Robert C. Bowman, M.D.
It has been an interesting past 2 weeks. (November 2006)
We have been told that the MCAT only works to predict performance (assumed to be
USMLE 1) because of the speededness component. The test is likely to remain a
measure of the fast and furious, even with little to suggest that this makes a
better physician or anything other than a better USMLE 1 test taker. Those less
organized in families, neighborhoods, and cities do not take tests as well as
those who are more organized in families, neighborhoods, and cities.
The test is an important tool, but is used incorrectly and even manipulated in
more new ways each year. Those less organized do not have access to the test
results and cannot compare it to other important measures of physician outcomes.
Those who do health policy only get information from those who are organized,
and thus few new solutions are presented that consider the populations that are
left out of the current organization of the health care system.
The week also included elections, referendums, and brought back the U of
Michigan and more reflections upon affirmative action, and actions in other
nations such as France attempting to grapple with hopeless youth.
One would have to wonder whether the intention all along was to use standardized
testing to get the desire effect of more admissions of those from the rich and
powerful who have higher standardized test scores.
1. Problem - my kid is not getting in to top colleges and medical schools, my
status and self worth is at stake, I must get my kid admitted
2. Solution - invest in more colleges and medical schools - too expensive,
rejected
3. Solution - find ways to get my kid admitted
4. Realization - My kid has better scores, (might not have the best people
skills or even understand people, but I won't be seeing my kid as a physician)
5. I am an organized, powerful, and influential person, I can use this in direct
influence on a school admissions process, or in a reversal of affirmative action
way
Too bad those admitted rarely serve those in most need of care.
Gallaudet University caves on leaderships issues because of a clear pattern of
discrimination so bad that even Senator McCain resigned from the board.
Organization around such an issue is certainly a problem, but of course those
who have not been deaf or experienced the conflicts between and among various
deaf groups may never fully understand the issues.
in The Chronicle Review from the Chronicle of Higher Education Ian F. Haney
Lopez posts an article about "How Colorblindness Perpetuates White Dominance
Race is clearly a part of the social distances, geographic distances, and other
distances that keep Blacks or any group from gaining admission, but is not the
only "distance." My research on medical school admissions compiles the evidence
that that lower income whites and rural whites are disappearing from medical
school at the most rapid rates. Basically rural whites have the same level of
admission as blacks and lower income origin whites have the same low levels as
Hispanics. Rural whites are no small group with 60 million people in the 90%
white areas of the nation, but they are distant and different.
National Average 1 medical student admitted per 200 who are medical school age
Above Average
Indian Asian 1 in 20
Asian 1 in 60
Highest income quintile 1 in 60 or 60% of medical students from just 20% of the
population (AAMC)
Foreign born Asian
Average at about 1 in 200 - white, urban, born in medical school county, second
quintile (AAMC)
Below Average
Foreign born not Asian
1 in 300 rural female
1 in 300 black female
1 in 400 all rural
3rd quintile in income about here
1 in 500 rural males
1 in 600 black males
4th quintile in income about here
1 in 800 - 1000 lower income rural
1 in 1000 Mexican American male
1 in 1300 Mexican American female
1 in 2000 or up, lowest income quintile - only 1 - 3% of medical students
despite 20% of the population (AAMC)
What is apparent is that those who are organized get what they want
Opponents of affirmative action
Opponents of a hearing President for Gallaudet
Opponents of state investments in lower and middle income peoples and those
"different" - No New Taxes, minimalist Headstart and No Child Left Behind
Those who are not organized as people, neighborhoods, and communities struggle
as noted by admissions ratios
as noted by health outcomes
as noted by education and child development investments, or lack of
Then there is the conflict with what we think we should be the most.
Nobel prizes for economics (John Nash) are rewarded for thinking that leads to
the realization that the focus must be on individual needs in the context of
what is best for others as well. Nobel prizes for peace are given to those who
promote microcredit (Muhammad Yunus, Grameen Bank) and improve the lot of
powerless women to get a shot at a more powerful nation.
Such are humans, flawed, striving, serving, protecting interests, or visionary.
However if we want a nation that reduces the stresses and strains within the
nation, or between our nation and other nations, we better organize to reduce
the inequities. Market forces unrestrained lead to a very different result that
what we all might desire.
Robert C. Bowman, M.D.
rbowman@unmc.edu