‘Pale, male, and stale’ is bandied about in medicine. I guess it represents a group of doctors who are pale, male (be careful in these gender fluid times), and stale (a simple proxy for ageism) who have had a pervasive and negative influence in the profession. But we should be wary of stereotyping for it is the instrument of the populist! My generation is no homogeneous group of men and women, but a colourful and flawed spectrum, who generally devote themselves to the profession and their patients, frequently to the detriment of themselves and their families. But we live in the days of ‘intersectionality’, which seems to reduce every individual to a list of ticks and crosses. Is stereotyping acceptable so long as it’s the ‘right’ type of stereotyping?
This new social wildfire is torching our institutions and hopefully delivering some renewal, but one institution is impervious to any change — social class. Medicine has the worst social mobility statistics of all the professions. In supposedly egalitarian and socialist Scotland, 86% of medical students have parents in the highest ranked professional group.1 Consider also that, between 2009 and 2011, half of all schools in the UK did not provide a single applicant to medicine in 5 years, and 20% of secondary schools in the UK provide 80% of all applicants to medicine.2 But here is an inconvenient fact: intelligence has a simple Gaussian distribution3 with regression to the mean. This means it is statistically impossible that medicine is even remotely a meritocracy, with the merest fraction of the most able accepted into medicine. Medical school admission is utterly and completely confounded by educational and social opportunity (but we should not be judgemental of the current medical students for they are good people, who simply competed in the current system, and let’s face it no one gets to choose their intersectionalism).
But as a pale, stale, male (and possibly a whining snowflake!), I have an idea. Nationalise all private schools and abolish all selective schools! But even the most progressive groups don’t have the guts to suggest this. For we are all hypocrites, and no one is about to give up privileging their own children. So here are some other suggestions.
The top universities’ attempts at outreach work and social inclusion is woeful. Write them rude letters and tell them to improve. Jeremy Hunt’s new medical schools with 1500 new places will undoubtedly help,4 but we need many more of these places and opportunities. The costs of training are tiny compared with the societal costs associated with a limited supply of doctors. Those in the allied professions should have preferential and accelerated applications into medicine. Bring in a medical student bursary similar to nursing. Most importantly, all state comprehensives with over a thousand students should have reserved places in medicine. Last, in the short term, contact your local secondary schools and actively offer mentoring and work experience in your practice.
Let’s all become social justice warriors.
- © British Journal of General Practice 2019