Becoming a doctor is one of the most respected career paths in the world. It promises an opportunity to help, to save lives, and make a lasting impact. But even before you take your first step into an MD or DO program, there’s a high-stakes game playing out in applications, tests, and interviews – and not everyone starts on equal footing. From increasing costs to diversity gaps, the process often favors certain students over others.

So, who really has the advantage in medical school admissions?

The Fauci Effect and a Surge of Inspiration

During the COVID-19 pandemic, we watched doctors on the frontlines with a focus like never before. Public health leaders, most notably Dr. Anthony Fauci, became household names, providing daily updates and guidance. For many students, seeing the dedication and expertise of healthcare professionals ignited an interest in medicine. This spike in inspiration is sometimes called the “Fauci effect.”

The Rising Cost of Applying to Medical School

Applying to medical school is expensive, with costs steadily climbing. Between 2019 and 2023, the total cost of applying to 20 schools rose from $1,455 to $1,725 [4]. This includes the AMCAS primary application, secondary applications, the MCAT (which increased from $315 to $330), and newer (sometimes optional) assessments like PREview and CASPer.

But the financial strain doesn’t stop there. MCAT prep courses often cost thousands of dollars, and students may spend hundreds or even thousands more on travel, hotels, and interview-related expenses. According to a 2022 survey, 55.3% of students reported that the cost of applying could discourage them from applying at all [4]. This means that students from low-income households, many of whom are from historically underrepresented groups, face a tough choice: should these costs and risk not matriculating, or risk missing out on the opportunity entirely.

Where Are Applicants Coming From?

Some states keep their future doctors local, while others send them out. States with fewer medical schools, like Alaska, have almost no in-state matriculation. In contrast, states with more schools, like California, keep more students in-state. The “did not matriculate” numbers sit around 40–65% for each state, showing that a big chunk of applicants don’t end up in any school.

Over 10 years of applications in six big states, we see that most lines are flat, but a few trends pop out: Illinois shows a slight increase in out-of-state matriculation, while Wyoming and Alaska see drops in students not matriculating. The maps confirm these trends nationwide. Wyoming had the biggest drop in students failing to matriculate, while Montana saw a small rise.

Some colleges produce more medical school applicants than others. Schools like UCLA, UT Austin, and University of Florida send hundreds of students each year. University of Washington stands out with ~75% of its 2025 class applying to MD programs. These schools aren’t just sending numbers – they often have more clubs, mentors, and prep resources, which can give students an extra advantage.

Together, these figures show that where you live and where you go to college can matter for your odds of getting into medical school, and that some states and schools create natural advantages for their students.

Who Is Actually Applying? The Diversity Gap

A common myth in applications is that admission committees make an effort to accept students under-represented in medicine. While women now outnumber men in medical school applications and matriculation, this larger number of female matriculants stems from a larger total number of female applicants.

Looking at applicant race and ethnicity, in 2022, only 9% of applicants were Black, 10% Hispanic, and 1% American Indian or Alaska Native [4]. Compare that to the U.S. population – Black Americans make up roughly 14%, and Hispanic Americans around 17% – and it’s clear why these groups remain as underrepresented in medicine (URiM) in applications.

Financial barriers contribute to this disparity. Students from high-income families can more easily afford application fees, test prep, and travel for interviews. Meanwhile, students from low-income households often must weigh whether applying to more schools increases their odds or pushes them deeper into debt. This economic segregation reinforces a cycle where wealthier students dominate the applicant pool despite an effort to increase URiM representation.

A study in Academic Medicine found that students whose parents had higher levels of education were more likely to apply to medical school, independent of academic ability [7].

Socioeconomic status (SES) reported above is based on parental education. Here, 5 represents students whose parents have graduate or professional degrees, while 4 indicates parents with college degrees. 3 reflects a middle SES background, typically with some college or a bachelor’s degree. Categories 1 and 2 correspond to lower SES, where parents have a high school education or less.

Virtual Interviews – A Pandemic Silver Lining

COVID-19 forced medical schools to rethink traditional in-person interviews. Suddenly, virtual interviews became the norm. For applicants, this was a huge financial relief. Travel and lodging costs, which can easily total $1,000 or more per school, were eliminated. At the California University of Science and Medicine, applicants who interviewed virtually in 2020 were nearly twice as likely to matriculate compared to those who interviewed in person [4].

Virtual interviews also opened doors for students who might not have had the time, money, or family support to travel long distances. A 2021 Journal of Medical Education study suggested that virtual interviews could also help schools attract a more geographically and socioeconomically diverse applicant pool [8]. While some argue that in-person interactions are important, the pandemic showed that accessibility can improve diversity – without necessarily compromising the quality of evaluation.

Does Diversity Matter?

Diversity in medical school isn’t just a numbers game, but translates to quality of patient care down the line. Patients often have better health outcomes when treated by physicians who share similar racial and cultural backgrounds [6]. Despite this, the physician workforce remains overwhelmingly White and male: in 2021, 63.9% of practicing physicians were White, compared to 6.9% Hispanic and 5.7% Black [4].

Faculty diversity is also limited. Professors and department leaders are disproportionately White and male, which impacts mentorship and guidance for students from underrepresented backgrounds [5]. When students don’t see people like themselves in leadership roles, it can affect networking opportunities and career development, rippling effects that impact patient care. Increasing diversity in medical school isn’t just about fairness, but about improving patient care and the health system as a whole.

The Road Ahead

The challenges are clear, but programs like the AAMC Fee Assistance Program (FAP) can offer some relief by waiving application fees and reducing MCAT costs. Expanding these programs by simplifying requirements, increasing the number of schools covered, or even eliminating MCAT fees entirely could make a real difference [4].

Partnering with nonprofits like The Healing Project can also provide mentorship, financial support, and guidance for students from underrepresented groups. Streamlining virtual interviews permanently could reduce financial barriers even further, allowing schools to attract students who might have been discouraged by high costs. Finally, schools must actively track diversity metrics and adjust policies to ensure all students have a fair chance, regardless of background.

The path to medical school is challenging, expensive, and competitive—but it doesn’t have to be unequal. By addressing cost, access, and diversity, schools can level the playing field, giving every student—regardless of background—the opportunity to answer the call to medicine.

Addendum: How We Looked at the Numbers

To understand medical school admission trends, we dug into multiple sources of data, mainly from the Association of American Medical Colleges (AAMC), which tracks every applicant and matriculant to U.S. MD programs. All figures used here come from AAMC data. We also used information from the American Medical Association’s Physician Masterfile, which tracks practicing doctors, and from surveys like the Matriculating Student Questionnaire, which asks first-year medical students about their backgrounds and experiences.

Once we had the data, we removed duplicates, standardized race/ethnicity/gender categories, combined similar entries, and removed variables unrelated to our analysis.

References

1. O’Connell RL, Kemp MT, Alam HB. The Potential Impact of COVID-19 on the Medical School Application. J Med Educ Curric Dev. 2020;7:238212052094066.
2. Hammoud MM, et al. Medical student performance metrics and COVID-19 disruption. JAMA. 2020;324:1005–7.
3. Murphy B. Applications to medical school up big. Is it the “Fauci effect”? AMA. 2020 Dec 18. Available from: https://www.ama-assn.org/medical-students/preparing-medical-school/applications-medical-school-big-it-fauci-effect
4. Bacare B, Mendu ML. The rising cost of applying to medical school — Lack of cost mitigation and trends in workforce diversity. Public Health Pract. 2024;8:100531.
5. Association of American Medical Colleges. Diversity in Medicine: Facts and Figures 2019 [Internet]. AAMC. 2019. Available from: https://www.aamc.org/data-reports/workforce/report/diversity-medicine-facts-and-figures-2019
6. Stanford FC. The importance of diversity and inclusion in the healthcare workforce. J Natl Med Assoc. 2020;112(3):247–9.
7. Boatwright KM, et al. Socioeconomic factors in medical school applications. Acad Med. 2018;93:1122–30.
8. Van Nuland S, et al. Virtual interviews and diversity in medical school admissions. J Med Educ. 2021;55:89–98.

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Yinglin Li