Medical Examiner

It’s Time to Scrap the MCAT

Doing away with the test would be one step toward improving diversity in medicine.

Doctors walking down a hallway with their backs turned.
A standardized test can’t tell if these are good doctors. Luis Melendez on Unsplash

Since the beginning of this pandemic, doctors and health care professionals have been denied personal protective equipment, hazard pay, and basic workplace protections. Many have been forced to choose between keeping their jobs and keeping their families safe. On top of all this, a new generation of doctors-to-be are expected to undertake the risk of coronavirus exposure just apply to medical school. Thousands of prospective doctors have shown up over the past few months for the Medical College Admission Test (commonly known as the MCAT), the primary exam required for the majority of medical schools.

As the COVID pandemic triggered national shutdowns in early March, the Association of American Medical Colleges (AAMC), which administers the MCAT, responded by briefly canceling the exam due to the danger that sitting in a room with others for hours and hours posed to prospective students (a danger that’s higher for Black and Latino students, who are more likely than other groups to contract and die from COVID). But in May, the test-taking started up again. The AAMC recently doubled down on the need for in-person exams—even as there continued to be tens of thousands of new coronavirus cases recorded nationally each day. While there are minor safety measures in place, like limiting the number of test-takers and shortening the famously long exam, the advocacy group Students for Ethical Admissions told the New York Times that there is inconsistent masking among test-takers, among other issues. Unsurprisingly, there are reports of test-takers getting sick.

No one should risk their life to take a standardized test—especially one that doesn’t provide a good way to screen how capable someone will be as a doctor in the first place. It’s time medical schools stop treating students as expendable and scrap the MCAT. Not just while coronavirus infection rates are high, and not just until there’s a vaccine—for good.

The MCAT is steeped in a history of racism and white supremacy. The ideological father of the MCAT, Abraham Flexner, neither a physician nor a scientist, spearheaded a national campaign to reform medical education by targeting Black physicians and Black medical schools. The Flexner report, released in 1910, codified his agenda by standardizing national medical education, using all-white schools as a model. This closed more than 70 percent of Black medical schools—leaving only Howard and Meharry—and pushed medical schools across the country to adopt standardized admissions exams. The AAMC argued in its recent open letter that waiving the MCAT now will introduce inequity into the review process, as some students have already completed the exam. But, as we know from history, the MCAT has always been inequitable.

The MCAT, like many standardized tests, is to some extent a measure of wealth rather than ability. Research shows that white students statistically do better on the MCAT because they attend wealthier colleges with more expansive curriculums, can afford expensive test prep and multiple retakes, and have the luxury of being able to pay to reschedule an exam if they feel they could use more time to study. The MCAT is expensive, costing upward of $320 for a single test alone. That’s on top of all the other costs of applying to medical school: There are the medical school application fees themselves ($170 for the first school and $40 for each additional school), then the school-specific supplementary applications ($100 on average per school), and then interview attire and the cost of traveling for interviews. While the AAMC does have a fee assistance program that can help cover the cost of MCAT registration, study materials, and medical school application costs, it is difficult to qualify for.

Proponents of the MCAT will ask how medical schools will screen applicants for admissions without a standardized exam. But it’s already happening. Several medical schools, such as those at Stanford, the University of Minnesota, and the University of Washington, have already waived the MCAT for this year. They are taking a more holistic approaches to evaluating application materials, which include college transcripts, essays, interviews, track records of volunteering, leadership, and research involvement. The truth is the MCAT is just not a good judge of whether someone will be a good doctor. As Iris Gibbs, the associate dean for medical admissions at Stanford, said recently, “Medicine is a profession that relies on more than whether someone can take a test and regurgitate knowledge.”

Part of what medicine relies on is doctors being able to understand and empathize with their patients. We need to be supporting potential students who come from diverse backgrounds, not filtering them out with the MCAT. Only 5 percent of doctors are Black, and just 5.8 percent are Latino. Thanks in part to this abysmal representation, health care disparities abound in this country. Black women die at record rates during childbirth. Black people have a higher chance of dying early from heart disease. COVID-19 has decimated Black, Latino, and Native American communities. And health care remains out of reach for millions of Americans. We desperately need more doctors of color; currently, racism is baked into the very fabric of medicine.

In the midst of a pandemic and a national reckoning on racism in America, it’s never been more important to have a critical mass of doctors and diversity in medicine. Medical schools have a choice. They can embrace what has always been—a test and admissions system steeped in racism that endangers us all—or they can change. They can decide whether the health of students and their families is worth risking or if it’s just as important as the health of their future patients. Ultimately, medical schools cannot lament the lack of Black and Latino doctors while actively putting those students at greater risk in this pandemic in order to continue to embrace a testing approach with racist roots. Rather than just paying lip service to diversity in medicine, they must actively tear down monuments to racism in medicine. The MCAT is a great place to start.