“60 percent of medical students, for example, hail from families with incomes in the top 20 percent of the nation. Meanwhile only 3 percent come from families with incomes in the lowest 20 percent. The prospect of having to borrow and incur debts of $150,000 to $250,000 to enter the profession causes many students to seek careers elsewhere.”
Having grown up in a family living below the federal poverty level, I am acutely aware of the impact that financial limitations can have on one’s perceived career choices. I originally enrolled in college as an Engineering major. Yes, I loved science, using my hands to build things, and working through problems. But I cannot deny that a major driving force was the pursuit of a degree that would guarantee me a job upon graduation. Academia or other alternatives that did not immediately pay were not options. They were also nebulous identities in the mind of a first generation college student.
With the support of generous scholarships, I was fortunate that money became less of an issue for me. I was able to engage in basic outings with friends, such as going to the movies. Purchasing books was no longer an ordeal. And I soon embraced my newfound luxury-albeit still very much limited-in exploring other careers.
Believe it or not, medicine was not one of my first choice career options. People assume that my South Asian identity equates to an identity of privilege stemming from class, education, or social networks. They also assume that it is due to this identity that my decision to pursue a career in medicine was inevitable. Yet, the Asian model minority myth undermines the narratives of significant Asian Americans who are also working in a framework of limited choices due to financial constraints. For instance, according to recent US Census Data,” 53.9 % of Bangladeshis living in Brooklyn are poor – the highest rate among the city’s eight largest Asian immigrant groups.The poverty rates for Bangladeshis was nearly double the numbers for blacks, whites, and Hispanics in the borough and citywide, according to stats from 2006 to 2010″ (1). Looking nationally, “Asian-Americans also experience a higher rate of poverty than non-Hispanic whites. According to a National Academy of Science’s analysis of census data, Asian-Americans have a 12.3 percent poverty rate. That compares to 9.8 percent for non-Hispanic whites” (2). Finally, the Asian American and Pacific Islander population is “one of the fastest growing poverty populations in the wake of the Recession” (3).
The myth of the Asian model minority also perpetuates an irrational fear of professions that are being “taken over” by minority populations. While stepping into an all-white classroom is perceived as normal, stepping into a classroom with a significant number of Asians or other minorities is immediately deemed as a deviation. The ongoing clamor over unofficial quotas that are utilized in admissions of educational institutions reflects such fear.
The aforementioned numbers are not presented as a means of imposing an hierarchy of suffering onto different demographics. It is referenced in order to elucidate the incredible diversity and complexity of the Asian American population, which is dangerous to homogenize. Analogously, it is dangerous to homogenize all physicians who work in underserved populations as those who themselves associate with a marginalized identity. Granted, the majority of such physicians may very well be minorities in one sense or the other. I myself intend to work with underserved populations as a physician-in-training and do indeed identify with multiple marginalized backgrounds.
However, it would be a fallacy to decree that the burden of caring for those suffering from the bulk of inequity in this nation should fall upon those very people who have struggled to overcome the effects of inequity in their educational and career trajectories. Rather, social accountability needs to be rendered as a pivotal component of the medical profession that I would venture to say has an intrinsic ethical and higher purpose by virtue of its responsibility for securing the welfare of humankind. All doctors, not just those who have grown up personally experiencing health injustices, should be spurred to advocate for patients. Interventions in medical education may be one way of cultivating such an impetus.
(1) http://www.nydailynews.com/new-york/brooklyn/new-face-poverty-brooklyn-bangladeshi-community-poorer-blacks-latinos-article-1.1075313#ixzz35bw4iRl1
(2) http://www.npr.org/templates/story/story.php?storyId=185534666
(3) http://nationalcapacd.org/spotlight-asian-american-and-pacific-islander-poverty-demographic-profile
Tehreem Rehman, MD MPH 