One of the many important decisions a future physician will make in his or her career is the medical school they choose to attend. The highly competitive application process is supposedly designed to ensure that our matriculating medical students will be able and wanting to contribute transformative innovation to the communities and institutions in which they end up working. However, given the dynamic nature of our health care system, many in the field of medical education have dutifully been questioning whether our medical training is advancing alongside our society’s needs.
In Dr. Jordan Cohen’s JAMA article, “Will Changes in the MCAT and USMLE Ensure That Future Physicians Have What It Takes?“ he discusses the new era of health care challenges our country faces. Dr. Cohen, who is the former president of the Association of American Medical Colleges (AAMC), rightly points out the need for future trainees and physicians who can understand the need for a system that attends to the trifecta of quality, cost, and access, but he doesn’t identify one of the most telling reasons behind why top medical schools may not be admitting the right applicants.
Part of the answer, and an equally important part of the equation, is whether pre-medical students are selecting the “right” medical schools, which in large part has to do with medical school rankings.
Dr. Cohen recognizes that the Medical College Admission Test (MCAT) and the United States Medical Licensing Exam (USMLE) cannot and should not be the sole factors that are used to differentiate students most suited to be leaders and innovators in medicine. It is a well-known fact that medical school rankings, primarily by US News and World Report, have a strong influence on students’ decisions for matriculation. To attract the best and brightest applicants, many medical schools and health systems do what is needed to improve their rankings. Would Harvard still be Harvard if it were not consistently ranked 1 or 2?
But if we look more closely at the US News ranking methodology, the only metric assessing the quality of matriculating students is average MCAT score and average college grade point average (GPA). These two factors alone contribute to nearly 20% of the medical school’s research ranking, which is traditionally the categorical ranking that the media uses when they report that Harvard Medical School or Johns Hopkins University School of Medicine continue to reign as the “best” medical schools in the country. Thus, the system incentivizes medical schools to favor the applicants with the best numbers to increase their own ranking, and by doing so, these rankings incentivize pre-medical students to strive for the highest scores possible.
There is, however, no formal recognition of the qualities that Dr. Cohen points out are far more important to the future of our dynamic health care system — innovation, initiative, empathy, or diversity, to name a few. It is thus not surprising that many students that graduate from top research universities still end up in high profile, lucrative private practices.
While the Association of American Medical Colleges may be “actively promoting a holistic approach to medical school admissions,” as Dr. Cohen quotes in his article, until the ranking system that is driving much of the supply-demand curve in US medical schools incorporates these qualities, we’ll continue breeding bookworms rather than health care leaders.
Abraar Karan is a medical student who blogs at Swasthya Mundial.