A Word From The President:

Preferring Doctors for a Diverse Society

Photo of Jordan J. Cohen, M.D.
The Center for Equal Opportunity (CEO) recently released a study examining the admission practices of five medical schools. The results of the study document quite clearly that these medical schools (as is true for virtually all 125 U.S. medical schools) admit black and Hispanic students who have grade point averages and MCAT scores substantially less impressive than large numbers of white and Asian students who are turned down. Linda Chavez, who heads CEO, interprets these results to suggest that medical schools are failing our country by conspiring to prepare a "less qualified" physician work force for the future. Let's examine that view.

Point number one: GPAs and MCAT scores reflect academic preparation. Given the dismal educational opportunities available to so many black and Hispanic kids in this country, how would it be possible for their GPAs and MCAT scores to be statistically equivalent to those of white and Asian students, who on average receive far better academic preparation? The medical school applicant pool is the passive recipient of an educational pipeline that is of notoriously unequal caliber, gushing with well-prepared white and Asian students but producing barely a trickle of blacks and Hispanics.

Point number two: Higher GPAs and MCAT scores do not necessarily mean better physicians. Students with superior GPAs and scores do, on average, make better grades in the first two years of medical school and do find it easier to pass the licensing examinations. These results are far from surprising. Of course students with better academic preparation do better on tests. The question is, do students who have an easier time with tests in medical school make better doctors?

Certainly we want our doctors to be smart and to have passed all of their courses; no one, whether from a minority or majority background, graduates from medical school who has not done so. Just as no one practices medicine who has not passed all the licensing examinations. But good doctoring requires a lot more than passing requisite exams. And there is no reason to believe that those other attributes we are looking for in our future doctors - compassion, dedication, truthfulness, caring - correlate with scores on multiple-choice exams.

And point number three: With the exception of certain Asian groups, all minority populations in this country are severely underrepresented in the medical profession. If we fail to give preferences to minority students who lack equivalent "academic qualifications" to whites and Asians, the future physician work force will be even less representative of our diverse population than the one we have now. To be sure, that work force could boast superior credentials earned through exceptional test scores. But would it be "more qualified" to care for a citizenry that is becoming increasingly diverse each year? The answer is clearly no.

All of us in medical education would much prefer to live in a world in which students from all racial and ethnic backgrounds arrived at our admissions offices with comparable GPAs and MCAT scores. We would also much prefer to live in a world in which all medical students - from whatever backgrounds - graduate from college with GPAs of 4.0, achieve perfect MCAT scores, and have Mother Teresa's character traits. But until we find such a world, choices must be made.

In choosing whom to admit to medical school, admissions officers reject most applicants - majority and minority alike - in favor of those who are judged most able to fulfill the medical profession's moral obligation to serve the health care needs of the American people - all of the American people. Preparing future physicians for this awesome responsibility also requires an educational environment that reflects the racial and ethnic diversity of our country. Given the medical school applicant pool, the choices we must make to meet our obligations cannot be made responsibly by blithely assuming that race doesn't matter.

As in so many other things in life, we must make trade-offs. Becoming a physician is a rare privilege. In a democratic society such as ours, becoming a physician should be reserved only for those most qualified to meet the rigorous educational requirements and to fulfill the profession's humanitarian mission. By the same token, becoming a physician in a democratic society should not be denied to those who, through no fault of their own, lack stellar "academic qualifications" but who, by dint of their intelligence, determination, commitment, and character, possess all the qualifications needed to succeed as effective, caring physicians. In balancing these trade-offs, we cannot blindly consider arbitrary measures of academic achievement and abandon "preferences" that acknowledge existing inequalities in our society. At least, not if we wish to remain true to our profession's values.

Jordan J. Cohen, M.D.
AAMC President

08 August 2001