It’s the dilemma every pre-med student faces come December: What internship am I going to get this summer? Each year, more and more applicants apply to medical school, with few additional schools opening: between 2013-14, 1464 more students applied to medical school while only 288 more seats were given out. This has forced students to get better grades, participate in more extracurricular activities, do more research, and find more ways to differentiate themselves to gain their coveted spots. Since most applicants have top-of-the-line grades and ample extracurricular involvement, a prestigious research internship can quickly become that crucial deciding factor on an application. Consequently, summer “break” has become a well-known critical time for students to strengthen and polish their applications to medical school. The question is: Is the competitiveness of medicine forcing more and more students to do internships that are unpaid, unproductive, and unhelpful just to check that last box on their resume? And is the nature of internship recruitment leaving minorities and those without connections out to dry?
As a pre-medical student, I interned in two different labs. In one, opportunities were thrown at me: I was included in research projects, offered frequent shadowing opportunities, and invited to exclusive case study meetings where doctors and fellows (and I!) discussed recent interesting patient cases. In the other, I spent the majority of my time organizing study binders, plugging in excel calculations, and sometimes even arranging my mentor’s work calendar. As a medical student, I have heard many similar stories from my peers about boring summers spent checking data in a research lab or filing papers at a medical office. This made me curious – were our experiences normal? Were many students enduring less-than-thrilling summers, hoping for a line on a resume or a letter of recommendation? I decided to conduct my own survey. In total, I gathered 107 total results from students in several medical schools across the US.
Fortunately, an overwhelming majority - 97% - of my respondents felt that their internships were, in fact, worthwhile. Stephanie Gopie of Florida Atlantic University Charles E. Schmidt College of Medicine wrote, “Pre-medical internships are a great way for the students to be motivated for their future. I got insight into what my life would be like ahead of time.” Another student from Sidney Kimmel Medical College at Thomas Jefferson University commented, “I made my own hours and geared it towards what I was interested in.” However, about a third of the respondents did state that they would not have completed an internship if they knew it would hold no bearing on their acceptance to medical school, and 19% of my respondents were “sometimes” or “often” required to do menial tasks (such as getting coffee, sorting papers, or doing general busy work). One student lamented that internships “should be more regulated so that students aren’t ‘used’ for free work.” In addition, only about half of my peers received pay for their duties. In a field with a barrier to entry as high as medicine, hospitals and organizations know that they can easily pick up some extra labor for the summer for free by employing students.
All of this is assuming, of course, that students were able to get internships in the first place, which is by no means a guarantee. Many of my classmates have ended up in internships that differed vastly from their interests, because those are the positions they were able to network their way into. For example, after one of my peers told me about her singular love for pediatrics, she went on to describe her internships in vascular surgery and emergency medicine. When I asked her why she chose these internships, she admitted that they were the only ones she could get.
Also recall that all the students I surveyed and talked to had actually made it into medical school. What about the others who weren’t as lucky? According to my survey, most students acquired their internships through a personal connection. I observed this in my own search as well: with no family in medicine, I had to search out second-order connections before I found any internships, while some of my peers with doctors in their families had easy access to prestigious, paid internships. Though it is true that personal connections are important in most fields, I find their necessity particularly worrisome in medicine – a field that is often touted as being an “old boys’ club” with little gender or racial diversity. Though the field is no longer male-dominated, only 6% of matriculants were black and 6% were Latino in 2014, compared to 13.2% and 17.1% of the population, respectively. This isn’t just because fewer minority students are applying (though that also is true) – while overall 46% of white applicants are accepted, only 41.6% of underrepresented applicants (Hispanic, Latino, Black, American Indian, or Alaskan native combined) gain admission. It is a proven fact that when patients have a doctor of the same race, patient experience is greatly increased and office visits last longer. Specifically, studies have shown that black patients are more likely to receive preventative care and feel more respected and better informed if their doctors are also black. If many available internships are given out to the children and family friends of current doctors (of which only 4.1% and 4.4% are black and Hispanic, respectively), then these internships may be widening the racial gap in medicine - and not contributing to better patient care after all.
If internships are to remain a vital part of a pre-medical student’s education, we have to figure out a way to do them better. Physician leaders should make efforts to give their internship positions to the best candidates – not the candidates they know the best. People are already working to even the playing field when it comes to internships: many have been created that exclusively admit underrepresented minority students. But in addition to improving access to internships, organizations also should strive to make internships as educational as possible for the students. This could easily be done at great benefit to the mentor; for example, almost any pre-med could easily be taught a simple lab procedure, such as preparing solutions or agar plating. The student would gain knowledge of a procedure, feel involved and independent, and the mentor would add valuable labor to his or her project. Fair Pay Campaign is one organization that is currently fighting for these basic internship standards in all fields. However, as elite and impenetrable as the medical field can often be, much of the change may have to occur from the inside. If every lab or medical office across the US made a commitment to employ one student per summer in a job that is openly accessible, educational, and paid (at the very least with lunch and a parking pass to offset basic expenses) the effect on pre-medical students, and thus the future doctors of this country, could be vastly changed for the better.
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About The Author
Michelle Ponder is a medical student at Sidney Kimmel Medical College Class of 2018.