Jordan Malray bounced around a lot after high school.
He took some college classes. Worked a few jobs. He just didn’t know what he wanted to do with his life.
He moved across country and worked nights in a bank. Took a job as a loan officer at a mortgage company. Then started his own small company publishing children’s books.
But deep inside, a seed that had been planted when he was a sickly child began to sprout. And finally, it grew too large to ignore.
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Now the 35-year-old is a first-year medical student at the University of South Carolina School of Medicine-Greenville who spends his days with classmates 10 or more years his junior.
Malray’s meandering path to medical school isn’t exactly traditional.
But along with grades, service histories and MCATs, medical schools are now looking at life experience — a difficult socioeconomic background, overcoming personal challenges, or having had one or more careers beforehand — as well as race and gender diversity when they consider which applicants to choose.
“We look at life experiences that students have had that give them a broader perspective on the world,” said Dr. Jerry Youkey, dean of USC SOM-Greenville.
“We believe that the patients they care for and families they interface with are coming from those kinds of backgrounds, so it increases their familiarity with the problems patients and families may have,” he told GreenvilleOnline.com. “They need to understand that some people may not be able to afford high-priced non-generic drugs, or when they return home from the hospital they may not be able to be compliant with treatment regimens.”
The definition of diversity is based on a concept called “distance traveled,” said Dr. Paul Catalana, assistant dean of admissions at USC SOM-Greenville.
“It encourages admission offices to define diversity not only to include racial and ethnic and gender diversity, but individuals who have overcome significant educational obstacles, or personal or family challenges, or perhaps are the first to attend college in their families, or had to work extensively in college to support themselves, or are applying to med school after another career,” he said.
“It’s all with the hope that each student ... can bring added value to the classroom, and in that way can also help other classmates who’ve had different experiences.”
The idea has developed over the past decade or so, he said, with the changing model of medical education that’s designed to produce better doctors.
Racial and ethnic minorities make up 26 percent of the U.S. population, but only 6 percent of practicing physicians, according to the American Medical Student Association. And only about 4 percent of medical school faculty are minorities, with a fifth of those teaching at traditionally black colleges or schools in Puerto Rico, AMSA reports.
While the average age of a new medical student is 24, according to Geoffrey Young, senior director of student affairs and programs at the Association of American Medical Colleges, he’s seen applicants as old as 46 or 50 — one an ex-marine and another an ex-financial broker.
Between 2009 and 2012, at least three-quarters of new med students were 25 or younger, according to AAMC. Fewer than 5 percent were 30 or older and fewer than 1 percent were over 35, which often signifies a second or even third career, Young said.
“There are times when they’ve always thought about medicine but for whatever reason — they weren’t a good student 10 years ago or circumstances in their life didn’t allow them to pursue it,” he said. “And now they’ve made a decision this is something they want to do. It’s a life dream for them.”
Originally from Los Angeles, Malray was hit by a car as a child, then contracted a rare disease.
“I spent a good amount of time in the hospital and I put doctors on a pedestal,” he said. “But I guess I thought maybe I wasn’t good enough to do that.”
With no direction by the time he was 21, he toyed with the idea of becoming a businessman. So he packed up his belongings and two dogs in his truck and headed for Atlanta, where he’d heard there was a better business climate and lower cost of living.
He was always interested in science, though. And eventually he gained more confidence. So after the banking and publishing jobs, he applied to Georgia State University and graduated with a 3.9 GPA last year.
“It was a progressive decision,” he said. “As I got older, my mentality changed to I can do anything I put my mind to. And I have a strong interest in surgery. About the same time, my grandmother became very ill and I felt helpless. That pushed me over the edge to go into medicine because I didn’t want to be that helpless again.
“But I had to get over the hurdle of my age,” he added. “I thought I was too old to do this.”
In one recent ethics class, he said, the instructor asked if any of the students were born before 1984. Malray’s was the only hand to go up.
He realizes he’ll be 40 before he can start practicing medicine. But he feels just like any other student.
“There’s no discrimination against me because I’m the old guy,” he said with a chuckle. “And we’re all here for the same purpose. Regardless of how much experience I have in life, education-wise we’re all pretty much on an even field.”
Traditional students go directly to medical school from college, and often have more resources and access to educational opportunities than non-traditional students, Catalana said.
And there was a time when males dominated. But women now make up roughly half the class, Young said.
When Youkey graduated medical school in 1974, there were fewer than 10 women and no more than two or three African-American students in his class of 120. And most people had resources.
But at USC SOM-Greenville, which hosted its charter class last year, about 10 percent to 15 percent of students are under-represented minorities, Youkey said. And women made up 55 percent of the first class and 60 percent of the second class, he said. And at least two-thirds of students qualify for and get loans and scholarships.
The Class of 2016 has 29 women and 24 men; four African Americans, three Hispanics, and one Native American; three had other careers first; two were born outside the U.S. and speak English as a second language; seven are from rural communities; four are socioeconomically disadvantaged; and one is the first in his family to go to college.
The Class of 2017 has 33 women and 21 men; four African Americans and one Hispanic; one second career student; four born outside the U.S.; 10 socioeconomically disadvantaged; four from rural communities; and one first-generation college graduate.
“We estimate about a third of the class of each of the two classes brings with them characteristics that would fairly be described as having a personal experience that meets what we hope is the distanced-traveled concept,” Catalana said. “There are many individual stories where they have overcome remarkable obstacles that would challenge us all.”
One of them is Nathan Gasque, a 22-year-old from Florence who studied bioengineering at Clemson, at first with an eye on developing new medical treatments.
The second of three children, Gasque was diagnosed with an immune deficiency as a boy that left him perennially sick and missing school. He shattered his femur in the 6th grade, nearly lost his arm to a MRSA infection he contracted while playing football his junior year in high school, and got swine flu twice his freshman year in college.
But all that seemed like practice when he suddenly began seeing flashing lights, falling over while walking to class, and his hands started shaking uncontrollably.
The terrifying symptoms were caused by an arterial venous malformation, a cluster of blood vessels in his brain, which had burst. A scar down the back of his head and neck is a legacy of the risky surgery to remove the AVM and implant titanium plates, an operation that left him in the intensive care unit for a week.
Remarkably, his recovery was complicated by a case of mononucleosis, yet he somehow managed to graduate from Clemson with a 4.0 GPA.
It all convinced him that he needed to be a physician.
“It all helped me to grow up faster,” he said. “Also when dealing with patients...I can relate better. I’ve been in their shoes multiple times. I’ve faced the possibility of death several times.”
A different perspective
Medical schools value such life experience as enriching the class, Young said.
“It brings a very important perspective to the classroom,” he said. “They may have overcome hardships and that speaks to one’s perseverance.”
Tamara van de Star grew up in Amsterdam, the daughter of an American-born ballerina. After fleeing a difficult situation there, she, her mother and two younger brothers moved into two rooms in her grandfather’s basement in a small rural town in Tennessee, she said.
“It was always a dream of mine to live in the U.S. and I was very happy to be here. But it was a cultural shock,” said the fresh-faced 23-year-old.
“We didn’t have a lot of money. My mom didn’t get a job for a year. We didn’t have health insurance,” she said. “It was difficult. But you’re just in survival mode.”
When van de Star began applying to colleges, she earned a full scholarship to Duke, where she majored in psychology and worked part-time to get by. Then she was accepted at USC SOM-Greenville, where she also was given a scholarship.
She began classes this month with eager anticipation, and relishes the challenges ahead.
“Life is full of surprises and cards you never thought you’d be dealt,” she said. “Now, I’m just happy to be ... in this amazing country where you can do anything you want to do. I’m really happy I came here. It feels really right.”
Diversity in medical education is important not only for social equity, but to help improve health care systems and, by extension, health, said Dr. Nida Degesys, president of the American Medical Student Association.
And many medical schools have pipeline programs in high schools that provide opportunities for students who might not otherwise have any, she said.
AMSA, which supports diversity in students and faculty, has a committee devoted to educating students about health equity and disparities to promote cultural competence, said Degesys, herself a non-traditional student.
“My undergraduate degree was in political science and my only undergraduate science course was in astronomy,” she said. “I thought I’d practice law and do human rights law.”
But after college, she interned at the State Department in Washington and then volunteered for the Peace Corps, where she saw medical missions first-hand. That changed the trajectory of her life. She decided she could work for human rights as a doctor, too.
“In medical school, I noticed a lot of students like me coming from very different backgrounds and having very different paths to medicine,” she said. “Even the immediate past president of AMSA got a law degree, and a master’s in public health, and then her MD.”
After majoring in engineering at USC and graduating with a degree in retailing, Ryan Batson became a homebuilder with his father’s company and helped put his wife through law school.
But when glaucoma stole his father’s sight, he decided to pursue another career and was thinking about following in his mother’s footsteps and become a pharmacist.
“I took the PCAT (Pharmacy College Admission Test) and shadowed some hospital pharmacists. But while rounding with them, I realized I’d rather be doing what the doctor was doing,” said Batson, 31.
So after a year at Clemson taking some pre-med courses, he’s a second-year medical student at USC SOM-Greenville, and his wife, now pregnant with their second child, is helping put him through school.
“I don’t think I would have gotten here without going that way, though. I goofed off in college. Didn’t take it seriously,” he said. “At Clemson, I ended up with a 4.0 (GPA) for the year.”
Though he’s just begun medical school, Malray is thinking about cardiothoracic surgery as a specialty right now. But he’s keeping an open mind.
“Being a health care provider is one of the greatest things anyone can aspire to,” he said. “I wish I could have had this mentality when I was younger. I could be an attending now.”