Push by adcoms for lower MCAT scores?

[JJRousseau]

The SES imbalance in professional school is a structural problem that goes far deeper than MCAT prep. Like I mentioned earlier, adcoms can do whatever they want but attracting primarily service-minded people who are also academically capable is a very challenging goal. It cannot be achieved if the material conditions of medical training and practice do not change.

Let's count some of the ways:

1. Maybe we can start with the fact that many working class people in this country don't even come into contact with a Dr unless its an emergency or they are getting their child's shots / physical done for school because they can't afford one. A lot of pre-meds start out because of an experience they have with a family members illness (or even their own). For a lot of people that "experience with a family member's illness" is that they didn't have insurance and a family member's medical care left their family financially devastated, or that family member simply opted out of medical care and sought alternative or no other treatment. As a translator I've had to look people in the face and tell them there was nothing we could do when they asked us how to choose between receiving necessary treatment and feeding their family for a month. I dont think these people, their families, or their children are leaving with anything like a positive impression of the powers of the medical profession. They might, but I speculate that they are less likely to be inspired.

2. Prestige chasing matters a lot less in working class families. We all know plenty of people who got on this path (and maybe even stayed on it) because of the prestige of the medical profession.

3. Every step of this process is incredibly financially prohibitive and rewards those that do not have to finance their own education by working through school. I think this is sort of self-explanatory and has been discussed in the thread. Furthermore, taking on hundreds of thousands of dollars of debt that can be repaid slowly over a very long time period after a very long period of training might not be a very attractive option when there are other ways to get into the workforce faster, pay off undergrad debt, and help support your parents / family members.

Here's an idea: Make medical school free and have everyone pay for their training with mandatory service where they are needed most after their first years of medical training but before specializing (if they are thinking about specializing). I think this would get more of the 'right' people to line up and clear out some of the others.

Infinite likes for this post. In France the most prestigious academics pass an exam which allows them to teach high school students in struggling neighborhoods for 1 to 3 years before an almost guaranteed position in the sciences, humanities, or social sciences in academic communities. Why not? I would happily return to rural America for 2 to 3 years of clinical service before pursuing my ideal career as an academic physician if it meant no debt burden, even 5 years if it didn't penalize a 20-30 year career afterward exploring research and teaching alongside clinical medicine.

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[Lucca]

Infinite likes for this post. In France the most prestigious academics pass an exam which allows them to teach high school students in struggling neighborhoods for 1 to 3 years before an almost guaranteed position in the sciences, humanities, or social sciences in academic communities. Why not? I would happily return to rural America for 2 to 3 years of clinical service before pursuing my ideal career as an academic physician if it meant no debt burden, even 5 years if it didn't penalize a 20-30 year career afterward exploring research and teaching alongside clinical medicine.

I would do it in a heartbeat even with debt as long as it didnt impact the rest of my career since I want to a career in the basic sciences. I didn't know about that system in France, it's also a terrific system for academics here to be completely honest. Given how glutted most academic departments are, a temporary pathway of guaranteed employment doing something worthwhile and relevant to your career sounds great.

 

[JJRousseau]

2. Prestige chasing matters a lot less in working class families. We all know plenty of people who got on this path (and maybe even stayed on it) because of the prestige of the medical profession.

I sadly don't know about in the US, but in the UK amongst the working class, prestige is seen as a negative. I have friends from working class backgrounds with serious emotional struggles because they pursued a higher degree in the UK at a top-tier institution from a working class background and they feel their identity is annihilated (they don't fit in with bourgeoisie/aristocracy and are too good for working class). Similar sentiment could exist in US, but I haven't experienced it.

 

[Lucca]

I sadly don't know about in the US, but in the UK amongst the working class, prestige is seen as a negative. I have friends from working class backgrounds with serious emotional struggles because they pursued a higher degree in the UK at a top-tier institution from a working class background and they feel their identity is annihilated (they don't fit in with bourgeoisie/aristocracy and are too good for working class). Similar sentiment could exist in US, but I haven't experienced it.

Maybe. I suspect the working class in the UK is a lot more class conscious than the US so being a "class traitor" is felt more acutely than it is here. The ruling class here is *extremely* class conscious, but the working class is less so; in fact, to paraphrase Kurt Vonnegut, it is practically conditioned to loathe itself.

This is getting off topic for this discussion though

 

[JJRousseau]

I would do it in a heartbeat even with debt as long as it didnt impact the rest of my career since I want to a career in the basic sciences. I didn't know about that system in France, it's also a terrific system for academics here to be completely honest. Given how glutted most academic departments are, a temporary pathway of guaranteed employment doing something worthwhile and relevant to your career sounds great.

Me too. My knowledge of the French situation is based on a humanities studying close friend from Paris. But she claimed it was not unique to humanities. You have to be very, very good to pass the exam though in the respective field.

I agree with you that even with the debt burden, the opportunity to serve the underserved and not have it striking against you as someone interested in academic medicine would be fantastic. I will end up in a major city because of my interest in academic medicine, if I wasn't obsessed with science and medicine (and my wife didn't have career interests drawing her to the city) I would be very happy living in a town of 7000 people in rural Virginia, Montana, Alaska or Maine.

 

[JJRousseau]

Maybe. I suspect the working class in the UK is a lot more class conscious than the US so being a "class-traitor" is felt more acutely than it is here. The ruling class here is *extremely* class conscious, but the working class is less so; in fact, to paraphrase Kurt Vonnegut, it is practically conditioned to loathe itself.

This is getting off topic for this discussion though

The folks in the UK are more class conscious IMHO and yes, we've veered off topic. Apologies to the thread.

 

[Jalby]

Jalby is that you?

No. I'm

Counterpoint would be the MCAT score range jump that occurred in the mid/later 2000s, and how extreme it got. Places in the span of ~7-8 years moved their 10th percentile marks up past where their medians had been, and many places got up to 98-99th percentile medians. The type of school Penn is didn't change from 2006 to 2014 but the scores sure did.

This just kills me that you keep going back to this. The top schools remained the top schools. They have about 1,000 spots. The number of applicants went from 37,000 to 50,000+. So the people going to the top schools go from 1 out of 37 to 1 out of 50.

Of course the percentile means would go up. There is a ton more people applying. Penn didn't change it's admissions procedure. The applicants changed.

 

[Jalby]

Do students from middle and upper class families make up a majority of med students more than lower?

8 people of my 168 class at USC Came from San Marino High school, one of the best and richest HS's in our city

 

[sullen-burger]

@Lucca Yea the SES problems are structural and probably aren't totally fixed at the level of MCAT prep. They most likely start at the beginning with your environment as a kid.


To your first point

1) How do you engage the public in a nation-wide PR campaign to show that they can trust caregivers and eventually, see them as role models? I appreciate you sharing your story as a translator, that's very noble.


2) I'm not sure I know much about prestige seeking in the lower versus upper classes so I'm taking your word for this. On the face of it, I don't see a majority of people getting into this for the glory but I could be wrong.



3) the money aspect of education in the US is 100% the main barrier to this. Because both of your points 1 and 2 would be taken care of as long as every kid who wanted to find exposure to medicine got that chance in a higher education setting (where they have like minded students or mentors or counselors).

I would happily return to rural America for 2 to 3 years of clinical service before pursuing my ideal career as an academic physician if it meant no debt burden, even 5 years if it didn't penalize a 20-30 year career afterward exploring research and teaching alongside clinical medicine.

These currently exist here. I mean isn't that what the NHSC public service loan forgiveness program is for? And the reserve/active military payback programs?

Granted those are for once you're already past the hurdles of getting into and finishing medical school but, they do exist.

 

[ridethecliche]

 

[Lucca]

@Lucca Yea the SES problems are structural and probably aren't totally fixed at the level of MCAT prep. They most likely start at the beginning with your environment as a kid.


To your first point

1) How do you engage the public in a nation-wide PR campaign to show that they can trust caregivers and eventually, see them as role models? I appreciate you sharing your story as a translator, that's very noble.


2) I'm not sure I know much about prestige seeking in the lower versus upper classes so I'm taking your word for this. On the face of it, I don't see a majority of people getting into this for the glory but I could be wrong.



3) the money aspect of education in the US is 100% the main barrier to this. Because both of your points 1 and 2 would be taken care of as long as every kid who wanted to find exposure to medicine got that chance in a higher education setting (where they have like minded students or mentors or counselors).





These currently exist here. I mean isn't that what the NHSC public service loan forgiveness program is for? And the reserve/active military payback programs?

Granted those are for once you're already past the hurdles of getting into and finishing medical school but, they do exist.

I think people will respect, trust, and admire physicians more if they feel that physicians are working for them. The average person on the street is more like to think of physicians in general as pharma shills and greedy fat cats all the while treating their own physician (if they have one) like a member of their own family. The main problem with this perception is that the entire healthcare system appears to be set up to wring as much profit out of a patient as possible and reduce patient care to the absolute bare essentials thus eliminating the possibility of an interaction is that is more humane and fruitful for the physician and the patient; i.e., one where the patient is not just wasting the physicians time when they have 100 questions or spends 15 minutes just to say that their chest pain is back, where the physician does not feel like they have to rush through patients or practice in such a way as to maximize RVUs. If patients dont think physicians are on their side it is because many institutional cues seem to perpetuate that idea. Nurses on the other hand are the most trusted professionals out there, I think, when you read the surveys (importantly, its not as if doctors are at the bottom, they are still quite respected and trusted). As salaried (and decidedly non-rich) professionals who spend more time with the patient and whose responsibility it is to come at the press of a button or listen to every concern they have a different impression on the patient.

How do you make people believe physicians work for them? Easy, ensure that every person that needs a physician is able to see one at little to no cost to themselves. Eliminate profitable incentives for unethical and wasteful care practices. People complain about the ways hospital administrators take home bloated salaries while doing little to improve care and a lot to get in the way of it. Dump the profit motive and I bet those people will be more than happy to let physicians and other healthcare professionals run the hospital cooperatively, as they still do in many parts of the country. This is a great book on an example of cooperative health care delivery as a scalable business model: Amazon product ASIN 0295975873
NHSC is awesome. I'm very glad it exists. But its not exactly what Im talking about. If I were to do NHSC it would mean committing to primary care as a career. I'm interested in academics and basic science. I dont want a primary care career. Leaving the research/academic track for 4 years to do primary care (something Id be happy to do otherwise) in an underserved area in a cutthroat academic environment while others are doing postdocs/fellowships/publishing papers/obtaining grants simply isnt an option. Now, if everyone had to do a service commitment as a part of training there would be no long term career consequences. I also think the mandatory exposure to that kind of practice setting would lead to a lot of people choosing to continue in that type of career permanently.

 

[bonedoc5576]

No. I'm not advocating for anything. I was simply trying to help you understand the response you commented on a little better.

Those that are chosen with lower scores prove they have what it takes in different ways and at least meet the minimum of what it takes to be a successful doctor. Sociology proves that challenges many times impact education and standardized tests. To account for that should be applauded. You don't have to get a 37 to be a great doctor or to even be the best, how is that hard to understand?

Medical schools are giving people a chance with lower scores and it seems to be working out just fine.

My views are in response to the topic: "Push for lower MCAT scores by adcoms." I'm advocating that moving away from quantitative assessment of skills is detrimental to the quality of medicine. Lowering the bar for training of pilots was undertaken in commercial aviation in response to economic pressures and led to the tragedy of Continental Flight 3407 where the pilot pulled up instead of nosing down in response to a stick shaker (stall indicator) and 50 people died. Let me approach the argument another way. Let us begin with the premise that high numbers don't matter and that there is virtue in diversity and equal opportunity. I would suggest then that all allopathic residency slots be allocated on a lottery basis and equal numbers should go to both MD and DO candidates (because the latter group are equally hard working and deserving, and I know personally a DO who is fine orthopedic surgeon). Also, in the spirit of inclusivity, we should grant full hospital admitting and operating room privileges to mid-level providers (my bad), I mean NP's and PA's, because let's face it doctors are smart but they aren't caring.

 

[LizzyM]

I do like the idea of service in underserved areas as a condition of medical training (I seem to recall this is the system in Mexico) but it is far better for the community being served to recruit a physician who wants to be there and who settles in for 30 years than to have 10 physicians each assigned there for 3 years. The continuity of care goes straight to he11 when there is such a churn in attending physicians.

 

[mcloaf]

My views are in response to the topic: "Push for lower MCAT scores by adcoms." I'm advocating that moving away from quantitative assessment of skills is detrimental to the quality of medicine. Lowering the bar for training of pilots was undertaken in commercial aviation in response to economic pressures and led to the tragedy of Continental Flight 3407 where the pilot pulled up instead of nosing down in response to a stick shaker (stall indicator) and 50 people died. Let me approach the argument another way. Let us begin with the premise that high numbers don't matter and that there is virtue in diversity and equal opportunity. I would suggest then that all allopathic residency slots be allocated on a lottery basis and equal numbers should go to both MD and DO candidates (because the latter group are equally hard working and deserving, and I know personally a DO who is fine orthopedic surgeon). Also, in the spirit of inclusivity, we should grant full hospital admitting and operating room privileges to mid-level providers (my bad), I mean NP's and PA's, because let's face it doctors are smart but they aren't caring.

TL;DR: I don't have a great comeback to those pointing out that my overly simple solution to a complex and nuanced situation is inadequate, so here's a laughable slippery slope straw man argument instead.

 

[Lucca]

I do like the idea of service in underserved areas as a condition of medical training (I seem to recall this is the system in Mexico) but it is far better for the community being served to recruit a physician who wants to be there and who settles in for 30 years than to have 10 physicians each assigned there for 3 years. The continuity of care goes straight to he11 when there is such a churn in attending physicians.

It's the case in my country in South America as well.

I definitely agree on this point, but throwing massive amounts of money at doctors isn't getting them to the places they are needed most so I'll take a problematic "Teach for America" type solution in the mean time.

The second question worth asking is not just "how do we get people there?" But "how do we get people to *want* to go and stay in underserved areas?". Again, I think it comes down to material conditions. Better public schools everywhere in the country. More cultural development projects in non-rich, non-urban areas. Incentivize businesses and entrepreneurs to leave the city or make capital more accessible or cheaper (tax breaks for example) in places that need more development. To avoid urban to rural colonization have the resource allocation process be democratic and based on what the local people need and want the most. It's not going to solve all problems overnight and it's far from perfect, but we should be tackling these types of problems from all sides instead of being asleep at the wheel like we are.

All political solutions must first, in my opinion, answer the questions: what are the material conditions, what do they need to become, how do we change them. Anything else is public relations or pandering disguised as strategy. "Historical Materialism: Stuff Doesn't Just Happen" (TM).

 

[mwsapphire]

Safety might be a concern in some neighborhoods, especially for women.
I couldn't get a volunteer position at a hospital near my home, so I volunteer at a hospital in a n underserved area. I love it, but I have to be driven there because driving there is like driving through the 7th circle of hell except everyone wants to cut you off and speed the fick through intersections.And the area around the hospital is dangerous, especially walking alone. One time I was crossing the street and this guy, supe rdrunk at like 12 pm, starts saying " Allah Akbar " at me.
My point is, some underserved areas are just not great to live/work in if you have a family or are a young doctor living alone.
But n=1 and I'm just a college student so I guess I don't know.

 

[Lucca]

Safety might be a concern in some neighborhoods, especially for women.
I couldn't get a volunteer position at a hospital near my home, so I volunteer at a hospital in a n underserved area. I love it, but I have to be driven there because driving there is like driving through the 7th circle of hell except everyone wants to cut you off and speed the fick through intersections.And the area around the hospital is dangerous, especially walking alone. One time I was crossing the street and this guy, supe rdrunk at like 12 pm, starts saying " Allah Akbar " at me.
My point is, some underserved areas are just not great to live/work in if you have a family or are a young doctor living alone.
But n=1 and I'm just a college student so I guess I don't know.

This is definitely something important to take into account as well. Not only in urban areas but rural areas where it is not as easy to live somewhere safe and commute to the hospital in SS Chicago for example. People don't want to raise kids where 60% of the population is very old, smokes, and crime rates are high. These communities have been neglected for decades, it's not a trivial problem to reverse.

 

[efle]

This just kills me that you keep going back to this. The top schools remained the top schools. They have about 1,000 spots. The number of applicants went from 37,000 to 50,000+. So the people going to the top schools go from 1 out of 37 to 1 out of 50.

Of course the percentile means would go up. There is a ton more people applying. Penn didn't change it's admissions procedure. The applicants changed.

Idk if you read the thread I posted but it's pretty straightforward math to check the growth.

In 2006, there were ~9000 people scored above Penn's median (~70,900 test takers and 12.7% scored 33+)
In 2015, being generous there were ~1000 people scored above Penn's median (~96,000 test takers and less than 1% scored 39+).

I'm totally, completely aware that the applicant pool grew, and there were more people with high scores walking around. What I've been saying over and over is that the growth does not even come close to explaining this magnitude of jump. There were not so many more high end scores walking around that it would naturally cause 87th median to drift up to a 99th median. The raw number of people that Penn was drawing half its class from shrank by an order of magnitude.

 

[LizzyM]

Idk if you read the thread I posted but it's pretty straightforward math to check the growth.

In 2006, there were ~9000 people scored above Penn's median (~70,900 test takers and 12.7% scored 33+)
In 2015, being generous there were ~1000 people scored above Penn's median (~96,000 test takers and less than 1% scored 39+).

I'm totally, completely aware that the applicant pool grew, and there were more people with high scores walking around. What I've been saying over and over is that the growth does not even come close to explaining this magnitude of jump. There were not so many more high end scores walking around that it would naturally cause 87th median to drift up to a 99th median. The raw number of people that Penn was drawing half its class from shrank by an order of magnitude.

At the top schools, its all about the 1% in more ways than one.

It wouldn't surprise me if the other top schools, and the top-school-wannabes, have had similar trends. It's all about the slight advantage one gets in the USNews rankings by choosing top MCAT scorers. It is a profound perversion of the admissions process being driven, in part, by jockeying for prestige by the medical school deans. (everyone else knows the rankings are bull.)

As I've been thinking about it, and thinking about the slide I posted yesterday that was on Yale's website but created by AAMC, I think that it is not the adcoms that are seeking to recalibrate the MCAT but the AAMC and AMA that are looking for ways to change the face of medical school classes as a way of training the physicians America needs and who will go to the places they'll need them.

 

[efle]

At the top schools, its all about the 1% in more ways than one.

It wouldn't surprise me if the other top schools, and the top-school-wannabes, have had similar trends. It's all about the slight advantage one gets in the USNews rankings by choosing top MCAT scorers. It is a profound perversion of the admissions process being driven, in part, by jockeying for prestige by the medical school deans. (everyone else knows the rankings are bull.)

As I've been thinking about it, and thinking about the slide I posted yesterday that was on Yale's website but created by AAMC, I think that it is not the adcoms that are seeking to recalibrate the MCAT but the AAMC and AMA that are looking for ways to change the face of medical school classes as a way of training the physicians America needs and who will go to the places they'll need them.

Other top schools generally did do similar, in some of the worse cases going up 5-8 points on their medians.

I thought good progress had been made on URM numbers though? Were the %s still too low?

 

[ace_inhibitor111]

Idk if you read the thread I posted but it's pretty straightforward math to check the growth.

In 2006, there were ~9000 people scored above Penn's median (~70,900 test takers and 12.7% scored 33+)
In 2015, being generous there were ~1000 people scored above Penn's median (~96,000 test takers and less than 1% scored 39+).

I'm totally, completely aware that the applicant pool grew, and there were more people with high scores walking around. What I've been saying over and over is that the growth does not even come close to explaining this magnitude of jump. There were not so many more high end scores walking around that it would naturally cause 87th median to drift up to a 99th median. The raw number of people that Penn was drawing half its class from shrank by an order of magnitude.

One thing to consider is that the average MCAT for all matriculants increased only slightly from 30.3 to 31.4, which is similar to the increase in applicant MCAT of 27.4 to 28.3. Unless there are are corresponding drops in median MCATs of all other schools to compensate for the increase in MCATs of the Top 20, I think there are other possible reasons for the change. (Of course, there are new schools to consider, but there aren't that many and median MCATs generally range from 30-31).

To me this hints at an influence of a different applicant pool to the Top 20 rather than them suddenly preferring higher MCAT scorers. Perhaps more applicants with high MCATs are applying to the Top 20 and those with low MCATs are self-selecting themselves out. Maybe the Top 20 respond differently to an increase in applicant pool than those past the Top 20. You may still be right, but these reasons are something to consider.

 

[efle]

One thing to consider is that the average MCAT for all matriculants increased only slightly from 30.3 to 31.4, which is similar to the increase in applicant MCAT of 27.4 to 28.3. Unless there are are corresponding drops in median MCATs of all other schools to compensate for the increase in MCATs of the Top 20, I think there are other possible reasons for the change. (Of course, there are new schools to consider, but there aren't that many and median MCATs generally range from 30-31).

To me this hints at an influence of a different applicant pool to the Top 20 rather than them suddenly preferring higher MCAT scorers. Perhaps more applicants with high MCATs are applying to the Top 20 and those with low MCATs are self-selecting themselves out. Maybe the Top 20 respond differently to an increase in applicant pool than those past the Top 20. You may still be right, but these reasons are something to consider.

I don't think the math works out like that, where higher medians at the top 20 means lower medians elsewhere, because everyone who matriculates somewhere gets counted the same. That is, Penn admitting a group centered around 38 vs 33 will not affect the overall numbers as long as those people in both cases held an additional admit somewhere else. The big assumption here of course is that people admitted to Top 5s or Top 10s or whatever will (almost) all have additional admits elsewhere, which I think is a very safe assumption.

Plus there's also the app ranges that got added to the new MSAR. They are probably a little lower than prior years due to many people not understanding their score, but in broad strokes I think they prove that these schools are drawing from only the upper crust of their app pool. Using Penn again as an example, the 10th percentile for accepted students is a 34, equal to a 515. Only 25% of their applicants had a 515+. So it's not that they're only getting apps from the top scorers - they are in fact drawing 90% of their admits from the top quartile of their pool. (They also draw half their admits from just the top decile of their pool).

 

[sullen-burger]

NHSC is awesome. I'm very glad it exists. But its not exactly what Im talking about. If I were to do NHSC it would mean committing to primary care as a career. I'm interested in academics and basic science. I dont want a primary care career. Leaving the research/academic track for 4 years to do primary care (something Id be happy to do otherwise) in an underserved area in a cutthroat academic environment while others are doing postdocs/fellowships/publishing papers/obtaining grants simply isnt an option. Now, if everyone had to do a service commitment as a part of training there would be no long term career consequences. I also think the mandatory exposure to that kind of practice setting would lead to a lot of people choosing to continue in that type of career permanently.

Correct me if I'm wrong but for the NHSC I thought you could do internal medicine or family medicine to qualify as primary care and after your commitment is paid, specialize with a fellowship in what your heart desire? Although I see your point how you'd be left behind in the pub aspect if this were not across the board.

But then again you could say that most entering the research arena are currently at a disadvantage when it comes to the existing good ol boys club bias amiright or amiright.

 

[Goro]

My,my....all this text and electrons spent in this thread over so little.

There is no movement by Deans to move to treat 500 MCAT scorers any better, or to loosen standards. If anything, we're all still aiming for the best of the best.

At the best, if med schools go for a few more 510-513 scorers, as opposed to the 525+ scorers, that won't be a bad thing, except for the hyperacheivers in this forum who are stat-obsessed.

My views are in response to the topic: "Push for lower MCAT scores by adcoms." I'm advocating that moving away from quantitative assessment of skills is detrimental to the quality of medicine. Lowering the bar for training of pilots was undertaken in commercial aviation in response to economic pressures and led to the tragedy of Continental Flight 3407 where the pilot pulled up instead of nosing down in response to a stick shaker (stall indicator) and 50 people died. Let me approach the argument another way. Let us begin with the premise that high numbers don't matter and that there is virtue in diversity and equal opportunity. I would suggest then that all allopathic residency slots be allocated on a lottery basis and equal numbers should go to both MD and DO candidates (because the latter group are equally hard working and deserving, and I know personally a DO who is fine orthopedic surgeon). Also, in the spirit of inclusivity, we should grant full hospital admitting and operating room privileges to mid-level providers (my bad), I mean NP's and PA's, because let's face it doctors are smart but they aren't caring.

 

[Jalby]

Idk if you read the thread I posted but it's pretty straightforward math to check the growth.

In 2006, there were ~9000 people scored above Penn's median (~70,900 test takers and 12.7% scored 33+)
In 2015, being generous there were ~1000 people scored above Penn's median (~96,000 test takers and less than 1% scored 39+).

I'm totally, completely aware that the applicant pool grew, and there were more people with high scores walking around. What I've been saying over and over is that the growth does not even come close to explaining this magnitude of jump. There were not so many more high end scores walking around that it would naturally cause 87th median to drift up to a 99th median. The raw number of people that Penn was drawing half its class from shrank by an order of magnitude.

Penn is a top 5 school. It is at the edge of the Bell Curve. You would absolutely expect more of a shift. I also highly suspect you are picking the subject with the biggest jump in Rankings. I remember Wash U has a 36 average before and now they have a 37.

Alright, now I found a list from 2004 of the med school rankings with MCAT score. It isn't even that much of a jump. Upenn was at 34.5 back then.

Top Medical Schools in America(US) -- 2006 Rankings

 

[efle]

Penn is a top 5 school. It is at the edge of the Bell Curve. You would absolutely expect more of a shift. I also highly suspect you are picking the subject with the biggest jump in Rankings. I remember Wash U has a 36 average before and now they have a 37.

Alright, now I found a list from 2004 of the med school rankings with MCAT score. It isn't even that much of a jump. Upenn was at 34.5 back then.

Top Medical Schools in America(US) -- 2006 Rankings

No there are much bigger examples - U Chicago went 30-31 to 38 for example, and WashU was a 34.2 in my 2006 source from that SUNY page, but yeah I'd have expected them to be the closest to the top to start with.

I dunno how to make it much more clear than I already did several times in that thread though. I understand what you're saying about there being a larger # of high score applicants. I've gone through several times in a couple places showing the amount of growth comes nowhere close to explaining the degree of MCAT climb, but I can try once more using another school and instead looking at how much climb should have happened if MCAT emphasis had stayed the same. Even from something like 34 to 37 doesn't add up.

• Lets say a top school had a 34 in 2006. That means they drew their top half from 6660 people (including the 34s, top 9.4%). Call it top 6500.
• Fast forward a decade and lets say they still want to draw their top half from only the best ~6500 scores. Now that the pool has grown, they're looking for the best 6.8%! Wow that got more elite!
• That would be a 35 median. One point climb due to the raw numbers increasing.

There was more to it dude. Alternatively could think abt it as:

• If the emphasis on top x raw number stayed the same, then when you doubled the total testing population, you'd see the median percentile become twice as rare (for example, from 90th percentile to 95th percentile).
• We saw a testing population growth of only ~35% yet many places had their median percentiles become several fold more rare (for example, 33 to 37 is top ~9% to top ~2%).

 

[begoood95]

It's the case in my country in South America as well.

I definitely agree on this point, but throwing massive amounts of money at doctors isn't getting them to the places they are needed most so I'll take a problematic "Teach for America" type solution in the mean time.

The second question worth asking is not just "how do we get people there?" But "how do we get people to *want* to go and stay in underserved areas?". Again, I think it comes down to material conditions. Better public schools everywhere in the country. More cultural development projects in non-rich, non-urban areas. Incentivize businesses and entrepreneurs to leave the city or make capital more accessible or cheaper (tax breaks for example) in places that need more development. To avoid urban to rural colonization have the resource allocation process be democratic and based on what the local people need and want the most. It's not going to solve all problems overnight and it's far from perfect, but we should be tackling these types of problems from all sides instead of being asleep at the wheel like we are.

All political solutions must first, in my opinion, answer the questions: what are the material conditions, what do they need to become, how do we change them. Anything else is public relations or pandering disguised as strategy. "Historical Materialism: Stuff Doesn't Just Happen" (TM).

Someone has read their Marx. 😉

 

[mwsapphire]

No there are much bigger examples - U Chicago went 30-31 to 38 for example, and WashU was a 34.2 in my 2006 source from that SUNY page, but yeah I'd have expected them to be the closest to the top to start with.

I dunno how to make it much more clear than I already did several times in that thread though. I understand what you're saying about there being a larger # of high score applicants. I've gone through several times in a couple places showing the amount of growth comes nowhere close to explaining the degree of MCAT climb, but I can try once more using another school and instead looking at how much climb should have happened if MCAT emphasis had stayed the same. Even from something like 34 to 37 doesn't add up.

• Lets say a top school had a 34 in 2006. That means they drew their top half from 6660 people (including the 34s, top 9.4%). Call it top 6500.
• Fast forward a decade and lets say they still want to draw their top half from only the best ~6500 scores. Now that the pool has grown, they're looking for the best 6.8%! Wow that got more elite!
• That would be a 35 median. One point climb due to the raw numbers increasing.

There was more to it dude. Alternatively could think abt it as:

• If the emphasis on top x raw number stayed the same, then when you doubled the total testing population, you'd see the median percentile become twice as rare (for example, from 90th percentile to 95th percentile).
• We saw a testing population growth of only ~35% yet many places had their median percentiles become several fold more rare (for example, 33 to 37 is top ~9% to top ~2%).

There's more discussion on that here:
TIL one decade ago, average MCATs at top medical schools were ~32-34
On the thread you created , non the less XD

 

[efle]

It's the case in my country in South America as well.

I definitely agree on this point, but throwing massive amounts of money at doctors isn't getting them to the places they are needed most so I'll take a problematic "Teach for America" type solution in the mean time.

The second question worth asking is not just "how do we get people there?" But "how do we get people to *want* to go and stay in underserved areas?". Again, I think it comes down to material conditions. Better public schools everywhere in the country. More cultural development projects in non-rich, non-urban areas. Incentivize businesses and entrepreneurs to leave the city or make capital more accessible or cheaper (tax breaks for example) in places that need more development. To avoid urban to rural colonization have the resource allocation process be democratic and based on what the local people need and want the most. It's not going to solve all problems overnight and it's far from perfect, but we should be tackling these types of problems from all sides instead of being asleep at the wheel like we are.

All political solutions must first, in my opinion, answer the questions: what are the material conditions, what do they need to become, how do we change them. Anything else is public relations or pandering disguised as strategy. "Historical Materialism: Stuff Doesn't Just Happen" (TM).

Idk man, has there ever in history been a society where the big open empty countryside was as full of interesting stuff as the cities? I can't even fathom how this could be a thing. There's just no way to make most people from 1mil+ population centers find rural life appealing

 

[begoood95]

Idk man, has there ever in history been a society where the big open empty countryside was as full of interesting stuff as the cities? I can't even fathom how this could be a thing. There's just no way to make most people from 1mil+ population centers find rural life appealing

This. There are some people who like the rural environment -- those people will gladly go. However, many others simply can't stand the lack of entertainment (all forms) and etc. I am one of those people, and I don't think there's anything wrong with that.

It's unfortunate that our rural areas need the most attention, but I don't think (basically) forcing physicians to spend time there with debt reducing incentives is going to solve anything. The rural issue goes much deeper than that: its structural, and it's going to take institutional changes to alleviate their problems -- not a handful of doctors spending 2-3 years there. As @Goro was saying, there is no continuity of care in such a case, and, really, at that point you're just putting a bandaid over the problem.

 

[AnatomyGrey12]

Idk man, has there ever in history been a society where the big open empty countryside was as full of interesting stuff as the cities? I can't even fathom how this could be a thing. There's just no way to make most people from 1mil+ population centers find rural life appealing

It's like I've said before, if you want someone to go practice medicine in X farm town then you need to take people from X farm town. Trying to tell a bunch of city people (hell even people from suburbia or cities at 80k+) that they should want to do rural medicine just isn't going to work. The people we recruit for medical school doesn't really reflect the type of doctors we actually need, and some schools don't really live up to their mission. The fascination with "prestige" is real. Take my state school for example, their "mission" is to produce doctors for the state's needs. My state has a desperate need for PC docs, especially outside of the most populated areas, and our state school openly bashes on PC. When students show an interest in PC attempts are made to dissuade them. It's sad.

 

[mwsapphire]

This. There are some people who like the rural environment -- those people will gladly go. However, many others simply can't stand the lack of entertainment (all forms) and etc. I am one of those people, and I don't think there's anything wrong with that.

It's unfortunate that our rural areas need the most attention, but I don't think (basically) forcing physicians to spend time there with debt reducing incentives is going to solve anything. The rural issue goes much deeper than that: its structural, and it's going to take institutional changes to alleviate their problems -- not a handful of doctors spending 2-3 years there. As @Goro was saying, there is no continuity of care in such a case, and, really, at that point you're just putting a bandaid over the problem.

Totally unrelated: Any luck this cycle? Your stats are amazing!

 

[efle]

It's like I've said before, if you want someone to go practice medicine in X farm town then you need to take people from X farm town. Trying to tell a bunch of city people (hell even people from suburbia or cities at 80k+) that they should want to do rural medicine just isn't going to work. The people we recruit for medical school doesn't really reflect the type of doctors we actually need, and some schools don't really live up to their mission. The fascination with "prestige" is real. Take my state school for example, their "mission" is to produce doctors for the state's needs. My state has a desperate need for PC docs, especially outside of the most populated areas, and our state school openly bashes on PC. When students show an interest in PC attempts are made to dissuade them. It's sad.

I've always wondered what the numbers looked like for mission driven programs, as far as % that end up specialized and/or in cities.

Also have to wonder if this is an applicant pool that is very large. Like what percent of the people in X farm town even get educated past high school, let alone going into university with the ability to survive BCPM weedout and with good enough MCATs to predict success in med school?

 

[begoood95]

Totally unrelated: Any luck this cycle? Your stats are amazing!

Gracias! I actually haven't applied yet, but will be this next cycle (i.e., in June). I'll be updating everything as I go and will maybe make some sort of log of all my experiences so that I can help others in some way. Hopefully I'm successful, but ya never know with this beast of a process!

 

[Lucca]

Idk man, has there ever in history been a society where the big open empty countryside was as full of interesting stuff as the cities? I can't even fathom how this could be a thing. There's just no way to make most people from 1mil+ population centers find rural life appealing

I'm not suggesting that everyone move to the countryside all of a sudden. Just saying that putting in more than 0 effort into making the country a desirable place to live for working professionals might help.

 

[mwsapphire]

I'm not suggesting that everyone move to the countryside all of a sudden. Just saying that putting in more than 0 effort into making the country a desirable place to live for working professionals might help.

 

[mwsapphire]

I've always wondered what the numbers looked like for mission driven programs, as far as % that end up specialized and/or in cities.

Also have to wonder if this is an applicant pool that is very large. Like what percent of the people in X farm town even get educated past high school, let alone going into university with the ability to survive BCPM weedout and with good enough MCATs to predict success in med school?

Ouch.
That's a bit of stereotyping there. I'd be careful with that.

 

[begoood95]

I'm not suggesting that everyone move to the countryside all of a sudden. Just saying that putting in more than 0 effort into making the country a desirable place to live for working professionals might help.

I'm usually not a pessimistic person, but I don't think that's ever going to happen. In fact, here's a little thought experiment:

Say we make a rural town as desirable as a large metropolitan area. It's got everything -- music, theatre, restaurants, culture, diversity, and so-on. Presumably, people will start to move there, at an increasing rate... and then it stops being rural, by definition. Furthermore, the demographics of rural areas, generally, are such that they're more conservative and therefore would presumably not enjoy our "metropolitanization" plans. They like the small town feel. They enjoy the countryside, and etc. We're not going to make a rural area more desirable for professionals because their interests are, in general, completely opposite to those living in rural areas.

It's just not going to happen, unless you pick people from rural areas and train them to become physicians. And even then, nothing is guaranteed. They may end up liking cities more than living in bum**** nowhere. I'm just not very optimistic that, at least with our current approaches, we're solving anything, and I think it will be very hard to convince physicians to move to rural areas.

edit: in b4 people get angry at my use of bum**** nowhere -- I've experienced bum**** nowhere so I can say that😛

 

[efle]

Ouch.
That's a bit of stereotyping there. I'd be careful with that.

why what's gonna happen to me for talking about worse education rates in rural areas

its not like I told some premed from a small town they're too dumb or something

 

[DrHart]

Can people not learn to enjoy living in rural areas? Also, are loan repayment programs and higher salaries in rural areas not enough to attract new PC docs? Is the lack of "city" culture too much of a deterrent?
I come from a large suburb that is a part of a metro. I have family who live in rural areas and I actually think it would be pretty pleasant to live in a place like that. Plenty of space, lower cost of living, friendlier folk (albeit more conservative than I'd prefer)... idk
If the problem isn't fixed by attracting more docs to BFE, could telemedicine be a more effective option?

 

[mwsapphire]

why what's gonna happen to me for talking about worse education rates in rural areas

its not like I told some premed from a small town they're too dumb or something

Well stereotyping is still a pretty crappy thing to do.
I'm like, two different types of minority, ( minority^2, if you will) so I really hate stereotypes.

 

[AnatomyGrey12]

I've always wondered what the numbers looked like for mission driven programs, as far as % that end up specialized and/or in cities.

I will say I think our state school is probably not super representative of other mission driven programs. Some of them do a pretty good job of producing PC docs.

Ouch.
That's a bit of stereotyping there. I'd be careful with that.

Some stereotypes exist for a reason. He is right, an issue is getting these people from these rural areas to the point where they have the opportunity to pursue higher education and having them put together an acceptable medical school app.


If there is one thing that DO schools do well is actually looking for candidates that fit their mission, and finding people interested in rural PC from the start.

 

[begoood95]

Can people not learn to enjoy living in rural areas? Also, are loan repayment programs and higher salaries in rural areas not enough to attract new PC docs? Is the lack of "city" culture too much of a deterrent?
I come from a large suburb that is a part of a metro. I have family who live in rural areas and I actually think it would be pretty pleasant to live in a place like that. Plenty of space, lower cost of living, friendlier folk (albeit more conservative than I'd prefer)... idk
If the problem isn't fixed by attracting more docs to BFE, could telemedicine be a more effective option?

I mean, I'm sure people could learn to enjoy living in rural areas, or rather, they could get used to or put up with living in a rural area -- but if you're heart is in the city, it's going to take a lot to push that person to move to the countryside.

Now the telemedicine point is interesting, and I think could help a bit!

Well stereotyping is still a pretty crappy thing to do.
I'm like, two different types of minority, ( minority^2, if you will) so I really hate stereotypes.

I don't think @efle is stereotyping per se. I don't have the data, but I'm pretty sure education rates, and especially moving on to secondary education, are lower in rural areas. That's not stereotyping as much as it is relaying a statistic.

Now, the comment on being able to "survive the weeding out process" is a little more prejudiced, but still not that bad.

 

[mwsapphire]

"survive the weeding out process" is more what I was referring to.

 

[jcorpsmanMD]

"survive the weeding out process" is more what I was referring to.

It's a true statement though? Many pre meds get weeded out or washed out. Whether they're from the city or rural areas.

 

[mwsapphire]

It's a true statement though? Many pre meds get weeded out or washed out. Whether they're from the city or rural areas.

Stereotyping that a rural kid would be much less likely to do it is a bit harsh.
I just wanted to make sure he was aware that that's a bit crass.

 

[jcorpsmanMD]

Stereotyping that a rural kid would be much less likely to do it is a bit harsh.
I just wanted to make sure he was aware that that's a bit crass.

Again, he's right. Being a rural kid I can attest to that. My education was easily subpar compared to many of the friends I made at university. I struggled, not to do well, but to comprehend information as well as my friends in as short of a time as them. You are certainly at a disadvantage being a rural kid with a terrible education. Hence why I imagine if you ask most people matriculating to medical school many of them aren't from rural towns. May'be he could have been more careful with his words in order to not hurt gentle people's feelings, but again, he's right.

I'm from a rural town in the Midwest, I'm surely not offended. Just glad I didn't get weeded out

 

[AnatomyGrey12]

Stereotyping that a rural kid would be much less likely to do it is a bit harsh.

Have you ever had experience with rural areas? They are less likely to do it because not a ton of them go to college and want to do something medicine. Just statistically it is less likely to happen. I don't think @efle was saying that people from rural areas are stupid, just that it is less likely for them to make it to the application stage due to a variety of factors. It could be poor education up to that point, culture, or other factors.

 

[efle]

Lmao guys I didn't realize it was controversial to say education quality is usually lower/more limited in rural areas and weaker backgrounds predicts greater struggles in university level science work

 

[jcorpsmanMD]

Lmao guys I didn't realize it was controversial to say education quality is usually lower/more limited in rural areas and weaker backgrounds predicts greater struggles in university level science work

It's not. You're 100% right lol