The COVID-19 pandemic has highlighted the critical role that physicians play in healthcare, with medical schools reporting as high as 50 percent increases in applicants. Along with application surges, medical schools are refining how they select applicants, with some schools no longer requiring formal test scores and others conducting virtual interviews going forward.
At the University of California San Francisco's School of Medicine, there was a large uptick — about 34 percent — between the 2019-20 admissions season and the 2020-21 season, Catherine Reinis Lucey, MD, executive vice dean and vice dean for education at the UCSF School of Medicine, told Becker's.
New York City-based New York University Grossman School of Medicine reported a 4 percent increase in medical school applications during the 2020-21 season. Rafael Rivera, MD, associate dean for admissions and financial aid at NYU's medical school, told Becker's this is the smallest increase they have had in recent years, since the school announced its program would be tuition-free for all students in 2018.
In December, NPR reported a 50 percent increase in applications at Stanford (Calif.) University School of Medicine, as well as a 27 percent jump at Boston University School of Medicine.
Some admissions officers have called the trend the "Fauci effect," caused by people looking at work medical workers and public health officials, such as Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, have done during the COVID-19 pandemic.
Dr. Lucey, with UCSF's medical school, acknowledged the work of Dr. Fauci. However, she stopped short of citing that as the only contributing factor.
"It's hard to peg that on Dr. Fauci because the decision to go to medical school can't turn on a dime," she said. At the beginning of the pandemic, "Dr. Fauci was doing a good job and people were compelled by the need for more doctors, but students had to then turn around and take their [Medical College Admission Test] and be ready to apply by fall, and that's not usually a couple months' worth of decision-making."
Therefore, "it's hard to know what exactly caused this really dramatic increase, but may in fact be changes in the economic environment [as well]," said Dr. Lucey.
Still, she said she believes there might be a "Fauci effect" this year, and she wouldn't be surprised if there was an even bigger increase in applications this coming year.
MCAT requirement
Amid the surge in applications, some medical schools did waive the MCAT requirement for students seeking admission in 2021 because of barriers created by the pandemic.
UCSF School of Medicine was one of those schools. Dr. Lucey said across the University of California system, officials decided they would still consider an applicant if the person had COVID-related problems and could not meet the MCAT requirement. Overall, her school took a holistic approach to admissions and looked at all metrics, including GPA, who the person is, and the person's career intention.
In the end, only a handful of people at UCSF's medical school went through the last admissions cycle without an MCAT, said Dr. Lucey.
"A small number of students, we felt comfortable enough with other metrics we had on them that we were able to offer them admission," she added. "It turned out to be less of a problem than people thought, because a lot of people had already been preparing for exams when the pandemic and stay-at-home orders hit."
NYU's medical school expects everyone to take the MCAT and said the MCAT is a vital part in predicting an applicant's performance in medical school and beyond.
"The requirements to apply to NYU Grossman have remained the same because society's needs in its physician workforce fundamentally haven't changed," Dr. Rivera said.
Like UCSF, NYU's medical school takes a holistic approach. It conducts multiple mini interviews and considers GPA and MCAT scores as just a portion of its application selection process.
In response to the COVID-19 pandemic, Dr. Lucey expects this will be another year of flexibility around the MCAT requirement at U.S. medical schools.
NYU expects to continue to conduct admission interviews virtually since there are many benefits to applicants, including reducing the cost of applying to medical school.
Acceptance of medical school applications and the effect on physician shortages
The increase in medical school applications and flexibility around the MCAT requirement also comes as the U.S. could face a shortage of between 54,100 and 139,000 physicians by 2033, according to the latest data from the Association of American Medical Colleges.
At UCSF, Dr. Lucey said the philosophy is that the medical school is trying to train a workforce.
"We don't say we only admit primary care, or we only admit physician-scientists. We try to admit a class with eventual career interests," she said.
For example, she said the university has a program focused on helping to train the physician-scientist workforce, as well as programs directed at addressing the unmet needs for care in specialized populations. Dr. Lucey said that includes a program focused on students interested in practicing and leading health systems that is designed to address the healthcare needs of people in urban environments who have restricted healthcare access.
She explained: "What we've tried to do with our admissions process and our curriculum is to create an environment where we can recruit students who have interest in serving communities in all the ways physicians can serve communities. That's the way we're looking at how we address physician shortages to sort of redesign these special tracks to supplement the instincts our students have when they're coming into medical school."
NYU opened an independent medical school, the Mineola, N.Y.-based NYU Long Island School of Medicine, in 2019 to address physician shortages. The Mineola school focuses on training primary care physicians.
Dr. Rivera said both medical schools allow for an accelerated three-year MD program so students can enter the workforce one year earlier.
Match Day
Students who do make it through medical school typically participate in Match Day, in which they are matched with slots at residency programs. In March, about 1,000 residency applicants were not matched.
But Dr. Lucey did not place significance on this year's number, noting there's always a baseline level of people who don't match.
She said when people don't match into residency, it generally means they chose to pursue a competitive specialty that has a restricted number of physician slots, such as dermatology or neurosurgery.
"Often unmatching relates to career choice and not a problem of insufficiency of residency positions," said Dr. Lucey.
Boston-based Mass General Brigham said all residency recruitment was virtual throughout the pandemic.
Bridget Perry, director of communications, told Becker's that virtual recruitment eliminated many of the costs associated with travel. Residency applicants were able to expand the pool of places where they applied.
Mass General Brigham reported 430 matches in an April 16 news release shared with Becker's. Of the 430 matches, the hospital had a record number of diverse applicants and recruited a cohort that is 54 percent women and 26 percent groups that are underrepresented in medicine.
The hospital's diversity, equity and inclusion teams worked with program leads to have outreach to minority candidates. Twenty-eight percent of candidates who matched with the hospital's internal medicine department were from groups underrepresented in medicine. In its obstetrics and gynecology department, where there is growing concern over racial disparities in maternal and reproductive health, more than half of incoming residents are underrepresented in medicine.
Changes to medical school strategy
Medical schools are implementing permanent strategy changes in how they recruit applicants, but also what their students will learn during their program.
Dr. Rivera said NYU's Grossman medical school puts significant emphasis on research activities.
He explained: "I believe that what society needs most are physician-scientists. The COVID pandemic shone a light on the critical importance of research in ensuring the health and well-being of our society."
For UCSF, the pandemic has shown there is the need for comprehensive workforce planning, not only for physicians but for nurses, public health experts, pharmacists and respiratory therapists, said Dr. Lucey.
Dr. Lucey said: "I think we need a better handle on what is the future of the healthcare workforce going to be, not only to address the next pandemic but also take the momentum of people being excited about addressing healthcare disparities and optimizing social determinants of health and really tackle some of these big problems. I think it really might impact us from planning about how big residency programs should be, but also the types of ways we prepare our graduates to be really effective in the collaborative environment we're going to need to help serve our communities."