Cameron Brown knows he can’t wait to be a doctor, and as of earlier this year he had years worth of experiences to show for it on his application. He had experience working full-time at a neurology clinic and a job lined up researching the impact of housing mobility on children with asthma. Beyond what could be seen on his LinkedIn profile, Brown had a personal interest in making health care more accessible after witnessing the barriers his family, many of whom are immigrants or people of color, faced.
The one thing Brown didn’t have was an Medical College Admissions Test (MCAT) score.
Each year, more than 85,000 students take the MCAT in order to share their scores with prospective medical schools. With a $325 registration fee and an average prep time of 200 to 300 hours for high scorers, the MCAT has often been criticized as a “barrier to entry” for underrepresented applicants. With increasing calls for diversity in health care since 2020, the way admissions committees use the MCAT has the potential to change the demographic makeup of a given medical school class.
Brown knew he wanted to apply in this cycle to start medical school in 2023, so he scheduled a testing time in April 2022. While he didn’t have family members in health care who could advise him, he reached out to other students at Hopkins about the best ways to prepare. More mainstream prep courses can run from $3499 at the Princeton Review to $6999 at Kaplan.
Being on a budget, Brown opted instead to buy a used set of prep books online and talk to his parents for assistance purchasing $350 worth of prep material from the Association of American Medical Colleges (AAMC), the nonprofit that writes and administers the MCAT.
The night before his exam, he reported feeling so anxious that he was not able to sleep in an interview with The News-Letter.
“That was partly promulgated by the message I got from Hopkins Institution, explicitly from faculty and from the pre-med advising office who told me that my GPA was not good enough to get into medical school and the only way I could make up for that was a high MCAT score,” he said. “I remember going into that exam room and feeling very exhausted.”
About a week before his graduation, Brown received his score back. He had scored eight points lower than his highest practice exam.
While Brown reported being aware that the MCAT had an important role in his application, medical leaders have also called for changes to admissions practices that take into account the challenges students may face in preparing for and taking the MCAT.
Dr. Max Jordan Nguemeni Tiako, a resident at Brigham and Women’s Hospital in Boston, published a narrative review this year on how medical schools sustain racial inequality in their admissions and education practices. He commented in an interview with The News-Letter on the nature of how admissions committees view MCAT scores.
“The MCAT in itself, it’s a test. I don’t think it’s inherently bad. It’s what we do with it,” he said. “Schools probably want a higher average MCAT score so they can look smart on paper or look like they’re competitive for the US News ranking purposes.”
While medical schools are often incentivized to admit a class of students with high MCAT scores for objective ranking purposes, one study reported that students in the middle third of scores (495-504) have similar graduation rates to students who scored in the upper third of scores (505-528). Schools that admit more midrange applicants also tend to have more diverse classes.
Tiako also noted that there is limited data on students who never took the MCAT but still attended medical school thanks to early-assurance programs such as Brown’s Program in Liberal Medical Education. A study comparing applicants who applied to Brown with or without the MCAT found comparable residency placement outcomes and a marginal difference in medical school grades.
After getting his score back, Brown scheduled an appointment with the Office of Pre-Health Advising and was told to retake the exam no later than June if he still wanted to apply this cycle. While Brown did report being advised to enroll in a masters or post-baccalaureate program to improve his GPA and thus compensate for a lower MCAT score, he knew that wouldn’t be a viable financial option for him; Hopkins’ post-baccalaureate program currently costs $45,360 a year and does not offer financial aid.
“I got lucky with [my] undergraduate, but I’m not going to get lucky with medical school. That’s going to be $300,000,” Brown said.
Over the next six weeks, Brown balanced graduation and submitting his primary medical school applications with studying for the MCAT full-time. He purchased a subscription to UWorld, a popular MCAT prep platform, for $150 and began to score higher than he had when studying before. He reports coming out of his June exam feeling much more confident than he had in April.
On August 1, Brown received his score back. He scored the exact same he had in April.
According to the AAMC, an MCAT score does not necessarily have a one to one ratio with how many questions a test taker gets right or wrong. Rather, each raw score is scaled based on the difficulty of a given test and how other test takers performed that day. This is also part of the reason it can take scores 30 to 35 days to come back to students; this scaling process takes a significant amount of time.
At this point in the application cycle, Brown had already submitted his primary application and had little choice but to go forward applying with his given MCAT score. Ultimately, he hopes that admissions committees will be able to look beyond the numbers not only on his application but on other medical school applicants.
“I think the health care system weeds out the wrong people. They want people who are going to find cures and new ways of treatment, which is great and we need that. But that also comes at a cost because we’re selecting for people who are going to be really great in the lab, but not in the clinic,” he said. “It doesn’t matter how much I understand inorganic chemistry. Ultimately my patients won’t care.”
Ellie Rose Mattoon is a junior from Austin, Texas majoring in Molecular and Cellular Biology and Public Health. Project MD 2027 documents the challenges, inequities and triumphs of Hopkins students applying to medical school for entry in 2023.