[Plasmoid]

Because there are so many applicants that have good grades.

A more cynical view is that the governing boards want a way to pick and choose who they let in. So they create "holistic" application systems to get "360 degree view of the candidate".

[waterhouse]

No matter how many have good grades, you can always pick the top n by grades—unless there's a ceiling that the top m > n have all hit. Which, if you're talking about "grades" as in GPA, is plausible.

MCAT seems more relevant, though. According to Claude: "Roughly 0.1% or fewer of test-takers score a perfect 528 in any given year — typically only a few dozen individuals out of the ~120,000 or so who sit for the exam annually." So it should work fairly well for them to sort by MCAT and take however many they have (or expect to have) room for.

[ryandrake]

I think OP's point was that the governing boards don't want the people with the top n grades. They want certain people, and by making the admissions criteria fuzzy, they can pick and choose those certain people and then say "well, our admission criteria is subjective," and "we are looking for 'well rounded people," and all kinds of other vague weasely ways to let them legitimately shape the student body in the way they want.

See also: "Cultural fit" when hiring.

[BobBagwill]

One of my roommates who was premed had a "hot car" poster as a motivational study aid. After a short term as a candy striper at a local hospital, he changed majors. The system works! ;-)

[oivey]

At a certain point, grades become arbitrary and won’t necessarily select for the best candidates. Obviously the current system doesn’t, either.

The actual solution is to increase the number of slots for training doctors to match the huge number of qualified applicants. It makes even more sense given that there is a shortage of doctors and health care costs are astronomical.

[andrew_lettuce]

I want a doctor who was a strong student with diverse experiences, lots of soft skills and can handle the entire psychological spectrum of being a doctor, not the doctor who was solely the best at exams.

[triceratops]

There are all kinds of doctors though? The ones who don't have soft skills or diverse experiences can go into pathology or other fields that don't involve as much patient interaction. Why lose out on their gifts altogether if they're genuinely interested in medicine.

[jjmarr]

> No matter how many have good grades, you can always pick the top n by grades. Which, if you're talking about "grades" as in GPA, is plausible.

I live in Ontario and we're there. 40% of Waterloo students had above a 95% average in high school. The average GPA to get into UofT med school is 3.94/4.00 GPA.

What has happened as a result is students killing themselves and each other. If you fail one test in any course, you cannot move to the next level.

So, if you go on the UofT subreddit there's endless stories of pre-med students sabotaging each other. Faking friendliness, destroying notes, etc etc. This is arguably rational because the pool is small and there's little to gain by studying harder if you already have a perfect GPA.

https://www.reddit.com/r/UofT/comments/1sbu811/had_no_idea_t...

You don't want this type of person as a doctor. They will sabotage others because that is how they got ahead in the past. In a medical environment that kills people.

[triceratops]

Too many kids want to be doctors and have the grades for it? That's an opportunity, not a problem.

Training more doctors is just never an option for some reason.

Don't build systems that reward amoral psychopaths.

[jjmarr]

We've opened a new med school after a decade of planning. 1.5% acceptance rate.

[waterhouse]

> This is arguably rational because the pool is small and there's little to gain by studying harder if you already have a perfect GPA.

So there is a low ceiling, and if they instead used MCAT or something with a higher ceiling (where, apparently, the number of perfect scores is about 50 per year—in America, presumably lower in Canada due to population size), then studying harder would benefit them. That seems like a much better outlet for competitive urges.

But also, how small is the pool of qualified applicants? If there were something like "they're going to take n people from your school, at which there are 30 plausible candidates", then sabotaging one might conceivably be worthwhile. But if the pool is—well, Google says 3,000 medical students get accepted each year in Canada (and the qualified applicant pool is presumably at least somewhat larger), and sabotaging one person is extremely unlikely to help you personally. (This is one case where it's good that the expected-value "benefits", of sabotaging person X, are widely distributed among thousands of medical candidates, and thus it's a "free-rider problem" where no individual candidate has a strong motivation to do the work.)

Is there some multi-stage thing where they pick 10 people from each high school, or 30 from a town, or something? Or is there major grading on a curve, or a big benefit for being the top person in your classroom of 15? That seems like how you would get real incentives for this backstabbing behavior. Otherwise, I can't see how it's rational (even to a complete sociopath), and would have to chalk it up to individual miscreants and possibly some kind of culture that encourages it in other ways.

[jjmarr]

> Or is there major grading on a curve, or a big benefit for being the top person in your classroom of 15?

Yes. UofT even has "down curves" where your mark is lowered to ensure the correct distribution.

[triceratops]

> Because there are so many applicants that have good grades.

So train more doctors.

[waterhouse]

That would increase competition and thus depress wages for existing doctors, who are the ones who make the decisions here. I heard, from a medical school attendee, that she overheard some doctors discussing whether it would be a good idea to require a fifth year of medical school to become a general practitioner (luckily, they were like, "Eh... nah"). It did not seem like it bothered them that this would make it even harder for civilians to get medical care.

[triceratops]

I thought lawmakers made the decisions. Silly me! :-D

[waterhouse]

Theoretically yes. But I think at least part of the decision they've made is to delegate a chunk of the decisionmaking to doctors' guilds. Which—on the one hand, they are experts of a sort, but on the other hand, they have an obvious conflict of interest.

https://en.wikipedia.org/wiki/American_Medical_Association#R...

Wow. 1997: https://www.baltimoresun.com/1997/03/01/ama-seeks-limit-on-r...

> “The United States is on the verge of a serious oversupply of physicians,” the AMA and five other medical groups said in a joint statement. “The current rate of physician supply — the number of physicians entering the work force each year — is clearly excessive.”

> The groups, representing a large segment of the medical establishment, proposed limits on the number of doctors who become residents each year.

> The number of medical residents, now 25,000, should be much lower, the groups said. While they did not endorse a specific number, they suggested that 18,700 might be appropriate.

[triceratops]

I've read about that before. I personally am of the belief that Medicare funding for residency slots should be eliminated over time. Also freely allow the opening and expansion of medical schools and teaching hospitals. Over time things should settle into a comfortable equilibrium of enough doctors making decent wages for everyone to be treated at a reasonable cost.

But maybe that's a free market fantasy. Who knows.

Or the alternative. Government-owned everything healthcare - facilities, hospitals, med schools, doctor practices. Doctors only work for the government.

The current system is neither here nor there and is designed for maximum profit.

[vel0city]

> Because there are so many applicants that have good grades.

Sounds like we need more spots for these people to go