Is medical school admissions basically a lottery?

If you’re an avid reader of this blog, you can probably guess what my answer is. But to me, the answer itself isn’t as important as understanding how we get that answer, because it is only by knowing the process of finding the answer that we will be able to answer similar questions correctly in the future.

In short, the answer is pretty clearly a no, despite what many frustrated applicants might think. Comparing the medical school admissions process to a lottery is not only an insult to the intelligence and efforts of medical school admissions committees, but it shows a problematic perspective to the process overall.

Why this is problematic

I think we can agree that a lottery refers to anything that is a purely chance event. So when we buy lottery tickets in hopes of becoming the next millionaire, it’s a lottery because besides buying the actual ticket, nothing we do can increase the chance of our ticket winning more than anyone else’s. Why? Because the winning numbers are picked completely randomly. However, this also means that there is nothing we can do to decrease our chances of winning either.

So to compare medical school admissions to a lottery is essentially proposing that not only are admissions decisions made by chance, but also, that nothing can be done to increase or decrease your chances of being accepted relative to all of the other applicants.

However, this notion can be dispelled quite easily. For instance, if I had gotten a 21N on my MCAT, I would not have received an interview at Queen’s in the first place, because they have certain MCAT requirements. And so in the grand scheme of things, it is true that you can increase your chances of getting into medical school by doing well on the MCAT, because the higher your score, the more medical schools whose MCAT requirements you will meet. Given all this, medical school admissions as a whole can’t be a lottery.

Of course, I expected someone to reply that while the pre-interview assessments may not be a lottery, the post-interview assessments can be. For instance, this past year Queen’s interviewed 760 candidates and accepted only 100 in the first round. Because of that, some applicants were especially adamant about calling the process a lottery.

And again, we can dispel such a notion quite easily. I believe I can say quite confidently that a candidate who walked into their interview and just sat there silently, never speaking a word or answering a question, who be immediately rejected. I believe I could say the same for a candidate who walked in and started swearing randomly or harshly insulting the interviewers. If you agree with me that these would lead to automatic rejections, clearly there must be ways we can affect our chances of acceptance during the interview, and thus, the interview process cannot be a lottery.

At the same time, it would be narrow-minded for anyone, including the admissions committees themselves, to claim there is no variance, luck, or chance involved in the process. But they shouldn’t have to admit that there is, and it should be common sense that it exists. Variance exists in all parts of our life, so it shouldn’t be weird that we also find it in the admissions process.

No one “deserves” anything

Yet for some reason it’s a concept that we struggle with. We often seem to think that we “deserve” things, and become upset when we don’t get it. For example, someone who has a 4.0 GPA, 40T MCAT, and is on the front cover of Nature magazine might think they “deserve” to get into medical school and start calling the process a lottery if they don’t. Now, I’m sure it’s obvious what’s wrong with this thinking, in terms of believing that doing X, Y, and Z would guarantee anyone a spot in medical school, let alone being proof that this person would make a better doctor than someone else.

But the bigger problem lies in the idea of believing you actually deserve anything in situations like this. Imagine you are a safe driver, and you do everything right, but some drunk idiot runs a red light and smashes into your car. You might be frustrated and complain, and say “I am a safe driver, I don’t deserve to have this happen to me”. But that’s wrong. Being deserving has nothing to do with it. The fact is that when you take your car for a ride, you accept the fact that you might get into an accident today, regardless if the fault is your own. No one “deserves” to be hit and no one “deserves” not to be hit. The idea of deserving in a process of incomplete certainty is irrelevant and more of some sort of personal comfort tool than anything.

It would be different if there was a direct relationship, in which case, you might be deserving and get screwed. For instance, if you gave a restaurant 5 dollars, you deserve to get your meal in return. That’s because both sides are engaged in a relationship where the system is already established.

But medical school admissions is not like this. Committees don’t say “if you get this GPA, volunteer this many hours, get this MCAT score, and say this in an interview, you will automatically get in”. There is no magic formula for getting into medical school. And because of this, no one “deserves” anything.

Understanding that you don’t “deserve” to get in more than anyone else is an important hump to get over. You can say that person A is more likely to get in than person B, but it would be irrelevant to analyze whether one is more deserving than the other. The admissions committees don’t look at it that way, so why would you?

Of course, this doesn’t mean the best candidates are the ones who get in

I kept feeling this article was a bit incomplete, but I couldn’t put a handle on it until this morning. I forgot one of the major reasons why some people think the process is like a lottery – because sometimes certain individuals who seem like great candidates to become physicians don’t get in, and some individuals who don’t seem like great candidates do.

The fact is that the admissions process is inevitably imperfect, and I don’t think any medical school thinks that they always get it right. I’m sure you’ve come across physicians who you think aren’t doing a good job, and that’s the product of not only an imperfect admissions process, but also an inability to predict future circumstances. All medical schools can do is hope that they’ve picked the right people from the applicant pool that year, and work with what they’ve got.

The problem with medical school admissions is that they’re working with limited information. All they get are some numerical scores, an essay, some letters, and a relatively short interview – not to mention the subjectivity involved with evaluating some of these. All they can do is come up with a process that they think will select for candidates with potential to be competent physicians, with no guarantee they actually will be.

In addition, and it’s something I’ve stressed countless times - it’s not the best physician candidates who get in, but the individuals who do the best in the admissions process. Of course, the hope of the admissions committees strongly believe there is a correlation between the two, or else they wouldn’t have the process that they do – but this doesn’t mean the two always co-exist within a person. There will always be individuals who would make fantastic physicians who may simply not be good at marketing themselves through essays, and there of course will be individuals who are fantastic at the application process but would make relatively worse physicians.

I’ll be honest – I’m sure there are people who applied but didn’t get in this year who would make better a physician than I would. There are so many qualified applicants for fewer spots. However, my hope would be that with enough attempts, those who would make great physicians will eventually get in.