Purpose, Privilege, and Pathways: Advancing Socioeconomic Diversity in a Pathway Program to Medical School

Introduction: Diversity in the physician workforce is associated with improved patient outcomes, yet individuals from lower socioeconomic status (SES) backgrounds remain underrepresented in medicine. Doctors of Tomorrow (DoT) is a pathway program at the University of Michigan Medical School that provides mentorship and interactive learning experiences to expand health care career access for students from resource-limited backgrounds. DoT recruits students from two Detroit high schools that require entrance exams, raising concerns that the program may disproportionately enroll students from higher SES households with greater social capital. This study aims to evaluate the SES of DoT participants to assess whether the pathway program is reaching students from resource-limited backgrounds and those who are underrepresented in medicine. Methods: A cross-sectional, web-based survey was conducted among 122 parents of DoT students to assess socioeconomic markers. Findings were compared with Detroit population data from the American Community Survey and with national medical school applicant and matriculant data from the AAMC. Results: The survey response rate was 62%. Only 7% of DoT parents reported working in health care. Compared with Detroit census data, DoT households reported higher parental college education and home ownership, while household income was similar. Racial composition was predominantly Black in both the DoT cohort and Detroit overall. Compared with national medical school applicants and matriculants, DoT parents were less likely to have a college degree and had a distinct racial distribution. Conclusion: DoT recruits students without pre-existing access to health care mentors, with household income comparable to Detroit overall, but who significantly differ from national medical school applicants. Ensuring socioeconomic diversity in pathway programs to medical school is essential for diversification of the physician workforce and better outcomes for historically marginalized patients.