Perspectives
Ifeoma Ikedionwu
How an MD Cannot Outrun a Broken System
“Even though medicine claimed they wanted people like me to succeed, its lectures and landscape and structures insisted I shouldn’t be there.”
“Wow, that’s a pretty name. What does it mean?” --“It means gift or good thing from God”. I almost sound like a broken record at this point. I have been introducing myself since I learned to say my name in kindergarten. While these introductions started out short, as I became more cognizant of my lived experiences, more adjectives have been added. These have all felt like Girl Scout badges that denote the complexity of the human experience and affirm the positive impact my life has had in making me into who I am today. However, medical school has turned these badges into tools. They are constant reminders to the ivory tower that is the medical field that modern physicians are not so different from the patients we now see [1].
I identified first as a Nigerian and then as an American growing up–my Dad made sure of that. Although I was born here, my parents continued to incorporate our native traditions into my childhood. My mind would often go blank before replying to my relatives’ greetings with “o di mma” in Igbo just like I had practiced. During our annual conventions, I would diligently learn about the kola nut ceremony when guests came over or the dowry when it was time to be married. I appreciated these instances especially when I would return from these events and convince my peers that my cousins didn’t ride to school on elephants.
As I continued to navigate through the world, I picked up more identifiers-- some instilled by society, others through experiences. My understanding of socioeconomic class and status evolved as my family structure splintered. While I never felt less than when I applied for free or reduced lunch or got my AP class fees waived, I knew my close friends never had to consider this. Conversely, the awareness of my life as a woman heightened in situations where I faced gender stereotypes head-on. I vividly remember being instructed to 'dress more like a lady' or being sequestered to note taking in group projects because ‘I had the nicest handwriting’. These instances ignited a fire within me, pushing me to challenge societal expectations. I wore jeans and a tee shirt almost every day of high school and did not care when a classmate shamed me for not shaving my legs every morning. I also sat in the awkward silence when I declined being the secretary and watched my other lab partners find reasons for them to not do it either.
College became a turning point in my life, unraveling a subtle realization that I had been grappling with depression and anxiety. Unlike the dramatic portrayals in movies, my experience with these internal battles did not manifest with visible intensity. Instead, it hid beneath the surface, concealed by the adrenaline-fueled pursuits of my premed courses and volunteer work. The only times they would spill through were holiday breaks when my phone racked up eight or nine hours of screen time, when I never had to leave my room because I had a personal bathroom and enough snacks to last me weeks.
Sitting to write medical school applications, I reflected on how my worldview drove my education and advocacy work for people overlooked or discriminated against. My work in high school with a grassroots organization advocating for victims of child abuse initially taught me how to speak on behalf of those who could not. In college, I wanted to apply these skills to those outside of my immediate community. Embracing my ethnic culture pushed me to become a Global Engagement ambassador so I could be familiar with other cultures. I spent hours answering secondary essays about “how my previous experiences prepare me to work at safety net hospitals with immigrants, publicly insured, and low income people”, “how my diversity and the diversities of others manifest in my personal and professional activities”, and “how much I align with a school that values diversity as a measure of excellence.” It was reassuring knowing that medicine was looking to recruit future physicians interested in working in under-resourced communities, who had diverse lived experiences, who wanted to go beyond their own circle to impact their community. For all intents and purposes, medicine wanted people who also had a line of descriptors and adjectives to describe themselves that didn’t match the status quo.
Even though medicine claimed they wanted people like me to succeed, its current culture insisted I shouldn’t be there. Thirty-seven percent of physicians in the USA are women[1]. 30% of medical students and residents have depression[2]. A little over 20% of incoming medical students have an annual family income of $74,000 or less [3]. And, approximately 2% are Black womxn[4]. I already knew those facts. I knew them and saw myself as part of changing the landscape of medicine. Yet, medicine still needed to be reminded that if they were trying to make the future workforce mirror the general population, then that meant it also had to address the disparities, injustices, and marginalization that existed in the classroom and in the clinical learning environments, too. I had to grapple with whether I should disclose that I would be missing class for neurology appointments to determine the etiology of my newly developed hypersomnia in case they made me take a leave of absence. Physicians mixed up the names of BIPOC medical students, my friends at other schools lamented that their institutions recommended they not even bother applying for Step 1 accommodations because they were so stringent, and physicians brazenly talked about how patients’ adverse childhood experiences led to poorer health outcomes we could do little to address. It was as if they were so used to speaking offhandedly of the systems that minoritize, disenfranchise, and lead to disparities as something only patients experienced; it may have never crossed their minds that the students they now lectured to may come from such backgrounds. In the past, these instances may have been minimized because it applied to none or one student. Now, that is not the case.
Across my medical school curriculum, I spend hours hearing how much higher black maternal mortality rates are than those of other demographics[5]. How, despite the fact that I was born with two college-educated parents, I am still more likely to have end-stage renal disease and develop chronic medical conditions and so many others because I am Black [6]. How people with mental health challenges have decreased access to healthcare and higher rates of morbidity and mortality[7]. There is stigma when students disclose their needs to administration as well as a lack of insurance coverage and resources. How even though I got into medical school, JAMA showed that low-income and students from under-resourced neighborhoods have the highest percentage of those who don’t end up graduating.8 How physicians don’t want to treat people with chronic illnesses or disabilities and how those patients consequently receive worse care.9 Many physicians are not adequately reimbursed for the accommodations needed to be ADA compliant. Even further, they are uncomfortable adequately treating patients with disabilities because they are never taught how to do so effectively in training.
As I sat in lectures, they never acknowledged that the statistics of the dead and suffering bodies actually included some of the very people present during their lectures. There is a disconnect between the makeup of medical students they taught 20 years ago and the ones sitting in front of them now. There are barriers in affording test prep resources, unconscious biases about what is deemed unprofessional that disproportionately impacts certain ethnic groups, minimal options for mentorship from those with shared identities, and ableist technical standards that unnecessarily bar competent applicants from matriculating. When you bring people with diverse backgrounds into medicine, you also bring the systemic baggage which kept them out in the first place. And that baggage desperately needs to be addressed.
That’s why I introduce myself over and over again. By repeatedly presenting myself with the descriptors and identities that have influenced my journey, I aim to prevent medicine from conveniently overlooking the undeniable reality that people with doctorates in medicine are still BIPOC, low income, chronically ill, gender minoritized medical students facing insurmountable challenges within a flawed system never intended to support us.
[1] https://www.statista.com/statistics/1100676/share-of-female-physicians-across-us-states/
[2]https://www.aamc.org/news-insights/healing-very-youngest-healers#:~:text=Almost%2030%25%20of%20medical%20students,10%25%20report%20having%20suicidal%20thoughts.
[3]https://www.aamc.org/system/files/reports/1/october2018anupdatedlookattheeconomicdiversityofu.s.medicalstud.pdf
[4]https://www.aamc.org/data-reports/workforce/interactive-data/figure-18-percentage-all-active-physicians-race/ethnicity-2018
[5] https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2021.306375
[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5872209/
[7] https://www.nami.org/support-education/publications-reports/public-policy-reports/the-doctor-is-out
[8] https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2794197
9https://www.healthaffairs.org/doi/10.1377/hlthaff.2022.00475