In response to criticism from the medical community, the U.S. News & World Report updated the methodology behind their 2022 Best Medical Schools in Primary Care ranking. A recent JAMA Viewpoint article entitled, “Increasing Transparency for Medical School Primary Care Rankings—Moving From a Beauty Contest to a Talent Show“ by Robert L. Phillips Jr, MD, MSPH, Andrew W. Bazemore, MD, MPH, and John M. Westfall, MD, MPH described the updates: “The rankings were modified in 2021 such that 30% of the score is now based on graduates practicing primary care after their residency training, rather than those entering primary care training. Initial residency comprises 10% of the score, which still overestimates primary care, but this measure has been reduced from its previous weighting of 30%. The remaining score (60%) is still largely based on reputation, which is assessed by (1) surveys of medical school deans, internal medicine chairs, or admissions directors (15%); (2) survey of primary care residency directors (15%); (3) student selectivity (median Medical College Admission Test score, 9.75%; median undergraduate grade point average, 4.5%; acceptance rate, 0.75%); and (4) faculty to student ratio (15%).” The authors call the updates to the methodology “a step in the right direction,” although they continue to express that the reputation portion of the score is subjective and self-perpetuating.
More important than the methodology update, the authors say, is U.S. News's addition of four new data-based rankings. The newly added rankings include: 1) graduates practicing primary care; 2) most diverse medical schools; 3) graduates practicing in medically underserved areas; and 4) graduates practicing patient care in rural areas. These rankings were created with the Robert Graham Center, a division of the American Academy of Family Physicians, and were defined to measure medical schools’ performance on key health care issues. The graduate-based rankings use data collected five-to-seven years after a physician’s training, making them more reflective of student outcomes and better able to showcase the public health contributions of schools that are hidden within the broader rankings. For example, the authors point to the disparity seen in the Harvard Medical School rankings; the medical school, ranked 8th for Best Primary Care, ranks 141st for graduates practicing in primary care fields. Conversely, the Pacific Northwest University of Health Sciences, which is unranked in the primary care ranking, ranks second for graduates practicing in primary care fields, second for graduates working in medically underserved communities, and seventeenth for graduates working in rural areas.
One of the article’s authors, Dr. Phillips, speaking with the AMA, notes that students should understand the large role that reputation plays in the mainstream rankings and should proceed with caution when using the rankings to inform their medical school options. “Students should be careful in using medical school rankings to inform their choices as many rankings are opinion-driven.” Rather, he recommended that students consider the more objective, data-driven rankings based on where and what graduates end up practicing. “We also hope that the new ranking heralds continued improvement of the information that help students make career decisions.
On a wider-scale, the authors call out the importance of the four new rankings in providing transparency into how schools contribute to key social outcomes, for policy decisions by both states and medical schools themselves. “These outcome measures should help medical schools to assess fidelity to their missions and alter admissions, curriculum, and training settings if different outcomes are desired.”