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Medicine as a Meritocracy

William H. Frishman, M.D.

American Journal of Medicine Editor Joseph Alpert

Joseph S. Alpert, MD, AJM Editor-in-Chief









When we (the authors, WF and JA) were graduating from medical school in 1969, 50 years ago, our class pictures in Boston showed a predominance of white males, a small percentage of white females, and even fewer African Americans, Asian Americans, and Hispanic Americans.

Today the class pictures at almost every medical school show just as many females as males, and a large number of minority students from both sexes, a remarkable change in medical student demography over the past half-century. Medical school has become a true meritocracy.

What has not changed are the demands placed on all medical students to be the best clinicians with a strong scientific underpinning, no matter what their background. Patients also need to have the best physicians available to care for them, individuals who are both humanistic and knowledgeable.

Every student accepted to medical school today has been recognized for their academic excellence and interpersonal qualifications during grade school, high school, and college. Students have been recipients of honor roll, dean’s list, Phi Beta Kappa, cum laude, and scouting recognitions. For years these awards have served as an incentive for students to work harder and become the best that they can be.

Both of us (WF and JA) authors served as officers in the military during the Vietnam War, a time when the armed forces were less discriminatory and more inclusive than in prior years. If a soldier or sailor performed at a high level, he/she was often rewarded with a citation or medal for excellence. These awards, too, served as incentives for everyone to perform at their best. Not everyone is the same. We were proud to serve along with Medal of Honor recipients, and not envious of them.

Today, all medical students start off in their first year with the same coursework, and they have similar clinical curricula, national board examinations, and expectations. Everyone has the opportunity to excel. Should excellence in the study of medicine not be rewarded? Should honors grades and student awards be discarded? Should military medals be discontinued? Should we abolish all national board examinations that separate students?

There is now a movement in some medical schools to abolish grades, examinations, and honor societies.1 The argument states that grades cause stress and general unwellness. Every student should know what they are getting into when they decide on a career in medicine. Each one had to compete and excel to get into medical school, so why should it be different when they are training to be physicians? There are good physicians and not-so-good physicians. Why shouldn’t the best be recognized?

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-William H. Frishman, MDa,, Joseph S. Alpert, MDb

This article originally appeared in the April 2019 issue of The American Journal of Medicine.

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