Notwithstanding my personal choice to avoid fixing what’s not broken, most of us nonetheless believe that the people onto whom we entrust our bodies, our lives, are the best and brightest we can find. No, they’re not perfect, and one would have to be an idiot to believe that there aren’t docs who are less than sufficiently competent. But we believe, because there really isn’t much of a way to endure medical treatment if we didn’t.
But medical schools are making it hard. So very hard.
Beyond having matriculating medical school students take an oath to diversity, equity and inclusion, including a commitment to indigenous medicine rather than merely the treatments that survive scientific method, there remains a belief since the olden days of Bakke that while racial diversity would be taken into account, the qualifications of all students would not be affected. Rather, if there was a choice between two fully qualified applicants, race could be used as a plus factor. But the applications would still be fully qualified. Is that still the case?
America’s top medical schools, worried they have too few minority students, are doing something about it. They are lowering academic standards for admission and trying to hide the evidence. Columbia, Harvard, the University of Chicago, Stanford, Mount Sinai, and the University of Pennsylvania have already done so. The list already tops forty, and more are sure to follow.
Of course, the universities won’t admit what they are doing – and certainly not why. All they will say is that their new standards add “equity” and “lived experience.” Unfortunately, adding those factors inevitably lessens the weight given to others.
There are a series of tweaks in admissions happening to remedy the lack of racial equity in the medial profession. And, indeed, it’s not as if physicians haven’t provided cause for concern, dealing with patients’ complaints of pain or illness differently, and inadequately, based on race. Do black people have higher pain tolerances? Are women’s complaints more likely to be psychosomatic than real, and so easily dismissed?
Yet, another “solution” is being tacitly employed by med schools to game the stats. The MCATs, the standardized tests used to determine success in med school, are being dropped or made voluntary. Grades are being downgraded as an admission qualification. They are being replaced by “holistic” qualifications such as “equity” and “lived experience.” The problem is that both leave a statistical trail of what med schools are doing.
But dropping the tests, or making them optional, presents a thorny PR problem. Schools fear they would sink below competitors in national rankings, which include MCAT scores. So, they are doing what undergraduate colleges have already done. They are colluding. By withdrawing jointly from US News and World Report rankings, they hope to soften the blow to each one’s prestige. (It’s an interesting question whether this collusion violates anti-trust laws, as their collusion about scholarship awards did.)
What medical schools call “equity” and “lived experience” are code words for discrimination by racial category. They are using this word fog to cloud over four crucial but uncomfortable facts. First, today’s standardized tests are actually fair and unbiased. Medical schools don’t deny that. They know test makers have spent fortunes over the past half century to scrub their tests of any racial, cultural, or ethnic bias. Second, medical schools aren’t claiming the tests are poor predictors of performance. They can’t.
These are inherently subjective words and notions, the third problem. The fourth is that by the time students get to med school, having already (hopefully) made it through with some reasonably high degree of science mastery undergrad, their “experiences” are largely the same. They passed organic and survived mystery meat in the dorm cafeteria.
There’s an old joke about “what do you call the person who came in last in his medical school class? Doctor.” And that was when everyone who was admitted to med school was pretty darn smart. What if they weren’t?
To implement the bias they prefer and do it secretly, medical schools are counting on public ignorance and apathy. When patients believe any subgroup of doctors has systematically higher or lower qualifications, they will take that into account. They do the same thing in choosing lawyers, dentists, accountants, and other professionals.
Are there self-selected specialties of med school grads who couldn’t make the cut? Maybe. Pathologists come to mind, as their patients tend not to complain. But what if your cardiologist wasn’t all that bright? It’s not brain surgery, you say? Fair enough. What about neurosurgeons?
That may be unfair to any individual practitioner, but it’s inevitable. That’s because ordinary patients (or consumers) have no direct way of judging professional competence. They can only look for indirect (and imperfect) signs of a good doctor. Did she go to a top medical school, for instance, or practice at a teaching hospital? If they think it is harder for an outstanding Chinese-American undergraduate to gain admittance, they will reasonably guess she’s a better student and a more-qualified doctor. They may be wrong about that particular doctor, but it’s a sensible guess.
In the bad old days of affirmative action, the claim was that a black person coming out of a top school was more likely an AA admit than a brilliant and fully qualified person. It tainted people based on race, as a proxy. As a general rule, I refused to accept that assumption, believing more along the lines of Bakke that they were just as smart, just as qualified, but merely given a plus to bring whatever their racial diversity could contribute to the mix.
The way to accomplish this isn’t to trash the tests or lower the standards, but to limit the influence of diversity to only those wholly qualified under objective standards. Granted, this means it could take a long time to get the stats medical schools would prefer, and may well mean they never reach their goal. But when it comes to something like people’s lives, lowering standards to make the numbers at the cost of lives here and there isn’t an acceptable solution for anybody. Black people want to survive their doctor visit just as much as white people. They may prefer a doctor of their race, but they won’t bet their lives on it.