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    Medical school applicants and enrollments hit record highs; underrepresented minorities lead the surge

    The 2021 first-year class is larger and more diverse than any before. Did the pandemic, social justice, or remote interviews boost motivation among aspiring doctors?

    Masked student raises hand

    Applicants to medical school soared by a record-setting 17.8% for the 2021-22 school year, led by historical increases among underrepresented minorities, according to new data from the AAMC (Association of American Medical Colleges).

    The number of accepted students and new enrollments into medical school also reached new highs, making the first-year class of 2021 larger and more diverse than any before it. Among the 22,000-plus students who began medical school this fall, those self-identified as Black or African American rose by 21.0% from 2020-21, followed by increases of 8.3% among Asian students and 7.1% among those of Hispanic, Latino, or Spanish origin, the AAMC found.

    “We are especially encouraged by the growth in applications and new enrollments by students in racial and ethnic groups that are underrepresented in medicine,” said Geoffrey Young, PhD, the AAMC’s senior director of transforming the health care workforce.

    No one can pin down one dominant force behind the boom. “I don’t think anybody knows why,” said Kevin Holcomb, MD, associate dean of admissions at Weill Cornell Medicine Medical College in New York City, where applications rose 15%.

    Instead, admissions leaders believe an unprecedented mix of developments compelled many medical school aspirants to leap from “someday” to “now”: pandemic-related shutdowns that cut off other opportunities and accelerated medical career plans; increased awareness of how doctors can help to alleviate social injustices; and changes that reduced fees for some students and eliminated travel costs associated with applying.

    “Most of the people who applied had been thinking about it for years” and got nudged by societal events, said Sandra Quezada, MD, associate dean for admissions at the University of Maryland School of Medicine (UMSOM) in Baltimore, where applications increased by almost 28%.

    While most of those aspiring doctors probably never read the oft-quoted observation that “an optimist sees the opportunity in every difficulty,” many adopted that outlook in the face of adversities that struck the country in 2020-21.

    Opportunities taken

    Perhaps chief among the adversities was COVID-19.

    Pandemic-related shutdowns and restrictions on in-person gatherings eliminated many opportunities for people to test their interest in medical careers and burnish their credentials, Quezada noted. There were fewer chances to shadow physicians, take internships, work in health care, or travel before taking on the rigors of medical education.

    “A lot of people who were trying to get in their gap year experiences had those experiences canceled,” said Hiral Choksi, MD, associate dean of admissions for Saint Louis University School of Medicine, which reported that applications increased by about 39%. “So, they thought, ‘I’ll apply now.’”

    The pandemic also brought into harsh public light social justice issues, such as disproportionate health outcomes and access to health care, as COVID-19 struck particularly hard for low-income people and people of color. Concurrent incidents of racial strife in communities around the country further intensified attention to inequities across various areas of life and their impact on health.

    “This class of students is very concerned with issues of equity and justice,” said Holcomb at Weill Cornell Medicine. “The pandemic shined a light on health care disparities. That could motivate somebody who says, ‘I want to make a difference in the world. What’s a pathway for doing this?’”

    The path to medical school also got a bit easier, thanks to several changes. One was the widespread shift by schools to interview applicants remotely to avoid the risk of spreading the coronavirus through travel and in-person meetings. Choksi believes that change increased the number of people who applied and how many schools they applied to, because each application didn’t require travel costs and time off from school or work.

    Costs also dropped for some because the criteria expanded for people to qualify for fee assistance for the Medical College Admission Test® (MCAT®) and fee waivers for medical school applications. (Some of those changes were in the works before the pandemic and happened to kick in then.)

    “We [UMSOM] had an increase in the number of applicants qualifying for [the Fee Assistance Program],” said Quezada, referring to the AAMC’s program that includes reduced MCAT fees, as well as waivers for medical school application fees.

    To be sure, not all medical schools saw application numbers rise. Among those that did, the fact of the increase was no surprise, considering the factors above, but some increases were far larger than anticipated.

    “We expected a certain increase,” said Mike Woodson, director of admissions at Tulane University School of Medicine in New Orleans, which reported that applications rose by about 35%. “We didn’t expect this much.”

    Cautionary observations

    Admissions leaders don’t believe that many people were freshly inspired to become doctors by witnessing overwhelmed health care workers caring for stricken patients or because they admired Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases — the so-called “hero” or “Fauci” effect. Rather, events around the pandemic appear to have influenced people who were, in the words of Quezada and Holcomb, “sitting on the fence” to take the leap.

    “No one in our new class said they had this epiphany because of COVID,” said Woodson at Tulane University. “They were always planning on applying” to medical school.

    The increased competition made it harder for people to get accepted. The number of accepted students did increase by 2.6%, but medical schools cannot quickly expand classes sizes significantly, as they need to develop everything from space and equipment to teachers and future clinical sites.

    The unprecedented application increases of 2021-22 are unlikely to continue. Medical schools report that applications for the 2022-23 school year are coming in closer to pre-pandemic levels.

    Key figures

    Here are selected figures from the 2021 data.

    Applicants set record

    For the past 20 years, the number of applicants has fallen or risen by 2% or 3% each year. For 2021-22, they rose by 17.8%.

    • Highest previous increase: 8.2%, for 2007-08.
    • Total applicants for 2021-22: 62,443.
    • Previous record for applicants: 53,370, for 2019-20.
    • First-time applicants: 46,758, up by 21.2%.
    • Increase in applicants since 2002-03: 85.7%.

    Racial, ethnic diversity expands

    For the first time since the AAMC has tracked this figure, most of the 2021-22 applicants were not White. (Applicants could choose more than one racial/ethnic category.) Here are the figures for the largest categories:

    • White: 49.7%.
    • Asian: 25.0%.
    • Black or African American: 11.7%.
    • Hispanic, Latino, or of Spanish origin: 11.7%.

    The class that started in 2021 (matriculants) is more diverse than in past years, with noticeable gains among those identifying as Black or African American and Hispanic, Latino, or of Spanish origin. The largest racial/ethnic categories are:

    • White: 51.5%.
    • Asian: 26.5%.
    • Hispanic, Latino, or of Spanish origin: 12.7%, up from 12.0% in 2020.
    • Black or African American: 11.3%, up from 9.5% in 2020.

    Acceptances increase

    Medical schools accepted more students this year than ever before: 23,711, up by 2.6% from last year. Acceptances have risen every year except one since 2002-03, usually by 1% or 2%, with a high of 2.9% in 2013-14.

    Matriculants increase

    Students entering medical school in 2021:

    • 22,666, an increase of 1.9%, which is in line with previous years.
    • Increase since 2002-03: 37.5%.

    Women’s presence grows

    For the third year in a row, women constitute the majority of applicants, matriculants, and total enrolled students. The number of accepted women reached a high of 13,152 for 2021-22, a record increase of 5.9%. The number of men accepted (10,537) dropped 1.0%, which is about the rate it has dropped each year since 2016-17.

    For 2021-22, women account for:

    • 56.8% of applicants.
    • 55.5% of matriculants.
    • 52.7% of total enrollment.

    See all the data on the AAMC website.