Back to Front PageVOLUME 6, NUMBER 4
 

Some observers have begun to wonder whether the recent decline in the applicant pool for medical schools is a cause for concern. Let's examine the facts.

It is true that the number of medical school applicants has fallen by some 21 percent since 1996.* But it is also true that the applicant pool is still ample and very strong. The number of applicants had reached an all-time high by 1996, totaling 46,968, or some 2.9 applicants per first-year position nationwide. For the class entering in the fall of 2000, the ratio of applicants to first-year positions was a healthy 2.3 (far above the worrisome and historic low of 1.6 to which we dipped in the mid-1980s).

In my view, still having well over twice as many applicants as available places in our 125 medical schools is hardly a cause for concern-especially given the spectacular academic credentials among matriculants. MCAT scores among the 16,303 entrants this year equaled or exceeded last year's levels; and mean grade-point average was 3.6, which is higher than it has ever been.

Even more important, today's medical students appear to me to be an exceptionally impressive group of people. The medical students I see around the country come across as every bit as, if not more, mature, idealistic, committed to service, and realistic about the future than I remember from years gone by.

So, rather than worry about the declining applicant pool, I think we should rejoice in knowing that medicine is still attracting ample numbers of the very "best and brightest" students. Indeed, given the many plausible reasons one can invoke for not seeking a career in medicine today, I believe it's a testimony to our profession's enduring appeal that the decline has not been even greater.

One can only speculate about the reasons why some students who might have chosen medicine in years past are now opting not to. I think the chief reason is our uncommonly robust economy, which offers many attractive alternatives to bright, ambitious students, especially those who are seeking a faster route to economic independence than medicine can offer. Another plausible and related reason is the large debt burden that medical students must anticipate. The vast majority of students must borrow money to finish medical school and the average debt at graduation now exceeds $90,000. This fact is not lost on prospective applicants.

Still other reasonable explanations for the decline are uncertainty about the future of our health care system and widely expressed frustration with managed care. Such negative commentary undoubtedly dissuades some potential applicants from making the effort, but perhaps not those who are most suited for medicine in the first place.

Looking beyond the sheer number of applicants in last year's pool one can draw some additional conclusions. On the positive side is the mounting evidence that medicine is finally overcoming its gender skew. The applicant pool now contains some 5,500 more women than it did 10 years ago. And this year's entering class featured 46 percent women, a 20 percent increase over a decade earlier. Much remains to be done, of course, to achieve gender parity within our faculty ranks, but help does appear to be on the way as the current cohort of women progress through their careers.

By contrast, on the negative side, is the persistent paucity of underrepresented minority (URM) candidates in the applicant pool and, hence, among our matriculants. Some encouragement can be drawn from the nearly 2 percent increase in the URM applicant pool this year as compared with the 7 percent decrease last year. Nevertheless, this year's numbers are still far below the peak reached in 1994-95. Moreover, despite more URM applicants to choose from, the number of URM matriculants fell still further from last year, resulting in the lowest number of first-year students from these groups since 1991! What's disheartening is that we appear to be turning away URM students who, despite all the reasons to pursue other options, had their hearts set on medicine.

As with the overall decline in the applicant pool, this widening gap between URM applicants and matriculants has many possible explanations, including the dispiriting impact of anti-affirmative action measures on both applicants and admissions officials. But regardless of the reasons, if we don't find ways to reverse the trend, we are clearly headed toward disastrous consequences for the future complexion of our profession. It is this foreseeable calamity that should concern us about today's applicant numbers, not the fact that the pool is shrinking a bit.

*It is noteworthy that several other health professions, including osteopathy, dentistry, podiatry, optometry, and pharmacy, have also experienced double-digit percentage declines in applicants over the past five years.



Jordan J. Cohen, M.D.
AAMC President

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