What are the attributes of a great medical school?
U.S. News & World Report’s ranking system says the best American medical schools score high in areas that include the quality of the school’s curriculum (based on the opinions of deans, school administrators, and hospital residency directors); grade-point averages and standardized test scores of incoming students; student-to-faculty ratios; federal research activity; and the proportion of graduates who specialize in primary care.
While these criteria are informative, they offer no insight into which schools are most effective in reducing health care shortages in the United States or boosting the career opportunities or trajectories of graduates who come from low-income backgrounds.
To gain insight into the societal improvements that medical schools make possible, new data should be added to the tiering methodologies that are used by U.S. News & World Report and other ranking systems: an economic mobility index.
Such an index has been developed by Michael Itzkowitz, a senior fellow at Third Way, a Washington, D.C.-based think tank, to grade undergraduate programs across the country. His index defines the value of a college based on the proportion of lower-income students it enrolls and the enhanced economic outcomes it provides them.
“Do college rankings actually reflect the purpose of our higher education system? Or are they simply a tool to generate the same list of well-resourced and selective schools year after year?” asks Itzkowitz in an article that he wrote for the Washington Post. “If the purpose of higher education is to lift the next generation up and leave them better off — rather than just reproduce the class divides that already exist — how do we effectively measure that?”
Itzkowitz believes that an economic mobility index offers “a better indication of the [undergraduate] colleges that are actually delivering on the promise of the higher education system as a whole: schools that are opening the door to a degree and lifting students up throughout the socioeconomic ladder.”
Itzkowitz isn’t alone in scrutinizing the prevailing college ranking systems: U.S. Secretary of Education Miguel Cardona also finds them to be, let’s just say, lacking.
“Too often, our best-resourced schools are chasing rankings that mean little on measures that truly count: College completion, economic mobility, narrowing gaps in access to opportunity for ALL Americans. That system of ranking is a joke!” Cardona said in a speech.
While Harvard Medical School might not agree that the U.S. News & World Report’s ranking system is a joke, it has found it to be deficient and announced this week it was withdrawing from it. A possible reason? Harvard Medical School may believe that the ranking devalues its efforts to recruit poor and working-class students, provide financial aid based on need, and encourage students to go into less-profitable medical careers after graduation. If that’s the case, then a ranking metric that captures the economic mobility that advanced degrees make possible for students of lesser economic means is a notion that’s catching on.
A medical school economic mobility index (MSEMI) would employ a similar methodology to Itzkowitz’s to ascertain how effectively U.S. medical schools create upward socioeconomic movement for their students from low-income backgrounds. The MSEMI can be calculated by comparing the average wage of a school’s graduates in hospital residencies — a fairly standard figure across the country — with the average parental income of their incoming students.
An additional measurement that would complement the MSEMI would gauge how many of a school’s graduates return to the locales from which they originated to build their careers and thereby address the health and wellness challenges of the area’s low-income residents. To determine this metric, schools would need to regularly assess and update the career paths of their former students.
Why is this addendum to the MSEMI important? According to the American Association of Medical Colleges, aspiring doctors who grow up in medically underserved areas or populations are much more likely to return to them to put their years of training into practice. Whether it’s Buffalo County in South Dakota, Owsley County in Kentucky, or the South Side of Chicago, impoverished areas desperately need the services of physicians and other categories of medical professionals.
An MSEMI computation that reveals which schools offer the greatest upward mobility for their graduates who originate from low-income backgrounds — as well as the greatest advantages for the medically underserved regions where newly minted doctors may choose to build their careers — would be an invaluable addition to include in medical school rankings. It would allow schools that facilitate the greatest good for their economically disadvantaged students and society at large to be emphasized, recognized, and noted.
Med school deans and administrators would gain tremendously by determining their schools’ MSEMI value. The resulting data would offer a snapshot of how successfully the school’s grads were using their education and skills to upgrade the health outcomes for America’s neediest patients.
Directors of admissions could prominently feature the index in their catalogues, brochures, and other materials for prospective students. Marketing executives could promote the data to the media. Lobbying teams could launch campaigns to pressure the outlets that rank schools to include MSEMI summaries in their assessments. Schools could also urge Congress to make the MSEMI a new component to consider when awarding federal research grants to medical schools.
Would there be resistance from U.S. News & World Report and the country’s medical schools with the largest endowments and donations (I’m looking at you, Harvard, NYU, Johns Hopkins, and others) to adding the MSEMI to school rankings? Most definitely. But if smaller schools begin calculating and promoting their impressive numbers and loudly question why it’s not being embraced by the top-resourced programs and ranking methodologies, I could see the momentum shift for this data point to become an essential factor that will allow for a comprehensive overview of the societal good that medical schools facilitate.
As the president of Ponce Health Sciences University, a medical school with campuses in Ponce, Puerto Rico, and St. Louis, Missouri, I am working with my team to calculate the MSEMI for our M.D. program. I challenge and welcome other med school administrators to do the same.
David Lenihan is the CEO of Ponce Health Sciences University and Tiber Health, a St. Louis-based medical education company.
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