As one of us (R.S.) wrote in a recent Academic Medicine commentary, structural racism is pervasive in academic medicine, and institutions need to take bold action. Schools must implement comprehensive anti-racist policies and practices across all lines, from curricular reform, to promotion of diversity and inclusion at all levels, to building systems of accountability. Such work takes time, and change will not happen overnight. However, we propose one simple, bold action that schools can take immediately to show their commitment to ending structural racism: decline to participate in the U.S. News & World Report (USNWR) best medical schools rankings. By doing so, schools extricate themselves from an incentive structure that maintains an inequitable status quo.

USNWR calculates scores from 5 domains: quality, National Institutes of Health (NIH) research activity (for a research ranking), match rates into primary care residencies (for a primary care ranking), student selectivity, and faculty resources. Academic medicine has long recognized that this scoring methodology does not include any measures of educational quality or of the practice outcomes of graduates. It is time to acknowledge that the USNWR ranking metrics also reward schools for racist outcomes. Below, we review 3 of the scoring domains and how these elements of the ranking methodology contribute to structural racism in the field.

• Quality: USNWR requests that deans rate peer institutions on a generic scale of “marginal” to “outstanding,” and only 30% of respondents reply. Lack of measurement clarity; low response rate; implicit bias against Black, Indigenous, and people of color (BIPOC) students and faculty; and social familiarity among an elite, predominantly White group can all contribute to lower peer ratings of minority serving institutions.
• Research: The research score is based upon the total dollar amount of NIH research grants awarded and the amount per full-time faculty member. Given known racial inequities in awards, lower funding for disparities research, and the “minority tax” of service imposed on BIPOC scholars, these metrics can devalue the work of BIPOC faculty and research on the health of BIPOC communities.
• Student selectivity: USNWR uses median Medical College Admissions Test (MCAT) scores to rate school selectivity. Generations of structural racism—producing inequities in wealth, housing, and education, among other things—have contributed to inequities in MCAT scores, even as research repeatedly shows that scores are unrelated to applicants’ future practice as physicians. Leaders have noted that the single-minded emphasis on MCAT scores hampers their ability to admit BIPOC applicants who may otherwise succeed in medical school.

Why are medical schools still participating, even touting, their performance in an admittedly flawed system? For many reasons, from reputation, to recruitment, to development and revenues, schools aim to maximize their scores on the USNWR metrics. We propose that schools should adopt the Racial Justice Report Card (RJRC), which evaluates health systems’ activities across a variety of metrics, including representation, marginalized patient protection, and equal access for all patients. In 2019, 17 schools participated in the RJRC, but these schools all have high USNWR rankings and thus may face the least risk in doing so. The RJRC will be more effective when the majority of schools participate in it and remove themselves from USNWR rankings at the same time.

Medical schools should abandon the USNWR rankings system not only because the methodology is poor, but also because these rankings incentivize schools to perpetuate structural racism. Participating in the USNWR rankings signals that academic medicine does not prioritize the health and well-being of BIPOC communities. Given that medical schools have so recently expressed their commitment to racial equity, and leaders in academic medicine are well aware of the flaws of the USNWR rankings, isn’t it time for a change?

By: Michelle Ko, MD, PhD, and Ruth S. Shim, MD, MPH

M. Ko is assistant professor, Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, Davis, California.

R.S. Shim is Luke and Grace Kim Professor in Cultural Psychiatry and professor of clinical psychiatry, University of California, Davis, Sacramento, California.

Further reading

Shim RS. Dismantling structural racism in academic medicine: A skeptical optimism. Acad Med. 2020;95:1793–1795.