Patients may suffer the painful consequences if the war against merit — and for racial discrimination — continues.
Patients may suffer the painful consequences if the war against merit — and for racial discrimination — continues.
T he Supreme Court’s recent ruling against affirmative action in college admissions isn’t deterring fans of race-based admissions — it’s inspiring them to seek workarounds. And that could be bad news for the Medical College Admission Test, or MCAT.
The nation’s leading medical-school association, the Association of American Medical Colleges (AAMC), developed and oversees the MCAT, a standardized exam that has been instrumental to medical-school admission for nearly a century. The exam was developed in response to high attrition rates in medical schools and broad acknowledgement that a standardized screening for aptitude best served the interests of the profession and patients.
The MCAT does a good job of treating medical-school aspirants equally. Multiple studies confirm that the test results show no evidence of “bias.” In other words, the test is equally good at predicting medical-school outcomes across racial and ethnic groups. The MCAT does not, however, promote equity: Data show that Asian medical-school applicants tend to score significantly higher than other racial groups, while black applicants tend to score significantly lower.
An organization that prioritized health-care outcomes would be indifferent to the demographics of the physician workforce. The AAMC, however, is keen to increase the number of black doctors, even if it means discriminating against other medical-school applicants or changing standards. Historically, the AAMC could imperfectly reconcile its appetite for both aptitude screening and racial favoritism by sorting students into racial groups and then selecting the top MCAT performers in each group. Yet the Supreme Court’s ruling against race-based admissions has rendered that option untenable.
Enter the AAMC’s workarounds. The association is moving to devise metrics that are untethered from aptitude or merit and narrowly skirt prohibitions on racial preference. It used to require that medical schools ascribe the “highest importance” to admitting students from an “underserved background.” Now it says they should prioritize individuals who’ve “lived or worked with groups that have experienced disadvantage.” This is a thinly veiled proxy for race.
If the AAMC remains committed to the principles of race-based favoritism over meritocracy, a showdown with the MCAT itself is all but assured. Before the Court’s decision, racial preferences had so skewed the admissions process that the MCAT scores of Asian applicants rejected from medical school appeared to be nearly identical to the MCAT scores of black matriculants. So long as MCAT scores are considered integral to a student’s academic readiness, such a blatant disconnect will surely put medical schools on the wrong side of the Court’s decision.
One would hope that the AAMC’s leaders would come to their senses and scrap their preference for race-based admissions. But if the recent past is any indication, they will instead double down at the expense of merit. A webinar hosted by the AAMC last year showcased “effective strategies” employed by the University of California, Davis to “increase enrollment of historically underrepresented and excluded students.” The school’s associate dean for admissions admitted that the purpose of its “socially accountable” admissions process was to address “gaps” between the demographics of the general population and the physician workforce, including the “overrepresentation” of Asian physicians. The presentation flagged MCAT scores as being the “wrong” metric for success.
The AAMC’s own data disagree, proving that MCAT scores are the single best predictor of student success in medical school. For example, more than 99 percent of students who score in or above the 95th percentile on the MCAT pass their Step 1 exam — the first of the three tests necessary for medical licensure — compared to 75 percent of students who score in or below the 25th percentile. Step 1 scores, in turn, predict clinical performance. So aptitude matters after all. Yet aptitude could be under threat if the AAMC continues its push to recruit students based on race.
When it comes to deciding between race and academic merit for medical-school admissions, the decision should be obvious. Yet for organizations that are obsessed with race, common sense is a tragically uncommon virtue. The Supreme Court’s decision could well set the AAMC on a path to war with its own MCAT assessment, which it designed to ensure that today’s medical students become the best possible physicians tomorrow. And patients will suffer the painful consequences if that ends up being the case.