Social Justice Medicine

In principle, Steve Salerno argues, we should want to see the best and brightest people become physicians. We should have medical school admissions standards that emphasize achievement, not identity. If you are choosing a surgeon to perform a complex operation on your child, would you select a surgeon who had been admitted to medical school and had been graduated from medical school for reasons that had little to do with merit?

At a time when the world is facing a pandemic, it is all the more important to be able to trust our physicians, that is, to trust that our medical schools have been admitting and promoting and graduating physicians on the basis of merit. And that means, not on the basis of race and ethnicity.

Naturally, social justice warriors do not see things this way. They believe that a disproportionately lower number of minority physicians must necessarily be proof of bias. And they insist that the bias begins to show its ugly face in the tests that screen out those students who will not do well in medical school. Those would be the MCATs.

Salerno explains:

In the beginning were the Medical College Admission Tests, or MCATs, a time-honored means of ascertaining worthiness for medical school. Formulated by the Association of American Medical Colleges, the MCATs assessed an applicant’s cognitive heft and baseline acumen in such no-nonsense disciplines as anatomy, biology, kinesiology, chemistry, and other precincts of hard biophysical science.

Then, around the turn of the millennium, early social-equity advocates began insisting, in essence, that the MCATs unfairly limited med school to people who showed significant potential as doctors. Specifically, the pool of physicians being churned out each year was judged insufficiently diverse. A chief concern was that African Americans, 13 percent of the US population, represented barely six percent of medical school enrollees. Efforts were made; the numbers ticked up incrementally.

As always, the social justice warriors had their explanation: racism. And they began to force medical schools to grant special privileges to minority candidates, regardless of whether they possessed the mental acuity to practice medicine:

Translation: If your enrollment of underrepresented minorities skews too far from population demographics, watch out. Thus began a willy-nilly search for correctives that today seems poised to eliminate all barriers—that is, uniform standards—that prevent med schools from simply anointing desired candidates qualified to practice medicine.

In the wake of the LCME’s watershed edict, working groups were convened, budget line items were created, and high-profile hires were made to facilitate diversity boosting and community recruitment. A main stumbling block seemed to be minority candidates’ poor performance on gatekeeper exams like the MCATs. Unintentionally ironic assertions began appearing in the literature. From anesthesiologist and author Dr. Maxime Madhere: “A huge obstacle to diversity is that most medical schools have the same criteria for all applicants.”

So, the medical schools relaxed entrance requirements. Unfortunately, none of them relaxed graduation requirements. The result was predictable:

Alas, under-represented minorites, once admitted, didn’t necessarily thrive. In fact, they were 97 percent more likely than were their counterparts to struggle academically as well as substantially more likely to wash out before graduation. This begat more scrutiny of the output end of the process. One white paper asserted uncritically, “In the competition to recruit minority students, most medical schools relaxed their admissions standards… On the other hand, no school relaxed its graduation requirements.”

From there it was only a matter of time before the social justice warriors would insist that the schools relax grading and graduation requirements.

Salerno explains:

Always, that circular foundational assumption: that under-performance is, must be, a byproduct of some diabolical social antecedent: If the numbers don’t support an equity agenda, the playing field cannot, by definition, be level.

When we need the best physicians, do we really want to turn medical schools into diversity factories, where race and ethnicity trump knowledge and ability:

Let us close with a bit of inescapable context, the infectious elephant in the room, as it were: The world’s current struggles against COVID—19 underscore the vital importance of quality medicine. If you are the best and the brightest, you should be in medical school. You should not be in medical school for reasons other than that.