Dr. Bowman,
My name is Melissa Lonning. I am a Senior at Winona State University in Winona
MN. I was surfing the Internet and came to one of your webpages. I followed the
links and found your main website. I am blown away. So many of the views that
you have regarding rural medicine revolve around many of the frustrations that I
am encountering. I have grown up on a farm and have always known that my future
entails becoming a rural rural physician. I have a true calling for rural
medicine and am so excited, not only for me, but for those I will be able to
serve. Unfortunately primarily due to academic reasons (23 MCAT score and a 3.58
GPA) I was not even considered an
"interviewable" applicant at the rural-emphasized medical schools I applied to.
To sit back and see my fellow classmates who have little or no intention of
going into rural medicine get interviews in these schools is excruciating. In
order to improve my application for next year, I am taking out a loan this
summer and taking a prep class for the MCATs and retaking them in August as well
as reenrolling this fall at Winona State and taking additional classes. Although
things are not going the way I had hoped, I am committed to getting into medical
school.
Anyhow, I just wanted to tell you that I appreciate the efforts you are making
through you work. I wish I would have came across your website sooner! I would
really appreciate if you could put me on the Rural Medical Educators Mail List.
Thanks again,
Missy Lonning
Dear Missy
Improving your MCAT is a good idea. Having top notch college advisor or other
advisor help can also be a boost. We would be happy to help you and thanks for
joining up.
At a recent Central Group on Educational Affairs meeting I had a chance to sit
in at a presentation regarding admissions decisions. The researchers wanted to
explore MCAT and other evaluation that would maximize the number passing USMLE
yet minimize the "exclusions." Setting MCAT and GPA too high would cut out up to
half of applicants, considered too restrictive. This was one of the only ways to
assure that all would graduate. Setting the criteria too low would mean more
students with failure, and high debt and no ability to pay. The four schools did
vary across the Midwest with public and private. They attempted by examining the
convergence and divergence of various curves and determinations to find the
maximal sensitivity and maximal specificity. They came up with MCAT scores of 8,
a total of 25, and a GPA of 3.0. There were also some interesting things that
happened with the "perfect" candidates regarding failure, but another time.
Also surfing the net I found an Alabama study of admissions since last MCAT
change. This study noted that they could identify 90% of those who were likely
to fail, but of those identified, 80% would still become physicians. Although we
have embraced evidence-based medicine, there is not good evidence-based
admissions.
Obviously this was interesting to me since our MCAT and GPA numbers for those
accepted have increased in recent years. At the same time the numbers of rural
background students accepted have declined from 27% to 16%. Those such as
yourself are taking the MCAT but not getting accepted. Comparing 1991 to 1999
the distribution of MCAT takers was the same with 16% of total MCAT takers from
towns of 10000. (There was a sizeable group of 30% who did not indicate their
town size to AAMC so even more than the 16% took the test, for those critics in
the audience who will compare the 16% to 27%)
Putting this all together, it seems that schools really do not give rural
preference any more. There is also something about the education, preparation,
or polish of the candidates that is a problem. Many suggest that college
advisors are key components of success in admissions. The data also suggests
that the 47 schools who used to give preference to rural background (JAMA Med Ed
issue in early 90's), are not doing so.
I think that there are many reasons for "overkill" in medical school admissions.
Admissions committee members are very devoted folks, who spend lots of time and
make decisions on limited data, and get little recognition or reward. Because of
recent court actions, their work has come under scrutiny any time it tends to
vary from MCAT and GPA and other measurable areas. They are also concerned
regarding students who may fail and not be able to pay huge debts. Also there is
a real anecdotal problem where members who "take a chance" on students who later
have problems, are given grief for some time. Accreditation, board score, and
research pressures also tend to push members to accept those with higher MCAT,
GPA, and college prestige scores.
Sadly the students who best fit these predictive measures are also the least
likely to choose the underserved rural and inner city areas. When students come
from different educational backgrounds and different colleges, the usual
predictors break down. Studies with minorities document this. The studies on
rural students are so far lacking in this area, but are a good bet since rural
students have different K-12 and often different colleges.
Despite all of the pressures, admissions committees have continued minority
admissions, and this stimulates my hope. I agree with Madison and others that
admissions committees can make different choices, if they study their outcomes.
It may take a few years (minority took at least 10), but they can change and
better meet the needs of the nation.
Now that the groundswell is developing to increase medical school class sizes
and numbers of schools, it is up to us to point out that the great majority of
new positions need to be devoted to real needs in the workforce, such as
psychiatry, geriatrics, family medicine, and physicians for rural and inner city
locations.
Robert C. Bowman, M.D.