The views and opinions expressed in this collection are those of the authors and do not necessarily reflect the positions of the Association of American Medical Colleges.
Dr. Lee is an Associate Professor of Medicine, Assistant Dean of Students, and Director of the Wellness Initiative at the University of Chicago Pritzker School of Medicine. She earned her medical degree from New York University, a masters of public health from the Harvard School of Public Health and completed her internal medicine residency at New York Presbyterian Hospital/Weill Cornell. At the University of Chicago, she leads innovative programming to improve physician and trainee well-being.
The demographic term, socioeconomic status (SES), refers to a person’s social standing or class and is a multivariate category that includes education, income, and occupation. A student’s SES can impact their lived experiences and how faculty and peers perceive them in medical school. Despite efforts towards increasing diversity at medical schools, socioeconomic diversity remains a challenge. Recent reports by the AAMC examined data over the past 30 years and found that close to 80% of US medical students come from the top 2 quintiles of household income in the country, and that students from low-SES backgrounds had higher rates of attrition in the first two years of school compared to their peers.
These reports helped me better understand the years of isolation and anxiety I experienced as I “made it” through each step in my medical education. I was proud of being from the colorful and gritty inner-city area of Los Angeles, where I was raised by immigrant parents who were hardy and loving but lacked formal education and had chronic financial ailments. However, I knew that because of my background, I might not have the requisite behavioral polish or access to strong social resources needed for eventual success in medical school. That thought was debilitating. I wondered: were there other students, residents, or faculty who grew up poor and understood my struggle, who still turned out OK? And, if there were, why was there no organization or space in medicine to come together to talk about these shared experiences?
In 2018, while I was on a gap year pursuing a research fellowship at the Pritzker School of Medicine, I decided to forgo my internal doubts and host a dinner to bring together students who identified as coming from socioeconomically disadvantaged backgrounds. With funding and support from our school’s Multicultural Affairs Office and Wellness program, I provided food for the 15 students who showed up for the event at my apartment. At this first gathering, there were students from all four classes representing a truly diverse array of ages, genders, and ethnic and geographic backgrounds.
As we went around the room and introduced ourselves, I asked everyone to share what their parents or guardians did for a living. From this single question, a very natural flow of conversation emerged. We shared how the financial hardships we faced fostered a strong sense of self-reliance, but how this self-reliance was also a limitation that instilled an intense fear of failure. Many of us discussed our complex relationships with our families and shared the common experience of feeling an intense pressure to succeed and fulfill a fantasy of "saving" our families from financial ruin. It was cathartic to discuss the guilt and emotional exhaustion that resulted from an overbearing sense of duty to our families.
In our conversation, many of us also shared the difficulties we had in reconciling the differences between our past and our entrance into careers of privilege and prestige, and the loneliness and isolation that often resulted. Throughout this evening, we openly shared our families’ various struggles with unstable employment and income, and the repercussions of their lack of formal education and status. These were themes that we collectively and intuitively understood. Importantly, we shared our stories with warmth, honesty, and a lot of humor.
From this first discussion, we realized there was a great need to continue this conversation and to support efforts for socioeconomic diversity. We went on to form “LIPS,” the Low-Income Pritzker Students group. It was a great risk to ask classmates to come together and be vulnerable, especially when many of us had previously not known each other. However, it took this vulnerability to build meaningful relationships with one another. LIPS has greatly enriched our medical school community and has given underrepresented students an opportunity to share and listen to each other’s experiences, transparently discuss concerns, find humor in our struggles and grief, and embrace each other as sources of support. It will take a concerted effort to make medicine a more equitable and accessible career for students from diverse SES backgrounds, and the initial steps include identifying one another and coming together to form allies with peers, residents, and faculty.
Lindsay Y. Chun, MD
Ophthalmology Resident, PGY1
University of Chicago Medical Center
University of Chicago Pritzker School of Medicine (‘19)
Lindsay Y. Chun, MD, is from Koreatown, Los Angeles, and a graduate of the University of Chicago Pritzker School of Medicine (‘19). She is currently in her first year in the MacNeal Hospital Transitional Year residency program, and will begin her advanced training in ophthalmology with the Department of Ophthalmology at the University of Chicago Medical Center. Twitter: @LINDCHUN Instagram: @LINDCHUNMD
Wei Wei Lee, MD MPH
Assistant Dean of Students
Associate Professor of Medicine
Director of Wellness Initiatives
Pritzker School of Medicine