First-Generation and Low-Income Students in the National Medical Student Body

Abstract

Importance: Diverse representation within the US medical student body and physician workforce is an important step to help address known pervasive health care disparities. Objective: To evaluate US medical school first-year matriculants between 2002 and 2015 through a disaggregated lens, parsing out low-income and first-generation students and understanding their intersectionality with racial and ethnic groups. Design, Setting, and Participants: Using deidentified student-level data of allopathic US medical school matriculants from the Association of American Medical Colleges Matriculating Student Questionnaire from 2002 through 2015, this cross-sectional study obtained demographic data with a focus on first-generation and low-income status. Data were analyzed from January 2022 through July 2024. Exposures: Race and ethnicity, first-generation medical student status, underrepresented in medicine (URIM) status (ie, identifying as Hispanic only, non-Hispanic American Indian or Alaska Native or Native Hawaiian or Pacific Islander only, or non-Hispanic Black/African American only), parental income, total student debt, and graduation status. Main Outcomes and Measures: Trends of first-generation and low-income students were evaluated longitudinally. Medical student parental income was compared with that of the US general population by race and ethnicity and generation status for the years 2002, 2008, and 2015. A multivariable logistic regression model was performed to evaluate URIM, parental income, first-generation status, and attrition from medical school. Results: Between 2002 and 2015, a total of 256 513 students were included in this analysis (48.0% women; 14.7% URIM; 7.4% first-generation). The proportion of first-generation students decreased from 8.7% in 2002 to 7.1% in 2015. When comparing student parental income with that of the general population for 2002, 2008, and 2015, the top 5% of households by income were overrepresented among non–first-generation medical students (21.1% in 2002, 31.5% in 2008, and 26.4% in 2015), while the parental income representation of first-generation students was more aligned with the general population (1.4% in 2002, 2.8% in 2008, and 0.8% in 2015). The graduation rate of first-generation students was 2.1% lower than the graduation rate of non–first-generation students. Medical students were more likely to not graduate if they were low-income (odds ratio [OR], 1.71 [95% CI, 1.60-1.84]), URIM (OR, 2.07 [95% CI, 1.98-2.17]), or first-generation (OR, 1.56 [95% CI, 1.47-1.67]). Conclusions and Relevance: This cross-sectional study of US medical student matriculants found a decrease in the number of matriculants who were first-generation. These students were at significant risk of attrition from medical school, particularly when considering the intersectionality with low-income and URIM identities. These results suggest a need to recruit and retain these students, so that the physician workforce better reflects the backgrounds and experiences of the communities served.