Ms. Tomlinson said that with every expense she takes on now, such as a $20 dinner out, she calculates what she will have to pay off in 10 years, at 7 percent interest. She struggles to make rent on her student housing at Mount Sinai, which she said is more than she would pay for a family house in Oklahoma City, where she lived previously.

Randall Tassone, a medical student at Harvard, was raised in a low-income household in rural Pennsylvania. Now surrounded by wealthier classmates, many of them the children of doctors, Mr. Tassone has come to understand money as something intrinsic to medical school culture, structuring social as well as academic life. Earlier this year he walked past a classroom poster advertising a service trip; it included a student testimonial: It was nice to feel like we did something to help the poor community.

It was identifying the poor as outsiders who arent part of our community, Mr. Tassone said. It made him realize, he said, Ive been invited into this institution that favors rich people.

Mr. Johnson said he experienced almost daily reminders of his socioeconomic status. A professor recently asked students, as an icebreaker, to describe their favorite family vacation spot. Mr. Johnson began to sweat, racking his brain for an answer before awkwardly offering the truth: His family had never taken a vacation.

That top medical schools seem to favor the rich is especially disturbing to low-income students because they know that their diverse experiences and perspectives are an asset, not a liability. A 2018 study showed that black patients have better health outcomes when treated by black doctors. Mr. Johnson said that emergency room patients have told him they feel more comfortable having a doctor who is African-American and from Stockton, someone who, like them, struggles to afford his medication.

I have a Ph.D. in not having money, Mr. Johnson said. Thats not easy to explain.

When he graduates from medical school, Mr. Velasquez plans to work in an emergency room where he can treat patients who are homeless, undocumented and the poorest of the poor. He wants to treat patients who look like his family, he said. But already he has learned that the dream comes at a cost.

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I Have a Ph.D. in Not Having Money - The New York Times