerous fact before she sent me down there — because apparently everyone else said no, and well I recently had quit because of non payment. So, you may then wonder, how is it that I put myself in that situation in the first place? Well, I received a call from her where she said, “If he doesn’t get tested, then he won’t be able to receive tutoring for a year from the school’s fine if you can’t do this one last assignment though…” What can I say, I’m a sucker — I mean how can someone applying to medical school not jump at the chance to drive to a drive-by infested neighborhood, give a district placement test for tutoring to a 3rd grader, then slide out of there neighborhood puncture free?

So, there I was trying to use my GPS to lead me to the quickest route to the kid’s house; and, as Murphy’s Law would have it Verizon doesn’t have that area covered. One thing I’ve learned about wondering around dicey neighborhoods is to never “appear” lost — ever. Fortunately, I found the apartment pretty quickly. It was a single bedroom apartment, though it was obvious by the bunk beds in the living room that space was limited. The kitchen was tiny to say the least, the average American bathroom had more floor space than this kitchen. You could do a 360 and you’d of seen all there was to see in their house. The mother didn’t understand English, so the child I was testing for English (oh the irony) and math soon had to translate some of our communication between her and I.

Everything went rather smooth, and as he stood he front of a tiny round table in the living room I gave him my pencil and a test, we were ready to start. Then I noticed something peculiar. “Why aren’t you sitting down? You should get a chair from somewhere to take this test”, I said. He looked at me, his mother then gave him an inquisitive look, with eye contact alone the child knew the mother wanted a translation. He translated, then he translated back to me “We don’t have a chair”.

A few weeks before that I had been tutoring an elementary student who couldn’t pay attention to what I was saying because she was always scratching her arms and legs. Everyone in the house had developed a cough, the kid, mother, brother, and grandmother. It soon became apparent from the squalor and the cockroaches’ daytime bravo, that it was probably all of the scratching and sneezing I saw were from pest allergies. I hated the situation my pupils were in, but I loved that I was there to meet it. I then remembered why I had come, and why I was there even though I knew I wasn’t going to receive squat, that I was financially in the hole, and I had to pay for medical school applications soon.

Before this time, I was tutoring college organic, general chemistry, physiology, biology. For a separate job, I also tutored high school “pre-premeds” in AP physics and chemistry. I really enjoyed working with some college students, it was great to see them grow. I still keep in contact with some of them, all of them have moved onto better things like research. Working with the high school students in their AP work was a lot less enjoyable, with the exception of one student. I recall one house call I made, it was the first visit, and well I look sort of like Bob Marley so I was apprehensive as that can be a big shock to some people — “Bob Marley is going to teach me biology”, they wonder. Never the less, I rang the door bell, and after hearing a few minutes of shouting across the other side of the door I was eventually greeted by a sharp eyed mother. I was eventually invited in, and asked if I wanted water. It was a very sterile white, the floors were white, the couches too were draped in white to hide their original color. I was then asked to sit down, the mother went upstairs while the aspiring premed youth I’d be tutoring stayed with me downstairs. The mother, upstairs with another woman that I couldn’t see started chattering off in a foreign language, shouts then transitioned into whispering. “I wouldn’t of known you’re talking about me if you weren’t whispering”, I thought to myself. After the upstairs gossip, the mother said “We can’t approve your payment yet until my husband returns, but if you give us a trial, we can then decide.” I didn’t know tutoring worked liked that, it was a pretty imaginative deal. So, I gave the youth the best tutoring session I could pull off, without pay. The initially quiet kid started to ask more and more questions, it turned out he was having a hard time with biology because he didn’t understand the basic chemistry. I finished the session, they tried calling me back later to “book” me, however that was my last new high school that I accepted for an appointment. I grew tired of catering to dictator parents, I had already left one assignment because the parents wanted me to pretty much cheat for their daughter, and for others I really didn’t want to be part of the artificial CV’s stuffing their parents had been planning for their child since they were a fetus.

That’s precisely how I went from a well paid private tutor, to one struggling to make ends meet. I started working with children that were disadvantaged becomes of socioeconomics because I thought I’d feel “better” about myself and how I spent my time. After I stopped receiving pay for tutoring (my bank account didn’t necessarily feel better). I kept tutoring kids and tried to mentor them for another 6 months (just before AMCAS opened) without pay. I actually almost didn’t have enough money to apply to medical school because of this period of “money aversion”, and I thought I might had to wait another year. Yet, somehow serving the people: tutoring science and math in the oncology department, and tutoring inmates and parolees (all stories for another day), ended up paying off a lot more than money ever could have. In the end, I learned a lot of things I could never learn with money. And well, I got into medical school, with my pride intact.