U.S. News and World Report Medical School Meltdown

How the fragile ecosystem of ranking crumbled so quickly

Medical schools have had enough. Citing concerns over the impact of the rankings on educational priorities, several of the nation’s top-ranking medical schools have withdrawn participation in U.S. News & World Report’s Best Medical Schools survey. Fierce Healthcare has a good rundown. Adam Cifu on the excellent ‘stack

Sensible Medicine

breaks it down better than anyone.

More interesting than those falling off are those staying.

The calculus is interesting. Harvard could drop because they live under the magical belief that they do something special. In fact, it was probably a smart move - they have nowhere else to go but down. But now they can live in infamy as reigning champion.

The lower players in the upper half know they could never reach number one, despite hard work, investment and proven success. So they’re all breathing a sigh of relief. It looks like some of the mid-listers are desperately holding out to finally claim ‘Number One’ as those ahead drop off.

What’s remarkable to me is the fragility of the ranking ecosystem. One falls, followed by a second. Then the whole thing just caves in. (The elephant in the room: Is health system ranking just as fragile? While the process for judging hospitals and systems is more robust and evolving, I don’t think it’s immune to this kind of collapse. More on this later…)

The long-running relationship between medical schools and U.S. News has been like a game of chicken — despite crowing over their perverse incentives, no school alone could afford to stare down U.S. News and collide with them at the last minute. We’ve become so dependent on judging higher education by this one measure that we really don’t know how to operate.

Maybe I’m wrong here, but it looks like a done deal for the medical school rankings. But I’ll push back and say that I think it’s unfortunate. And I think I’m in the minority here. Doctors and people on the operating end of these rankings don’t like these measures.

I just think amazing work should be rewarded. And ranked. But we’ve evolved to fear the idea of any kind of merit or reward. The problem is that the incentives in higher education, from admissions to accreditation and U.S. News, are tired and predictable. They hold medical education back. As another example of Goodhart’s law, the game has become more about studying to the test and riding on century-old reputations rather than serving the next generation of doctors and patients.

We still teach medical students like it’s 1910 — percussion, for example, is apparently still a competency. U.S. News is (was) uniquely positioned to lead and shake things up in education. And if they were smart they’d salvage their brand and take a scorched earth approach. Maybe incent schools to develop curricula that move the chains and prepare doctors for a very different future. Let’s acknowledge and reward those on the fringe assuming risk and doing the hard work rather than the tired incumbents.

Probably a good thing Harvard dropped.