Medical schools require a lot of volunteering and things like 'slinging hot dogs to pay tuition' don't count unless you grew up without clothes surviving on rabid dogs in the holler of W Virginia working the coal mines from age 8. We all know who has time to volunteer or do minimum wage healthcare instead of work the best paying shitty side job they can get: the rich.
It's set up heavily tilted so you have to be rich, or dirt poor enough for a sob story, or a desired minority. Even if you do volunteer a lot and are middle class, you probably didnt know anyone that could help you into the most prestigious positions. A middle class person of equal aptitude would likely go into something like engineering or law which have fewer class-signalling non-academic purity tests.
That gating on medical training has always been there (at least for 40 years, if not more). But the number of doctors from doctor families has increased.
And just generally, socioeconomic mobility has decreased in the US across the population.
Always been gated. But the slider has been dragged even further in the purity test direction. The intelligent un-pure now tend to become NP or PA, those programs still let you practice independently and slide more towards academics and less at whether a rich person set you up to be taken care of while you play mother Teresa until the switch flips the day you are accepted.
> Medical schools require a lot of volunteering
But...why? Why not just let in the applicants that have the best grades?
Because there are so many applicants that have good grades.
A more cynical view is that the governing boards want a way to pick and choose who they let in. So they create "holistic" application systems to get "360 degree view of the candidate".
No matter how many have good grades, you can always pick the top n by grades—unless there's a ceiling that the top m > n have all hit. Which, if you're talking about "grades" as in GPA, is plausible.
MCAT seems more relevant, though. According to Claude: "Roughly 0.1% or fewer of test-takers score a perfect 528 in any given year — typically only a few dozen individuals out of the ~120,000 or so who sit for the exam annually." So it should work fairly well for them to sort by MCAT and take however many they have (or expect to have) room for.
At a certain point, grades become arbitrary and won’t necessarily select for the best candidates. Obviously the current system doesn’t, either.
The actual solution is to increase the number of slots for training doctors to match the huge number of qualified applicants. It makes even more sense given that there is a shortage of doctors and health care costs are astronomical.
I think OP's point was that the governing boards don't want the people with the top n grades. They want certain people, and by making the admissions criteria fuzzy, they can pick and choose those certain people and then say "well, our admission criteria is subjective," and "we are looking for 'well rounded people," and all kinds of other vague weasely ways to let them legitimately shape the student body in the way they want.
See also: "Cultural fit" when hiring.
> Because there are so many applicants that have good grades.
So train more doctors.
That would increase competition and thus depress wages for existing doctors, who are the ones who make the decisions here. I heard, from a medical school attendee, that she overheard some doctors discussing whether it would be a good idea to require a fifth year of medical school to become a general practitioner (luckily, they were like, "Eh... nah"). It did not seem like it bothered them that this would make it even harder for civilians to get medical care.
I thought lawmakers made the decisions. Silly me! :-D
Theoretically yes. But I think at least part of the decision they've made is to delegate a chunk of the decisionmaking to doctors' guilds. Which—on the one hand, they are experts of a sort, but on the other hand, they have an obvious conflict of interest.
https://en.wikipedia.org/wiki/American_Medical_Association#R...
Wow. 1997: https://www.baltimoresun.com/1997/03/01/ama-seeks-limit-on-r...
> “The United States is on the verge of a serious oversupply of physicians,” the AMA and five other medical groups said in a joint statement. “The current rate of physician supply — the number of physicians entering the work force each year — is clearly excessive.”
> The groups, representing a large segment of the medical establishment, proposed limits on the number of doctors who become residents each year.
> The number of medical residents, now 25,000, should be much lower, the groups said. While they did not endorse a specific number, they suggested that 18,700 might be appropriate.
I've read about that before. I personally am of the belief that Medicare funding for residency slots should be eliminated over time. Also freely allow the opening and expansion of medical schools and teaching hospitals. Over time things should settle into a comfortable equilibrium of enough doctors making decent wages for everyone to be treated at a reasonable cost.
But maybe that's a free market fantasy. Who knows.
Or the alternative. Government-owned everything healthcare - facilities, hospitals, med schools, doctor practices. Doctors only work for the government.
The current system is neither here nor there and is designed for maximum profit.
> Because there are so many applicants that have good grades.
Sounds like we need more spots for these people to go