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National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice. An American Crisis: The Growing Absence of Black Men in Medicine and Science: Proceedings of a Joint Workshop. Washington (DC): National Academies Press (US); 2018 May 18.

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An American Crisis: The Growing Absence of Black Men in Medicine and Science: Proceedings of a Joint Workshop.

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8Financial Barriers to Medical Education

Highlights Presented by Individual Speakers

  • Financial barriers to medical education include not only medical school tuition, but also costs related to applying to schools, preparing for and taking standardized tests, and tuition for schooling prior to medical school. Not only do individual students bear these costs, but their families do, as well. (Knight)
  • Financing medical education can be a psychological barrier in addition to a material one. (Dyer, Knight)
  • Financial crises not involving education-related costs (e.g., medical expenses, temporary homelessness, and childcare emergencies) can threaten students' continuation in medical school. (Dyer)
  • Financial barriers occur in the context of other challenges like systemic racism, a lack of opportunity or role models, and negative social norms and values of Black men. (Knight)
  • Teaching financial literacy may help students make better financial decisions. Incorporating financial literacy in mentoring should begin at earlier ages, such as among high school seniors taking on undergraduate loans. (Mallett)
  • Financial costs may be especially burdensome for those who discontinue their medical education. (Knight)

This panel focused on the financial barriers Black boys and men face throughout the medical education trajectory, and discussed potential opportunities to address these barriers. Esther R. Dyer, M.L.S., D.L.S.,1 described scholarships and other funding that the National Medical Fellowships (NMF) provide to underrepresented minorities in health professional education. Joseph B. Hill2 discussed a unique collaboration between the Thomas Jefferson University and Alpha Boulé chapter of the Sigma Pi Phi fraternity, to support a medical education pipeline program. Michael Knight, M.D.,3 offered insight from his experience into the perceived financial barriers from the student perspective. Theodore Corbin, M.D., M.P.P.,4 led a brief discussion following the presentations.



, M.L.S., D.L.S., President and Chief Executive Officer1.


1 National Medical Fellowships

NMF is a nonprofit organization that provides scholarships and awards to underrepresented minority medical students and offers service-learning programs to students in the health professions. Franklin McLean, M.D., Ph.D., a physician/researcher who helped found the University of Chicago School of Medicine, established the Fellowships in 1946 in recognition of the lack of opportunities for Black physicians (including no residency programs for Black students at the time) and of the need for Black physicians to ensure access to high-quality health care for all Americans. Originally providing scholarships to only Blacks, NMF opened its funding to other underrepresented groups in the health professions in 1968. The organization aims “to identify and nurture talent early, to provide opportunities to level the playing field, and to be a good investment in the future of health care,” Dyer said.

Dyer provided a brief overview of the financial burdens of medical education, including application, tuition, and examination costs, as well as the resulting debt. She also described financing medical education as a psychological barrier among underrepresented minorities and how NMF can help students overcome this challenge, saying,

They need guidance and support to understand how they can achieve their dreams and their passions, and walking the paths that you [as African American leaders in medicine] have walked, and still manage to feed their families and eventually retire.

Dyer briefly discussed two of NMF's programs, the Dr. David Monash/Harry Lloyd and Elizabeth Pawlette Marshall Medical Student Scholarship Program and the Primary Care Leadership Program. The former provides service scholarships to 1st-year through 3rd-year medical students to conduct a community health project and residency scholarships of $25,000 to decrease medical school debt to 4th-year medical students who are matched as clinical residents in the Chicago area and who exhibit a commitment to serving underserved populations in Chicago.5 The Primary Care Leadership Program places 2nd-year and 3rd-year medical students, graduate nursing students, and graduate physician assistant students in partnering community health centers (CHCs). The program offers scholarship funding, mentoring, exposure to primary care, and the opportunity to make an impact in these CHCs.6

NMF also has an Emergency Scholarship Program, which provides bridge funding for students for whom financial crises threaten their continuation in medical school.7 These often-unexpected crises typically involve non-education-related costs—for example, medical expenses, temporary homelessness, childcare emergencies, and other crises. These funds also support 4th-year medical students' costs related to securing a residency (e.g., application fees, travel to interviews). Dyer offered examples of emergency scholarship recipients. Lagu Androga, a 3rd-year medical student at Albert Einstein College of Medicine, had an untreated eye problem that hindered his ability to pass his medical licensing step examinations. The NMF Emergency Scholarship Program supported a preparation course for Androga to pass the exams. Trevor York, a 4th-year student at the University of Buffalo State University of New York School of Medicine and Biomedical Sciences, was raised by a sick, single mother with no medical coverage or funds to pay for medical care. This experience inspired him to become a physician, but, by his 3rd year of medical school, he had only $500 in savings and increasing debt. Additionally, after setbacks in his medical school rotations, York needed to take time off to receive counseling. When York returned to his studies, he rebounded academically, but lacked funds to pay for basic costs—food, electricity, and rent. The NMF Fellowship offered him bridge funding for these costs and also to support travel to take his medical licensing step examination and to travel to interview for residency programs. Currently, he is a recipient of the NMF National Alumni Council scholarship and is in the process of identifying his residency options.

To close, Dyer presented a quote from Marcus Rushing, a 2012 recipient of the United Health Foundation/NMF Diverse Medical Scholars Program and a member of the NMF Young Alumni Leadership Council: “NMF provided me with financial support, and they gave me one of the greatest gifts that you can ever give a person: they gave me an opportunity.” Dyer reiterated that, in addition to funding, NMF offers support and opportunity. She said, “We [NMF] believe in them, and that this is an opportunity for them to be successful, and that we recognize that.”



, Senior Vice President and Chief Diversity Officer1.


1 Enterprise Office of Diversity, Inclusion, and Community Engagement, Thomas Jefferson University and Jefferson Health System

The Jackson/Minton Scholarship Fund provides scholarship funding to Black men to promote diversity at Thomas Jefferson University Sidney Kimmel Medical College.8 Hill recalled the dean of the college directing him to increase recruitment of Black men to the school upon his arrival at Jefferson. Looking into the history of the university, Hill discovered that the first Black graduate from Jefferson Medical College was Algernon Brashear Jackson in 1901. Together, Jackson and fellow African American Jefferson Medical College alumnus Henry McKee Minton founded Sigma Pi Phi, also known as the Boulé, a fraternal organization composed of prominent Black men, many of whom have been or are leaders in advocating for civil rights, social justice, economic and educational equality, and which offers professional and social support for Black professionals, including mentoring and fellowships for young Black men.9 This history spurred Hill to reach out to the Sigma Pi Phi to create a Jackson/Minton Scholarship for African American men at the Sidney Kimmel Medical College. With additional matched funding from the Sidney Kimmel Foundation, which generously supports the Jefferson Medical College more broadly, the Sidney Kimmel Medical College together with Sigma Pi Phi launched the Jackson/Minton Scholarship during the Democratic National Convention in Philadelphia in 2016.

While conducting initial fundraising in collaboration with the Boulé Foundation, several Boulé members who were also Jefferson Medical College alumni recalled the challenges and barriers they faced as students. Spurred by these comments, Hill expanded the fellowship to include a mentoring program featuring members of the Alpha Boulé chapter (of Philadelphia), to help guide students through the medical school experience. The goals of the Jackson/Minton Scholarship are to

  • Create a $1 million endowed scholarship (matched by the Sidney Kimmel Foundation for a total endowment of $2 million);
  • Increase enrollment of Black men at the Sidney Kimmel Medical College; and
  • Provide mentors from among members of the Sigma Pi Phi Boulé to scholarship recipients.

The scholarship also aims to support the Summer Training and Enrichment Program for Underrepresented Persons (STEP-UP) Medicine pipeline program at Sidney Kimmel Medical College. The STEP-UP program is a comprehensive summer enrichment program for undergraduate students from groups underrepresented in the medical professions and from economically disadvantaged backgrounds who intend to apply to medical school.10 It provides preparation for the Medical College Admission Test (MCAT) and for the medical school application process; enrichment programs on health policy, health disparities, and health equity; and experiences in clinical shadowing and workshops on medical skills.

Hill finished his presentation by remarking,

We wanted to make a difference. Here is an opportunity for successful African American males, most [of whom] are already physicians, to really give back and to really start identifying more African American males [to] come to Thomas Jefferson [University].



, M.D., Assistant Professor of Medicine and Patient Safety Officer1.


1 Division of General Internal Medicine, The George Washington University

Knight recalled his experiences and the experiences of fellow Black medical students he represented from his former tenure as president of the Student National Medical Association. He urged the audience to think about financial barriers early in the pipeline, starting with the costs of preparing for and taking the SAT in high school, college applications, undergraduate tuition and loans, applying to medical school (including preparing for and taking the MCATs and travel for interviews), medical school tuition, and through the costs of applying to residency programs. He described these as costs not only for individual students, but also for their families who may be financially supporting students through their schooling. He remarked,

We have to think about the challenges that families are going through. My own family [took on] thousands of dollars in credit card debt just [for me] to take the MCAT, just to go on interviews. Thank God I made it and got to medical school and actually have been able to give back, so we could pay that off.

He expanded on the financial burdens on those who discontinue medical education and how seeing the costs for these students who discontinue their education can discourage others. He commented,

There are many of us that don't make it. And when you see other students who have tried to go to medical school, and they are not successful, and they are still stuck with that debt, what incentive is it for me to go down that same path?

Knight also encouraged the audience to think about financial barriers in the context of other challenges. He described lack of opportunity, systemic racism, low expectations, and negative portrayals of Black boys and men in the media. He described the lack of role models as an incentive to pursue medical careers. Recalling his own experience, he said,

No one in the family is a physician. No one at church is a physician. Sometimes these opportunities are not even realities. When we go to school and are told, “Boys do this,” the incentive to excel in your academics—in science, in mathematics—is not there. If you are not seeing these examples, what is the incentive for us to pursue these careers?

For those who graduate college and are accepted to medical school, Knight described the cost of graduate medical education as a psychological barrier. He said,

When you are coming from a family that is hardly making anything, thinking about a loan in the hundreds of thousands, yes, you are going to be a physician. You are going to be able to pay it back. But think of coming from a family where no one has even had $100,000 in any bank account or anything such as that. You are signing up for a loan for $300,000. Just think of what that is doing to your mind and what that is doing to your incentive to even pursue this.

Knight concluded his presentation by describing the need to increase access to existing scholarships. Although many scholarships exist, knowledge of them does not necessarily reach many young students who are interested in pursuing health careers. He underscored the need to help young Black boys to navigate the medical education process and to alert them to available opportunities—financial and otherwise—to ensure this interest and potential is not lost. He closed his presentation by posing the question,

[Who] we are not seeing make it are those who are at the most risk that don't have those support systems. How can we utilize our resources to really affect and change the lives of those who are most in need?


Cato T. Laurencin, M.D., Ph.D.,11 raised the issue of what to do for students who discontinue their medical education, either who leave schooling before graduating or who complete medical school but do not match with a residency program. He also urged further consideration of costs unrelated to education, but instead related to family and social issues that can be financial burdens and barriers, the “mental anguish” these financial situations create, and their consequences for academic performance. Hill responded, “When [students] start medical school, the family issues, the social issues, don't stop. Many times, they get worse.” He added that people often justify the high costs of medical education with the high salaries of physicians. However, this premise may not be realistic for individuals whose life circumstances make it difficult to complete their medical education and become physicians on the expected timeline.

William Owen, M.D., FACP,12 raised the potential of financial literacy programs. He commented that even for students who receive educational loans, often they do not know how to handle money and consequently increase their debt. Building on this comment, Victoria Mallett, M.D., M.M.M.,13 raised the need for financial literacy at an even younger age. Underrepresented minority students often come to medical school with greater indebtedness from their undergraduate education. She therefore suggested the need to look at incorporating financial literacy in mentoring and to examine financial decision making among high school seniors taking on undergraduate loans. Recalling her experience with boys her family took in, she said

It was amazing to me when my “bonus sons” were in undergrad and getting their loans, they would talk about their refunds. I said, “That is not a refund. That is a loan that you have to pay back. And you will be saddled with it your whole life, because there is no bankruptcy. There is no forgiveness. You can never get out of this.” . . . Try to get a 17-year old to understand this. Since when do 17-year olds get to make a $100,000 decision? The banks have set this up, and we have allowed them to do that.



Dyer is president and chief executive officer of the National Medical Fellowships.


Hill is senior vice president and diversity officer, Enterprise Office of Diversity, Inclusion, and Community Engagement at Thomas Jefferson University and Jefferson Health and Alpha Boulé chapter of the Sigma Pi Phi fraternity.


Knight is assistant professor of medicine and patient safety officer, Division of General Internal Medicine at The George Washington University and former president of the Student National Medical Association.


Corbin is vice chair for research and associate professor in the Department of Emergency Medicine at the Drexel University College of Medicine.


For more information on the Dr. David Monash/Harry Lloyd and Elizabeth Pawlette Marshall Medical Student Scholarship Program, see https://nmfonline​.org​/about-our-scholarships-and-awards​/service-learning-programs​/monashscott-medical-student-scholarship-program (accessed March 9, 2018).


For more information on the NMF Primary Care Leadership Program, see https://nmfonline​.org​/about-our-scholarships-and-awards​/service-learning-programs​/nmf-primary-care-leadership-program (accessed March 9, 2018).


For more information on the NMF Emergency Scholarship Fund, see https://nmfonline​.org​/about-our-scholarships-and-awards​/nmf-emergency-scholarship-fund (accessed March 9, 2018).


For more information, see https://w3​.jefferson​.edu/giving/sigma-pi-phi.html (accessed March 9, 2018).


For more information about Sigma Pi Phi, see https://www​.sigmapiphi.org/home (accessed May 3, 2018).


For more information on the STEP-UP program, see http://www​.jefferson​.edu/university/diversity​/pipeline_programs/step_up.html (accessed March 9, 2018).


Laurencin is university professor, Van Dusen Distinguished Professor of Orthopaedic Surgery, and director, The Raymond and Beverly Sackler Center at the University of Connecticut.


Owen is dean and chancellor of the Ross University School of Medicine.


Mallett is dean of the School of Medicine at Meharry Medical College.

Copyright 2018 by the National Academy of Sciences. All rights reserved.
Bookshelf ID: NBK518880


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