Medical school attrition rates higher in underrepresented groups

Medical students from historically underrepresented groups face an attrition rate that is more than three times higher than that of other students, according to a recent study in JAMA Network Open.

“Diversity in the medical workforce is critical to improve health care access and achieve equity for resource-limited communities,” Mytien Nguyen, MS, an MD/PhD student at Yale University School of Medicine, and colleagues wrote. “The findings highlight a need to retain students from marginalized groups in medical school.”

In a retrospective cohort study, the researchers analyzed data of MD-only medical school students during the academic years 2014-2015 and 2015-2016 to investigate the association between attrition and marginalization, which was broken up into individual measures of race and ethnicity and family income, as well as structural measures — the resources in the neighborhood where one grew up.

The researchers reported that the attrition rate was highest among students who reported all three marginalized identities: low income, being from an under-resourced neighborhood and a race and ethnicity underrepresented in medicine. Their attrition rate was 3.7 times higher than students who were not from under-resourced neighborhoods, did not have low incomes, and who were not from groups underrepresented in medicine (7.3% vs. 1.9%; P < .001).

“Students who were [underrepresented in medicine] had low income and grew up in an under-resourced neighborhood had at least 40% higher odds of attrition than their counterparts in each identity,” Nguyen and colleagues wrote.

When broken down by demographic, compared with non-Hispanic white students, the group of American Indian, Alaska Native, Native Hawaiian and Pacific Islander students had the highest rates of attrition at 11% (adjusted OR = 3.2; 95% CI, 1.76-5.8), followed by Black students (5.7%; aOR = 1.41; 95% CI, 1.13-1.77) and Hispanic students (5.2%; aOR = 1.41; 95% CI, 1.13-1.77).

Regarding socioeconomic status, those from an under-resourced neighborhood had an attrition rate of 4.6% compared with a 2.4% attrition rate among those who did not grow up in an under-resourced neighborhood (aOR = 1.35; 95% CI, 1.16-1.58), according to the researchers. Those who had low income had a rate of 4.2% while those without low income had a rate of 2.3% (aOR = 1.33; 95% CI, 1.15-1.54).

The researchers concluded that medical schools and the Liaison Committee on Medical Education “should prioritize the evaluation of attrition rates across multiple marginalized identities to reduce retention gaps for marginalized students.”

“Given the higher attrition rate among marginalized student groups, medical schools should consider reforms that dismantle structural inequities in medical culture and training that equate privilege with merit and physicians as an elite class of citizens,” they wrote. “These reforms may begin with tuition and debt reform and purposeful partnership and support of local and national under-resourced communities.”