Opinion | Should Consumers Decide the Fate of Medical School Applicants?

Minorities are not only underrepresented in the medical profession — they are underrepresented on admission committees that select future doctors. But if it were possible to increase the minority composition of medical school admission committees, would it be possible to increase the diversity of the physician workforce. Better yet, what if it were possible to include members from the community on medical school admission committees? How would that change the physician landscape? After all, we are constantly hearing how patients prefer to see a doctor who looks and talks like them and shares a similar cultural background.

Even without members from the community, the fact is, recently matriculated and graduated medical school classes have become increasingly demographically and socioeconomically diverse, with greater representation of women and racial and ethnic groups — Black, Latinx, and other persons of color. Insofar as a diverse physician population can better serve the diverse patient population in the U.S., it is understandable why admission committees go to such great lengths to ensure diversity among their members and practice “race-conscious admissions,” recruiting students from various backgrounds and walks of life.

The idea of incorporating individuals from the community to serve on medical school admission committees is intriguing. My alma mater, the Lewis Katz School of Medicine at Temple University, in Philadelphia, is leading the way. As reported in the Philadelphia Inquirer and a Temple news release, five people who live and/or work in the community surrounding the impoverished North Philadelphia medical school campus and its hospital helped interview hundreds of candidates for the medical school class to enter this fall. And one of those members — a 33-year-old youth mentor and PhD student in Temple’s Department of Geography and Urban Studies — was a decision-maker on the 25-member admission committee, along with medical school faculty and physicians.

Medical school partnerships with community members are not novel — they generally exist to improve the health of the community. People with lived experience in the community may be able to identify social barriers to health and help suggest solutions. However, direct partnerships with admission committees are rare. Temple is the only medical school I know of to incorporate long-time residents or activists in the neighborhood on its committee. The community interviewers total more than 30 years of experience living or working around Temple, and they often have social service backgrounds.

Medical schools need to ensure a diverse student body to carry out their community missions and strengthen their capacity to treat underserved populations locally. In Temple’s case, 86% of hospitalized patients have government health insurance, either Medicare or Medicaid, according to a hospital report. Two-thirds of those who live in the hospital’s service area are Black or Hispanic, and the median household income is $35,405. It’s no surprise that Temple has one of the most diverse medical student bodies in the country — tied at number six, according to U.S. News & World Report rankings.

The community members asked by Temple to be part of the admission process received interview training, and for about 7 months participated in virtual interviews with candidates that took about 4 hours a week. Prospective students were asked why they chose Temple, what community means to them, how they would engage with marginalized groups and communities suffering disparities, and how they would handle sensitive clinical interactions — for example, end-of-life conversations with family members. Community members were also attuned to whether candidates’ answers seemed genuine or rehearsed.

Race and ethnicity definitely factor in when applying to medical school, making it an incredibly hot topic. Some individuals worry about minority underrepresentation while others are concerned about students who seem to be “overrepresented” in medicine. The latter are primarily white and Asian American (e.g., Chinese American, Korean American, Indian American) and may receive greater scrutiny than applicants from other ethnic or racial backgrounds in order to prevent their influx into medicine.

The addition of community members to medical schools’ admission committees raises some concerns too. What makes these individuals qualified to judge the accomplishments and merits of medical school applicants? How will members from the community be reached, and will the process be fair and equitable? What will be the criteria for their selection? What, if any, biases do community members bring to the discussion? Will they be tougher on their assessments of non-minority students applying for admission? Will their recommendations attempt to compensate for the fact that Black doctors are forced out of residency training programs more often than white residents? How will community interviewers deal with the reality that medical students’ career priorities may not include practicing primary care medicine in their backyard — and will candidates be truthful about their career aspirations, or will they be intimidated and lie?

The medical profession has been skeptical of the value of community members in certain instances — for example, the deployment of undercover “mystery” or “secret” shoppers in physicians’ offices to provide feedback about the quality and nature of physicians’ services. Similarly, consumers’ online reviews of physicians’ services have appeared in many different public websites, not to mention social media platforms such as Facebook, Twitter, and Instagram. Physicians’ reputations now hang at the mercy of keyboard warriors critiquing doctors untethered and usually without the benefit of quality control oversight.

On the other hand, the pharmaceutical industry has experienced positive outcomes utilizing members from the community. Members’ input into the design of clinical trials has helped promote diversity and inclusion in controlled trials and health research participation. Consumer involvement in the conduct of clinical trials is not only growing but seems to be welcomed by most researchers, who have been encouraged by the FDA to enroll and retain diverse study populations via “sustained community engagement.” Ensuring diverse and inclusive clinical research is considered an existential imperative.

The inclusion of community members in medical schools’ admission committees is a bold experiment and work in progress. The initial experience at Temple has been overwhelmingly positive. About 90% of prospective students who completed an anonymous survey said the community interviewer added value to their experience and helped them better understand the school. The goal, according to Temple’s associate dean of admissions, is to facilitate a match so that the right students choose Temple as much as it helps Temple choose the right students. That’s a perfect fit, a win-win combination — as long as everyone agrees on what constitutes the “right” student.

Arthur Lazarus, MD, MBA, is a member of the Physician Leadership Journal editorial board, a 2021-2022 Doximity Luminary Fellow, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia.

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