A National Medical Emergency: When Medical Societies Become Social Activists
The Liaison Committee on Medical Education (LCME), the agency recognized by the U.S. Department of Education to accredit medical schools in the U.S. and Canada, is made up of representatives from the American Medical Association (AMA) and the American Association of Medical Colleges (AAMC) (Ref.1). LCME approval is critical for medical schools as it is required in most states for licensing graduates and receiving federal financial aid (Ref.2). The purpose of the LCME 1942 founding was to recognize that medical societies have a responsibility to our society to ensure that graduating physicians can provide the best possible care. Therefore, accreditation of medical schools must depend on guaranteeing educational quality and its continuing improvement (Ref.3). For decades this meant that medical schools would graduate the highest possible quality of physicians based on results of standardized tests, a meritocracy (Ref.4).
In the past decade or so the sponsoring institutions of the LCME, the AAMC and AMA, have changed their belief in ensuring that the most knowledgeable medical students graduate, those who can integrate science adapted to each individual’s needs applied with concern, dignity, and humility. The two medical societies have abandoned the requirements of excellence and academic rigor needed to produce physicians with these skills. Instead, they have adopted a social activist position attempting to achieve equal racial/ethnic health outcomes by adjusting the racial/ethnic makeup of physicians (Ref.5,6). Importantly, however, both the AMA and AAMC have misunderstood the reasons for America’s minority health inequities. They have favored the idea that racial minorities’ health would improve if cared for by those of the same minority while ignoring the social determinants of health (SDOH). SDOH are a collection of factors such as educational attainment, social conditions, poverty and others that can affect ALL Americans (Ref. 7,8,9). Instead of addressing these root causes these organizations are focusing on a symptom. Not only are SDOH important in determining one’s health, but it is also THE most important factor (Ref.10). Thus the poorer health outcomes among different races is NOT due to the race/ethnicity of the attending physician.
The AMA and AAMC by adopting a race-based social activist policy to improve medical outcomes for minorities is ignoring important social factors such as single motherhood, fatherless boys, and failing schools. No racial or ethnic group is immune to these factors. Unfortunately, both organizations decided on a course of destroying merit as a basis for becoming a physician while trying to address health inequities. With time this will decrease the public’s trust in physicians and lead to overall poorer health.
Will the medical schools muster the courage to challenge the LCME and return to a merit-based selection and grading policy? This is doubtful as they are infected with the same ideology as their parent universities. Perhaps they will be forced to abandon race-based policies due to the recent Supreme Court decision banning affirmative action. Possibly leaders in minority communities will insist on school choice and intact families so that their students will be evaluated on a level playing field (Ref.11). It may be that the public will understand that their medical care is at risk and insist on having physicians that excel in patient care. Whatever the outcome, the idea of lessening admission standards and grading in medical schools is not in society’s best interests.
- On Medical Education, 2024, available on: https://lcme.org/
- What is LCME and Why is it Important? available at: https://hms.harvard.edu/sites/default/files/assets/About_Us/LCME/Files/SelfStudyProcess.pdf
- D.C. Kassebaum, Origin of the LCME, the AAMC – AMA partnership for accreditation, Pub Med, 1992, PMID 1547000, available at: https://pubmed.ncbi.nlm.nih.gov/1547000/#:~:text=The%20participants%20met%20for%20several,by%20pressure%20for%20continuous%20
- Robert H. Saglen, Academic Quality AND Public Accountability In Academic Medicine: The 75-Year History of the LCME, LCME, 2017, available at: https://www.lcme.org/wp-content/uploads/filebase/articles/October-2017-The-75-Year-History-of-the-LCME_COLOR.pdf
- Frequently Asked Questions: Race-Conscious Admissions in Medical Education, Association of American Medical Colleges, 2023, available at: https://www.aamc.org/media/65436/download?attachment
- AMA adopts policy for race-conscious admissions in higher education, AMA, June 13, 2023, available at: https://www.ama-assn.org/press-center/press-releases/ama-adopts-policy-race-conscious-admissions-higher-education#:~:text=CHICGO%20%E2%80%94%20With%20the%20Supreme%20Court,necessary%20safeguard%20in%20undergraduate%20and
- Paula Braveman, Susan Egerter, David R. Williams, The Social Determinants of Health: Coming of Age, Annual Reviews, November 22, 2010, available at: https://www.annualreviews.org/content/journals/10.1146/annurev-publhealth-031210-101218
- Russell M. Viner, Elizabeth M. Ozer, Simon Denny et. al., Adolescence and the social determinants of health, National Library of Medicine, April 25, 2012, available at: https://pubmed.ncbi.nlm.nih.gov/22538179/
- Healthy People 2030, Social Determinants of Health, Office of Disease Prevention and Health Promotion, available at: https://health.gov/healthypeople/priority-areas/social-determinants-health
- Why Is Addressing Social Determinants Of Health Important For CDC and Public Health? CDC, December 8, 2022, available at: https://www.cdc.gov/about/sdoh/addressing-sdoh.html
11. Libby Stanford, Charter Schools Now Outperform Traditional Public Schools, Sweeping Study finds, EducationWeek, June 6, 2023, available at: https://www.edweek.org/policy-politics/charter-schools-now-outperform-traditional-public-schools-sweeping-study-finds/2023/06
“With time this will decrease the public’s trust in physicians and lead to overall poorer health.”
Excellent point!
Benjamin, Thank you for your thoughtful additions to my essay. Any system other than MERIT is sher folly. Ken
Most of the organizations still do not achieve or apply themselves to the idea they are trying to implement.
If that were the case, the applicants accepted under racial and ethnic diversity would have to be steered into primary care. Or required to go into primary care. Otherwise having them in specialties or practicing in areas that do not reflect their racial or ethnic background would not achieve the desired goals. All that would achieve is the objective of equal outcomes in medical school racial makeup. And those specialties are trying to achieve there own representation goals would compete with this anyway.
Likewise we have not done a trial of accepting people with lower academic standards and forcing them to practice on people of their same ethnic background, might lead to worsening outcomes. Then there would be a decry that they were subjected to an experiment or given substandard care. There is no study showing that accepting people with lower academic standards and mentoring them through medical school with additional proctoring and special treatment, leads to the same results in practice.
Quite often the applicants of a varied ethnic background are from affluent parents. I will never forget the person I knew who had been accepted into medical school with a c minus average yet both his parents were dentists and he had attended the most affluent high school in the metropolitan area. My other classmates came from other countries or other regions and did not ultimately practice in the inner city region that I grew up and the medical school was supposed to serve.