Medical School Rankings: Explaining the Controversy

Medical school rankings draw headlines each time they are published, especially those released by U.S. News & World Report (USNWR).

Many students use these rankings when considering which medical school to attend, and it can also influence where professors choose to teach. Many medical schools place favorable ranking positions at the center of promotional and fundraising efforts.

Today, however, stakeholders are taking a closer look at medical school rankings, their value, and their possible unintended consequences. As a result, significant changes have been undertaken.

Historically, USNWR ranked schools on a mix of factors, including objective and quantifiable elements such as average standardized test scores and grade-point averages of accepted students, the amount of research funding the institution receives, and the student-to-faculty ratio. It also considers more subjective elements, such as reputation scores.

The controversy has two major points. The first is that relatively few of these factors directly assess the quality of the education students can expect to receive at the school. A 2018 review of outcomes for Medicare patients confirmed that “overall, little or no relation was found between the USNWR ranking of the medical school from which a physician graduated and subsequent patient mortality rates.” While some factors, such as student-to-faculty ratios, have a strong potential correlation, others do not.

The second argument is that the rankings instead measure relative privilege. While GPA and MCAT scores reflect student achievement, they are not the only way to measure achievement or even the most accurate method. Selectivity scores among students can represent how much time and funding they have to prepare for classes and tests, especially in the case of GPA, whether their school engages in grade inflation.

Similarly, access to research funding can measure how much time faculty and staff have to apply for grants. At schools with more funding, they can concentrate on applying for grants as much as conducting teaching or research.

Finally, because the reputation scores are based on a survey of school administrators, the school administration, rather than medical practitioners or other healthcare professionals, are overrepresented. Because university administrators tend to be graduates of wealthier schools, this may introduce bias in their vote, as they may rank their schools higher.

Many schools, including many top-ranked schools, responded to controversies by declining to send in their information for the ranking. Katrina Armstrong, dean of the Vagelos College of Physicians and Surgeons at Columbia University, reflected on these in a statement that the school would no longer participate in the USNWR rankings.

“The USNWR medical school rankings perpetuate a narrow and elitist perspective on medical education,” she wrote. “Their focus on standardized test scores comes at a time when it is widely understood that prioritizing these scores rewards well-resourced applicants without regard for selecting the individuals who can best serve the future needs of a diverse and changing world.”

Many schools, particularly historically black colleges and universities (HBCUs), had already refrained from participating, but they were recently joined by traditionally high-ranking medical schools such as those at Harvard, Yale, and Stanford. In response, USNWR said it would use a new and more appropriate ranking methodology.

Eric Gertler, executive chairman and CEO of USNWR, responded to the controversy by saying, “We know that comparing diverse academic institutions across a common data set is challenging, and that is why we have consistently stated that the rankings should be one component in a prospective student’s decision-making process.”

On April 15, USNWR released preliminary rankings that used new measures that gave more weight to faculty-to-student ratios and the percentage of students who enter primary care, added National Institutes of Health grant awards as a new factor, and reduced the weight of student selectivity and reputation scores. However, respondents maintained that this did not sufficiently address the issue, and USNWR embargoed the results until it could consider the responses. It released the final report and explained its methodology on May 10.

Because the scores do not require the school to submit data, many organizations that boycotted the rankings still appeared in the list.

Currently, the discussion continues. No schools that boycotted the rankings have returned to the updated USNWR rankings, but no other model has yet emerged to replace them.

Keme Carter, MD, associate dean for admissions at the University of Chicago Pritzker School of Medicine, commented, “My hope, for the health of our future physician workforce, is that their perspective shifts a bit toward looking at what the school stands for.” Carter wants to see information that will answer more fundamental student questions, such as “What are the opportunities they offer? Who could I become if I go to this school?”

The pros and cons of attending a top-ranked medical school depend on how well it matches what you are looking for. If you want to attend a school that heavily participates in research, then a top-ranked research school may be for you. However, schools may game their results to get a top ranking by admitting students with high test scores, regardless of other factors.

Other than rankings, there are many ways to pick the right medical school. Talk to people you trust, ask current students and faculty, review the school curriculum, determine its accreditation status, and look for news stories about the school in the media.

Medical school rankings matter for publicity and the reputation boost that schools can get from being listed as top-ranked schools. However, these rankings do not necessarily reflect your potential experience as a student.

No single approach has replaced the USNWR rankings to date, but student-focused measures are one method. In 2010, researchers suggested a measure of schools’ ability to deliver on their social missions.

Whether you want to attend a top-ranked school and if it will be worth it depends on how well the school meets your needs. Ranking lists plus your own research can help you find the right match.