Follow the evidence. It’s a foundational tenet of health care, as it is of all scientific inquiry. Yet today’s medical establishment is unwilling to confront the consequences of its attempts to maximize diversity. After years of lowering standards for applicants, medical schools are more diverse than ever before. Yet new studies show that many students are struggling, putting their future patients and careers at risk. Rather than revisit the means by which they are pursuing diversity, however, the medical elite want to double down on their failing course.
The campaign for diversity is long running and has some value, yet the ideological extremism of the past two years has led medical schools to adopt dangerous strategies. To fight supposed “systemic racism,” at least 40 institutions have dropped the requirement that all applicants take the MCAT, the gold-standard test that measures students’ grasp of this life-saving profession. The University of Pennsylvania’s Perelman School of Medicine, where I used to work, now waives the MCAT for a number of applicants each year, primarily from Historically Black Colleges and Universities.
It’s also getting harder to gauge whether graduates are well prepared. The U.S. Medical Licensing Exam, which residencies rely on when picking trainees, recently abandoned objective grading for a pass/fail system, largely on diversity grounds. And calls are growing for post-graduate resident evaluations to be weakened as well. That would let potentially unqualified individuals enter medical practice and endanger patient well being.
Sadly, increasingly vocal student and faculty activists have made clear to the medical establishment that raising concerns about these trends is verboten. Enter three new studies, which show that putting diversity ahead of quality has consequences.
The first study, published in May in the well-respected journal Academic Medicine, found that MCAT scores generally predict student outcomes. Those with lower scores fare worse over their four years in the classroom, and the strong correlation between MCAT scores and student success holds across racial, ethnic, and socio-economic lines. Left unspoken was the criticism of the putsch against the MCAT.
The second study came courtesy of another May issue of Academic Medicine. It looked at minority medical students’ readiness for the profession, as judged by clinical evaluations during their post-graduate residencies, when they begin to work directly with patients. On average, they scored lower on measures of medical knowledge, medical practice, professionalism, and several other essential indicators.
To be clear, many minority students surely excelled, while others brought the average down. The authors attributed their findings to biased evaluators, racist tests, or worse training, but if you put ideology aside, the more likely conclusion is that lower standards for students leads to worse performance by residents.
The final study was published by the news site Stat. In a thorough investigation of post-graduate residencies, it found that black residents “either leave or are terminated from training programs at far higher rates than white residents.” Stat assumes that racism accounts for this disparity, but the other studies point to a simpler and more credible explanation: after struggling in medical school and falling short in key professional indicators, some residents simply lose their positions due to poor performance. As a longtime medical educator, I can attest that no training program would make this difficult and disruptive decision for any reason other than competence and concern for patients.
Such findings should spark a diversity rethink among medical school administrators. They should be deeply concerned that they’re accepting and graduating a growing number of students who may not be ready for the rigors of the profession. They should also be concerned that more qualified students are likely being passed over, leaving patients with a less talented crop of doctors over the long run.
But a rethink is not what medical schools want. That would require questioning the ideological assumption that patients need to see physicians of the same race and gender, an idea contradicted by robust clinical studies. More to the point, it would call into question the entire diversity-industrial complex.
When I recently highlighted the troubling nature of the second study, academic medicine largely rallied to attack me. The chair of the Medicine Department at Penn’s Perelman School of Medicine sent a note to all faculty, trainees, and staff decrying my “racist statements” and recommitting the school to diversity. This ideology runs so deep that I doubt medical schools will put student quality ahead of diversity unless policymakers require it, either by mandating the MCAT for all students or withholding funding from institutions that put skin color ahead of medical excellence.
People of every race and background are fully capable of becoming world-class physicians. Medical schools should seek out the best candidates who are most likely to provide the best care for patients, regardless of what they look like or where they come from. Anything less jeopardizes the very purpose of these institutions. The medical elite may not want to admit it, but their current approach to achieving diversity has a steep cost, and it’s wrong to ask patients to pay it.
Dr. Stanley Goldfarb, a former associate dean of curriculum at the University of Pennsylvania’s Perelman School of Medicine, is chairman of Do No Harm.
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