ix in 10 medical school applicants end up with nothing more than a pile of rejection letters after pouring their hearts and souls into studying, volunteering, researching, and more. A few understand that their quest was a long shot. Many others start looking for reasons why they didn’t get in. Was it low test scores? Not enough volunteer time? Or was affirmative action the culprit?
Lively — and often bitter — threads on studentdoctor.net and Reddit condemn the use of affirmative action in medical school applications, usually with claims that black or Hispanic students got in while white students, with the same or higher scores, were rejected. Despite the social, capital, and educational advantages of growing up white, these gripers seem to believe that the world has suddenly flipped and being white is holding them back.
Many look past the importance of hard-to-quantify factors for getting into medical school like research, volunteering, recommendations, essays, and interviews and instead fixate on how minority applicants have lower scores on the Medical College Admission Test (MCAT) and lower grade point averages (GPAs).
The assumption that minority applicants are “stealing seats” in medical schools bothered me. So I put it to the test. Using publicly available data from the Association of American Medical Colleges (AAMC), I compared the odds of getting into medical school between 2013 and 2016 for white applicants and black applicants with the same MCAT scores and GPAs. (At the time, the top score on the MCAT was 45. The scoring system has since changed, and the top score is now 528.)
I compared only white and black applicants because underrepresentation in medicine is most clearly defined for these two groups. However, it is likely that the results would also apply to other underrepresented minorities.
As shown in Figure 1, at nearly every comparison, black applicants were, on average, preferentially admitted to medical school over their academically similar white peers. For example, a black applicant with an MCAT score of 31 (the median for all individuals accepted to medical school) and a GPA of 3.7 (the median for all individuals accepted to medical school) had, on average, a 30.7 percent higher chance of getting into medical school than a white applicant with a similar MCAT score and GPA.
I can almost hear the anti-affirmative-action readers saying, “I told you so. Why should we be giving such a massive boost to black applicants?”
In addition to righting the decades-long structural and historical factors that have limited opportunities for black students to enroll in medical school, there are many benefits to having diversity in the medical profession. A diverse physician population encourages innovation, promotes cultural competence to reduce health disparities, and shows minority youths that there are places for them in science and medicine. And physicians of color help society at large, not just minority communities.
But convincing readers that affirmative action is important and necessary isn’t my goal. I want to demonstrate how little affirmative action hurts white applicants, how few medical school spots black applicants get, and who is most likely to lose a spot to a black applicant with lower scores.
To start, realize that today there are only about seven black medical students in a class of 100. Affirmative action opponents somehow seem to think those seven take more spots from qualified white applicants than the other 93 white applicants do.
Let’s set the acceptance rate of black and white applicants equal to each other. If 63 percent of white applicants with a 31 MCAT score and 3.7 GPA are accepted, then 63 percent of black applicants with the same stats are accepted. This essentially takes away the advantages seen in Figure 1. By holding black applicants to the “same standards” as white applicants, we would expect about 750 fewer black applicants accepted to medical school each year, effectively halving the number of blacks who get into medical school.
Now let’s give all of those 750 spots to white applicants. (Of course, that’s not what would happen in the real world.) Figure 2 shows the outcome: Those who get the biggest bump in their odds of getting into medical school are the ones who are already most likely to get into medical school — applicants with high MCAT scores and GPAs. Those who have little to gain are already on the edge of not getting in anyway. By opening up 750 medical school seats to white applicants, those with a 26 on the MCAT and a 3.6 GPA probably still aren’t getting in.
Reducing the number of black applicants admitted to medical school by 750 and giving all those seats to white applicants would increase the acceptance rate of white applicants from 45.15 percent to 47.97 percent, a 2.82 percent increase. But as I learned from my analyses, that small increase is negligible when compared to the impact of increasing MCAT scores on applicants’ chances of admission. Though I do not show the analysis for GPA here, small increases in a white applicant’s GPA (maybe getting a B+ instead of a B in one class) improves his or her chances much more than reducing the number of accepted black applicants.
As shown in Figure 3, an increase of one to three points on the MCAT score does more to improve a white applicant’s odds of getting into medical school than would eliminating affirmative action. With a median 3.7 GPA, going from a 29 on the MCAT to a 32 increases the odds of getting into medical school by 17.38 percent — far more than the “equal acceptance” scenario posed above.
From the perspective of the AAMC, though such an increase in the MCAT score is relatively meaningless. A 3-point higher score on the MCAT could mean answering correctly just three more of the 230 questions, perhaps getting 75 percent of the questions right instead of 73 percent. Given that some guesswork is involved, and that applicants would likely get slightly different scores if they took the test multiple times, the AAMC reports MCAT scores with a 4-point range. If an applicant scores a 29 on the MCAT, the AAMC reports that his or her true MCAT score is somewhere between 27 and 31. In other words, a white applicant with a 3.7 GPA and 29 MCAT who correctly guesses the answer to one more question, simply by chance, is better off than if we “level the playing field” by holding black applicants to the same score-based admission standard.
Some of those who contend that affirmative action is what kept them out of medical school argue that some low-scoring black applicants are in the med school seats they should have gotten. I did the math to see how likely that is.
Figure 4 shows that it’s far more likely a white applicant “stole a spot” than a black applicant. For a white applicant with a 31 MCAT score and a 3.7 GPA, for every black applicant who scored lower and was accepted there are, on average, 4.11 white students who also scored lower and were accepted.
It’s only low-scoring white applicants (less than a 26 on the MCAT and a GPA less than 3.2) who are more likely to have “their” seats offered to black students than to white students. Yet at that end of the statistical spectrum, the chance of getting into medical school is less than 5 percent for both whites and blacks. But look at the average number of low-scoring black students accepted each year (132) and the total number of white applicants accepted each year (26,420). The chance that a low-scoring white medical school applicant will “lose” a spot to a low-scoring black applicant is 0.5 percent. How unlikely is that? It’s even less likely as the applicant dying in a car accident.
White applicants with low scores should realize that their MCAT scores and GPAs are holding them back far more than their black colleagues.
These analyses didn’t surprise me. When I interviewed at 11 medical schools last year, I saw no more than 10 black applicants among the 100-plus applicants I met. How could such a small group — blacks make up 9 percent of medical school applicants — be usurping so many white applicants medical school seats? The answer is that they aren’t.
My message to those who whine that minority students took their spots in medical school: Think about the five other white applicants who got in with the same statistics as each minority student. Then notice the amazing minority students who did cutting-edge research and incredible volunteer work just like you. Notice the obstacles that many of them have faced every day because of the color of their skin yet have excelled as students and as people in and out of the classroom. Think about how many more amazing doctors we could have if we had equality of opportunity earlier in the educational system.
Increasing the number of blacks and other minority students in medical schools can change the trajectory of the medical field for the better. And it isn’t costing white applicants a thing.
Spencer Dunleavy is a Rhodes Scholar at the University of Oxford. He will begin medical school at the Columbia University College of Physicians and Surgeons in the fall of 2019.