Objectives Empathy is central in patient-physician interactions and understanding its development is decisive for education. However, scientific literature reports a striking decline of empathy among medical students during their study course. Firstly, we aimed to replicate this result on a Belgian population. Secondly, as well reported by literature, we expected higher empathy scores for women. Lastly, as central, we expected higher empathy levels for medical students than for “control” students (commercial students were used as a control group: social interactions without a curing aspect) at the beginning of their study course, suggesting that empathy drives students to select specific education fields. Methods Through a cross-sectional design, we assessed students from medical and commercial educations at different years of study with the Basic Empathy Scale (N = 1602). We compared: (1) empathy scores at different scholar levels for both populations; (2) scores between men and women; (3) empathy scores between medical and commercial students in their first year of study. Results As expected, a significant empathy decline was displayed over time for medical students; women reported significant higher empathy scores than men; and, in their first year, medical students presented significant higher empathy scores than commercials. Conclusions Replicating the empathy decline on several student populations is crucial, especially by using different tools. This decline is a multi-factorial process that mainly reflects self-representation changes. The empathy gender bias is a strong effect observed in several empathy-linked phenomena. Finally, empathy is not only central but also drives students to select specific education fields.