With the current low attrition rates from medical school, nearly every student who enters medical school will become licensed to practice, meaning that medical school admissions committees have the sole responsibility of choosing the nation’s future physician workforce. Our study examining the perception of medical schools on barriers to URM recruitment sheds some light on how schools make admission decisions and how this affects diversity in the classroom. For example, low GPA and MCAT scores among URM applicants are perceived to be a barrier by the vast majority of respondents, suggesting that schools continue to place significant weight on these admissions criteria.
Concerns regarding overreliance on such metrics and their role as barriers to medical school diversity have existed among medical educators for over 20 years. Yet even today, expert opinion still remains divided on such admissions criteria, with some advocating for the continued role of the MCAT and GPA scores, and others calling for the abandonment of such criteria in favor of “noncognitive attributes” (i.e., altruism, maturity, etc). Most recently, the Sullivan Commission on Diversity in the Health Workforce recommended: “medical schools should reduce their dependence upon standardized tests in the admissions process … and the MCAT should be utilized along with other criteria in the admissions process as diagnostic tools to identify areas where qualified health professions applicants may need academic enrichment and support.”
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Our study also underscores the importance of visible URM medical school faculty and students in the building of a diverse physician workforce for the future. Consistent with prior reports, a large proportion of schools noted the effectiveness of URM students in recruitment and the absence of minority faculty as the biggest institutional barrier to URM recruitment. However, achieving diversity among faculty at medical schools has proved challenging, with URM faculty currently representing only 4.2% of medical school faculty. Even when traditional academic productivity metrics, such as grants and publications, are adjusted for, studies have consistently found that URM faculty are less likely to be promoted.
Further, our data on recruitment programs for URM students suggests that most medical schools employ a wide variety of initiatives to encourage applications and enrollment by URM students. However, aside from summer enrichment programs and URM student recruiters, schools felt that most other programs were only moderately effective. When combined with the data on barriers, it is striking that recruitment efforts do not seem to directly focus on the barriers identified by the majority of schools: faculty diversity and the strong emphasis that schools continue to place on MCAT and GPA scores as admissions criteria.
Lastly, we found that the majority of medical schools tended to rate themselves highly with respect to their performance in creating a diverse student body. It is unclear how schools evaluated themselves, as we found only weak correlation between self-rated success scores and the percentage of new URM students. As most schools believe they are doing rather well at URM recruitment, this finding suggests that many schools, on their own, may not aggressively pursue the additional requisite changes needed to achieve a more diverse physician workforce.
Limitations to our study include the low response rate as well as possible discrepancies between the medical schools’ views on URM recruitment and those of other groups, such as students. For example, while students often cite lack of financial resources as a barrier to entering and succeeding in medical school, less than half the schools in this study felt that lack of financial aid or parental income was a problem.
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Our nation has embarked on an ambitious agenda of eliminating the glaring racial and ethnic inequities that exist in our healthcare system. Achieving physician workforce diversity will be an important step towards achieving this goal, and our study shows that schools are investing tremendous efforts into minority recruitment. However, our study also suggests that current initiatives may not be addressing the central barriers that schools themselves identify—admissions criteria and URM presence among the faculty. Of note, these are institutional barriers, directly amenable to intervention by the schools themselves. Furthermore, our study also suggests that schools may have difficulty with internal evaluation of their recruitment efforts, perhaps underscoring the need for an external body to assist with the development of diversity goals and an evaluation of their performance. Until these critical issues are addressed, we fear that efforts to achieve a more diverse workforce will remain at an impasse.