A couple of weeks ago, I spent the evening in London, with three other doctors, talking to sixth-formers from “non-traditional backgrounds” (a euphemism for low socio-economic status) about studying medicine. A friend from medical school organised this careers event on behalf of Teach First, an independent charity that aims to broaden access to education. These were 16- and 17-year olds achieving high grades despite being in inner-city schools, where their peers were not pursuing A-levels, let alone higher education. I was struck by the frankness and astuteness of their questions and their motivation. It seems odd that medical school, where we train people to treat patients equally, regardless of their beliefs, income, gender, sexual orientation, colour or creed, should be less accessible to people from less well-off families.

The evidence that medical school is a middle class pursuit has been growing for over 40 years, and unsurprisingly, the problem is greater in countries with unsubsidised higher education. These have included studies of school students , medical school applicants, medical students, and doctors themselves. Socio-cultural perceptions of medicine can be a hurdle at school level. Although there are few differences by sex or ethnicity, striking differences exist when we consider schoolchildren by socioeconomic status. “Pupils from lower socioeconomic groups held stereotyped and superficial perceptions of doctors, saw medical school as culturally alien and geared towards “posh” students, and greatly underestimated their own chances of gaining a place and staying the course.”

This translates to a lack of applicants from working-class backgrounds, which is the major hurdle, rather than discrimination at the application or interview stage. The best data comes from the UCAS database, showing that admission ratios in 2000 varied around 10-fold by ethnicity (Asian versus white) - and around 30-fold by social class (from social class I to class V). Children with parents who attended university are more likely to attend university themselves. A study from Canada found that 16% of medical students have one or more medical parents, while an American analysis calculated that the offspring of male doctors are 14% more likely to get into medical school.

Together these data show the effects of cultural, educational and socio-economic influences in early life on future career choices. We have to learn from the success stories, and if we want to broaden access to medical school, we need to increase participation and awareness at school level. Interestingly, graduate entry medical schools may be more egalitarian in terms of social class. The other elephant in the room is the rising cost of tuition fees, especially when we know that applicants from "poor backgrounds see costs as constraining their choices". It is difficult to see how this government has argued that it has made university more accessible.