The influence of income on medical school admissions in Canada: a retrospective cohort study

Abstract

Background: The socioeconomic status of applicants to Canadian medical schools has been understudied in the past two decades. Institutional efforts have been made to address the lack of socioeconomic diversity across Canada during this time. We investigated the income characteristics of medical school applicants, as well as the relationship between applicant income and offer of admission, to characterize the current state of socioeconomic diversity in medical admissions.

Methods: We conducted a retrospective cohort study on 26,120 applicants at one Ontario medical school from 2013 to 2018. Characteristics of applicants who were offered admission were compared to the general population and applicants not offered admission. Regression analyses were used to investigate the association between median total neighborhood income and successful admission.

Results: The median total neighborhood income for medical school applicants was $98,816, which was approximately $28,480 higher than the Canadian general population. Those not admitted to the medical school had a median total neighborhood income of $98,304 compared to $105,984 for those offered admission (p < 0.001). This trend was seen in every province and territory in Canada. Median total neighborhood income was a predictor of an offer of admission; applicants in the >75th percentile income group had 54% increased odds of being offered admission when compared to applicants in the <25th percentile in our unadjusted model. Income was not significant in our adjusted models but showed that the income medians drastically shifted between pre-interview and post-interview periods, from $98,816 to $104,960 (p < 0.001).

Conclusion: Medical school applicants are from higher economic strata compared to the general population. Despite already representing a high economic stratum, a higher median total neighborhood income relative to other applicants was associated with an offer of admission.

Keywords: Admissions; CASPer; GPA; Income; MCAT; MMI; Medical admissions; Socioeconomic status; Undergraduate medicine.

Fig. 1

Flow chart summarizing the study process of file merger, data inclusion and exclusion methods

Fig. 2

Income distribution of applicants by province for all and accepted applicants, compared against their respective provincial total median household incomes*. *Information from Statistics Canada Census 2016. NFLD = Newfoundland & Labrador; NB=New Brunswick; NS=Nova Scotia; PEI=Province Edward Island; QC = Quebec; ON=Ontario; MT = Manitoba; SK=Saskatchewan AB = Alberta; BC=British Columbia

Fig. 3

Income distribution of all Applicants and Applicants offered admission, compared to Canadian population*. *Information from Statistics Canada Census 2016