‘Struggling to make ends meet just makes everything harder’: First Generation and Low Income in Medicine Association
Aline Thiengmany, a first-year medical student, says she has always been interested in a career in medicine. Her parents emigrated from Laos, and they raised Thiengmany and her younger sister in Mount Pleasant, Iowa. Thiengmany’s father had health problems when she was growing up, and she stepped in to help support her family as they navigated the complexities of the health care system in their new home.
“It’s confusing enough for people who were born here,” Thiengmany says, “but it’s very difficult for people who don’t speak the language, aren’t financially stable, or have low health literacy. Helping him navigate his health got me interested in medicine and working with marginalized groups as a health care provider.”
When she arrived at Stanford University for her pre-med undergraduate studies, she was excited to meet students from diverse backgrounds.
“What I wasn’t prepared for was the differences in wealth and accessibility to opportunities,” she says. “The money that some people had, and because of that, the experiences they had that I didn’t, that was one of the more stratifying things when it came to finding where I fit in.”
When it was time to begin applying to medical schools, the financial responsibility of the decision was heavy on her mind.
“The biggest hurdle for me was the sheer expense of it all: taking the test, all the prep courses that were required, then applying to all the different schools,” she says. “It’s a decision that affects you long-term, financially.”
Her reasons for choosing the Carver College of Medicine were largely practical—the affordability of in-state tuition, low cost of living, and proximity to her family were all pluses. But during the admissions interview process, she found the college to be an unexpected outlier in other ways.
“I really felt like the faculty had my best interest in mind. Even just on interview day, they made me feel like I was a valuable asset,” she says. “Like my differences made me unique and meant that I had something to offer. They made me feel like I had a seat at the table.”
At Stanford, she was part of a group for students who came from first-generation and low-income backgrounds like her own. She was pleased to learn during orientation week that the Carver College of Medicine also had a group for this student population.
“The people I met [in the Stanford group] became a big support system for me,” Thiengmany says. “I wanted to explore this group and help build a similar supportive community in med school, as well.”
First Generation and Low Income in Medicine Association
Third-year medical student Michelle Bremer serves as co-president of the First Generation and Low Income in Medicine Association (FGLIMed) at Iowa. Bremer grew up in San Diego, California, with her single mom, who was training to become a medical assistant.
“She had me as a teenager, so when she was going through school, I was a youngster,” Bremer remembers. “She would read her textbooks to me as bedtime stories, since she couldn’t afford to buy children’s books. That was my initial spark, and it evolved to medical school.”
As that spark was nurtured, it grew into an interest in connecting with other medical students with similar backgrounds.
In the summer of 2022, she worked with Nicole Del Castillo, MD, MPH, director of the Carver College of Medicine’s Office of Diversity, Equity, and Inclusion, and Denise Martinez, MD, UI Health Care interim associate vice president for health parity, to establish FGLIMed. The first members joined at the beginning of the 2022 academic year.
Though the group is still new, Bremer says she hopes it will address an immediate need—the lack of networking opportunities for students who don’t have the same access to resources and professional connections as students from more privileged backgrounds.
“When I was a freshman in college, I researched what you need to do to get into medical school and learned you need to shadow physicians. So, I joined the pre-health program at my school. They had a networking event with physicians, and I got connected with a couple of them and asked to shadow. They asked me to send my CV.”
At the time, her CV didn’t have much more than a babysitting job and a few volunteer events.
“They all said, ‘Well, that’s not enough, but maybe in a couple of years,’” she recalls. “How am I supposed to get things on my résumé if no one will let me because my résumé doesn’t have anything? You can’t just go stand in front of the hospital flagging down doctors and saying, ‘Can I follow you?’”
Bremer hopes that by offering more networking opportunities, current students won’t face similar barriers to pursuing a medical education. Bremer and the FGLIMed leadership board—which includes Thiengmany, who serves as advocacy involvement director—plan to implement a mentorship program for the students in their organization.
“We’ll start with mentorships between older and younger students, and we’re trying to identify residents, fellows, and faculty physicians from first-generation or low-income backgrounds to get involved too,” Bremer says.
Also in the works is a speaking series that will provide advice about financial topics, such as planning for the future during medical school, residency, and loan repayment.
“Struggling to financially make ends meet just makes everything harder, as though it’s not already hard enough,” Bremer says. “Having people who have been through similar situations to talk to and relate to is really nice.”
In the future, she hopes FGLIMed can give back to the community by working with elementary- and middle-school-aged kids to introduce them to medical careers.
“We want to inspire them to consider it as an option and know it’s possible to come from whatever background and make it here,” Bremer says.