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Academic Medicine:
doi: 10.1097/ACM.0b013e318245f3a3
Letters to the Editor

More About the Causes and Consequences of the Expanding Medical Student Debt

Greysen, S. Ryan MD, MHS, MA; Chen, Candice MD, MPH; Mullan, Fitzhugh MD

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Assistant professor, Division of Hospital Medicine, University of California, San Francisco, San Francisco, California; ryan.greysen@ucsf.edu.

Assistant professor of pediatrics and health policy, George Washington University School of Medicine and Health Sciences, Washington, DC.

Murdock Head Professor of Medicine and Health Policy, George Washington University School of Public Health and Health Services, Washington, DC.

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In Reply:

Dr. Ableson raises an important point about the medical school admission process. We believe the goal of diversity is to create equity and to produce a workforce that is more likely to meet the diverse needs of the nation—both by being more likely to practice with underserved or underrepresented minority (URM) populations and by being more culturally competent. Moving the existing, limited pool of URM students between various schools does little to increase diversity and may indeed be a poor use of resources.

Thus, we think it is fair to wonder whether schools should reassess their admission policies and focus their resources to aggressively recruit URM students who otherwise couldn't afford medical school. Some of those students may be those with multiple offers for scholarships or other forms of assistance, but many could be “new” students without so many options. In any case, we shouldn't criticize students with multiple options for wanting the best deal they can get—we all want this for ourselves.

Moreover, perhaps we should also question how we measure the success of schools in increasing the diversity of the workforce. Is it really just how many URM students you have and can graduate? Or, instead, is it how successful you are in creating programs that recruit and help students who otherwise wouldn't have been able to go to medical school and who eventually do return to underserved communities to provide needed care? The success of the latter goal is certainly difficult to sustain and even harder to achieve. But this is no reason not to try. We salute the many admissions officials who are already striving to meet these challenges.

S. Ryan Greysen, MD, MHS, MA

Assistant professor, Division of Hospital Medicine, University of California, San Francisco, San Francisco, California; ryan.greysen@ucsf.edu.

Candice Chen, MD, MPH

Assistant professor of pediatrics and health policy, George Washington University School of Medicine and Health Sciences, Washington, DC.

Fitzhugh Mullan, MD

Murdock Head Professor of Medicine and Health Policy, George Washington University School of Public Health and Health Services, Washington, DC.

© 2012 Association of American Medical Colleges

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