Fairness in Medical School Admissions

A favourite topic of mine is medical education and one of the more interesting aspects of medical education to me is admissions. In our current system, admission to Medical School is the major choke-point. Before you get that admission, you're not going to become a doctor. Once you get that admission, you are almost guaranteed to become a physician. It's a fairly important milestone.

It's also a very difficult milestone to get beyond. Medical school admissions, particularly in Canada, are insanely competitive. Just getting the GPA/MCAT combo to get looked at is a non-trivial task. Having the more subjective measures be up-to-par is an added challenge, your extra-curriculars, letters of reference, interview performance all can matter as well. Far more people apply than gain admissions and there's a large set of interested individuals who never bother to apply at all, knowing it would be futile.

Because admissions is the major choke-point to entering the profession, having an effective and fair admissions process is a meaningful concern. At some point, I'd like to dig into the nuances of this process in depth, probably over several posts. For now, I'll stick to commenting on one point that always bugs me: just because we have generally good physicians does not mean that we have a good admissions process.

The thing is, far more qualified individuals want to be physicians than are allowed to be physicians. Ontario takes approximately 1000 new medical students each year, most of whom will likely be very good physicians. Yet, there are several more thousand aspiring physicians who cannot gain admissions who would probably be good physicians as well. This leaves plenty of room for inefficiency, inequality, or in some cases, downright inequality in the selection process.

Here's a simple scenario - let's say you have three applicants for one medical school position, Jim, Bob, and Ray.

Jim is not qualified to be a physician, not even close. Both Bob and Ray, however, would probably make good physicians. Jim and Bob are both tall, but Ray is not.

A selection process that considers both height and qualifications would select Bob. Bob's qualified, so that's not a bad outcome for the system - at least we're not getting Jim! But it's not a fair system to Ray, who's also qualified, but doesn't happen to be tall, a factor which isn't relevant or within Ray's control.

The current admission systems are rarely so obviously preferential, but bias can still creep in. If there were 100 Jims and 100 Bobs and 100 Rays applying for 100 positions, without any stated preference for height, yet we ended up with 90 Bobs and 10 Rays, that's not likely to be a fair system. Sure, we didn't end up with any Jims, so height doesn't trump qualifications, but that's a small comfort to the many Rays who got passed over for Bobs when the only major difference between them is height.

With so many qualified applicants, it's not too hard to avoid the unqualified ones (though the odd one still slips through the cracks...). But that's not good enough, not for patients, and not for applicants who deserve a fair shot at the profession.