Purpose: Empathy development is often discussed as an individual capacity that students build through clinical experience. Less examined is how structural factors, including language background and clinical hierarchy, may make empathy development harder for some students than others, independent of individual effort or skill. This study explored how final-year medical students perceived structural barriers to empathic connection during clinical training. Methods: Semi-structured qualitative interviews were conducted with final-year medical students, several of whom were training in a linguistic and cultural context different from their own. Interviews explored students’ clinical experiences and empathy development. Transcripts were analyzed thematically, with attention to structural rather than personal barriers to empathic connection. Results: Language mismatch between students and the local patient population emerged as one of the most frequently reported barriers. Participants described this mismatch as limiting not only information gathering, but also the possibility of genuine relational connection. Students training outside their primary linguistic or cultural context described additional difficulty being taken seriously by patients. Clinical hierarchy was also described as limiting students’ ability to engage patients on equal, trust-building terms, regardless of the student’s empathic intention or skill. Conclusion: These findings reframe language and hierarchy not merely as situational inconveniences, but as structural barriers that make empathic development harder for some learners through no fault of their own. For institutions supporting diverse student populations, language access and hierarchy-related power dynamics should be treated as equity issues that shape who is able to develop and demonstrate empathic competence. This aligns with the forum’s emphasis on inclusion and holistic learner growth.