My family’s poverty nearly kept me from applying to medical school

Students like me are often forced to choose between supporting their families and pursuing their dream of a career in medicine. It doesn’t have to be this way.

Nearly four years after committing to the field of medicine, I received an acceptance letter from Harvard Medical School.David L. Ryan/Globe Staff

My mother snapped photos as I held up the University of Southern California welcome folder — the acceptance package from my top-choice school. We embraced, and besides my mother’s blessing, we exchanged few words. Our tears spoke for themselves. They represented hope for a better future. After living in a family shelter home, Section 8 housing, and a motel, I would be the first person in my family to attend college. This was not my moment — it was our moment.

Becoming a doctor topped my list of career interests when I was a teenager, not because of previous exposure to the field of medicine but because of its absence in my family’s life. While I was in middle school, my oldest brother’s undocumented godmother succumbed to breast cancer at the age of 41 because she lacked access to health care. Just after I left middle school, my family went without medical care for my ill mother because we could not afford a ride to the emergency department, let alone the treatment that would likely follow.

So I searched for “how to become a doctor” on the used laptop I had bought on eBay and found that one needed to complete four years of college, four years of medical school, three to seven years of residency, and a few more years of fellowship in the case of choosing a subspecialty. Not only were the training demands high but only a tiny percentage of applicants were accepted to medical school each year. I had never met someone who had gone through the process.

My mind raced. How could I commit to a path that required at least 11 years of training before I would reach a level of financial security that enabled me to provide for myself and my family? How could I commit to a path defined by such uncertainty? At the time, I didn’t even know about the exorbitant costs of applying to medical school, which include the application fees, test prep materials, and flights to visit schools. Some students, lacking the resources for these things, end up not applying at all.

I decided that I couldn’t take the risk. Sacrificing my dream, my passion, for a more financially secure path made more sense. I could graduate in four years and earn at least three times as much per year as my parents made. It struck me as the deal of a lifetime. So when I opened the USC folder on acceptance day, I was being welcomed not as a premed student but as an engineer.

An introductory engineering course confirmed what I already knew: I did not enjoy the work. I craved classes that examined the human condition. I wondered how the brain’s neural circuitry operated, how the human gut absorbed nutrients, and how I could ultimately use that knowledge to heal patients. I called a few friends from high school, and then my parents. Hiding my anxiety and downplaying how unalterable I considered my decision, I was careful bringing it up. My parents, to my great relief, encouraged me to pursue my dream. “Tú lo puedes hacer” — “You can do it” — they said repeatedly.

Codman Academy students work on a dummy during Harvard Medical School’s program MEDScience, which is designed to expose high school students to careers in STEM. Erin Clark/Globe Staff

Despite all the sacrifices my family had already made for me, they were prepared to make more — this time by choosing to stand by me on a path with no guarantees of my success. Whereas I had made my initial choice based on a hard calculus of financial need and a sense of responsibility to them, their encouragement hinged on love. They just wanted their son — all of their sons — to be happy. That evening, I committed to the path of medicine. Nearly four years later, I received an acceptance letter from Harvard Medical School.

A few months ago, I spoke with a group of mostly low-income students in Boston about my decision to go into medicine. In our virtual Q&A session, they didn’t ask me about my life as a medical student. Instead, they asked how I chose the long road to a medical degree over the lure of a four-year degree that would have allowed me to support my family sooner. I told them that when I chose engineering over premed, it was because I grappled with this very dilemma. Low-income students greatly desire to give back to their families and communities, and I wonder how many will heed my message to follow their passion into medicine.

Many of these students will become successful professionals in other fields. I lament that when they let go of their dreams, medicine loses yet another sorely needed doctor raised in the communities we aim to serve, communities that have been disproportionately affected by the pandemic. Their choice not to enter this field worsens the existing doctor shortage in America, where physicians of color and those from low-income backgrounds are significantly underrepresented. About 5 percent of today’s doctors are Black, 5 percent are Latinx, and another 5 percent are from the lowest household-income quintile. How many future doctors do we lose when students make this agonized choice not to pursue their dream of a medical degree?

When low-income students who yearn for a career in medicine struggle with how they can afford to pursue their dream, the burden is on them. They can apply for scholarships, and they can take out loans. But the burden should not be on them alone. We need the medical education system, which includes medical schools, the Association of American Medical Colleges, and the National Board of Medical Examiners, to ease the costs of applying to medical school and being a medical student — including paying thousands of dollars for licensing exams and their preparatory materials. Anti-poverty legislation, such as the expansion of tax credits under the Build Back Better plan, and programs that bridge the mentorship gap between students and doctors are also required now more than ever. The more low-income students meet doctors whose life stories and struggles mirror their own, the more the field of medicine will be diversified and will benefit.

The trade-off I made that day more than eight years ago — to abandon the surer thing, engineering, for the far less sure one, becoming a doctor, still nags at me. I still worry about my family’s finances. I worry about their health, too. I know that people from marginalized communities like mine tend to die relatively young. When will I be able to return home, fix their air conditioner, oven, and the run-down car they should not be driving? How will my lack of financial contribution over the years while I’ve been in school affect them?

When I feel weighed low by these questions, I remember the words my parents uttered that day: Tú lo puedes hacer. It’s what I tell the students I speak to, too.

David Velasquez is a student of medicine, public policy, and business at Harvard University.