Hi all, some good and interesting points from different perspectives. I was a little nervous to start this conversation as it might be contentious, but now I am glad to have done so. I will reply to what I can, but I recognize that my logic, knowledge, or experiences are limited and may not necessarily be applicable.
I've noticed a few responses that have the same pattern. Yes, the system is imperfect. And there are and will be many flaws that can't all be addressed. These flaws are not limited to medicine or its admissions. However, does that mean that we shouldn't try to address them? It pains me to see that, since the time Queen's Medicine expelled its black students, during 3 generations, we are just barely starting to encourage indigenous, black, and low-SES students to apply in a few select programs in some schools across Canada. These populations and their difficulties have existed for a long time and it's not a current issue.
With support, the majority of people can be trained to be competent at a procedure, and even do it extremely well. However, things like compassion and empathy are harder to train, if at all trainable. Is it ever possible to train somebody to truly understand what it's like for somebody working 2 jobs to support a family, unable to afford and adhere to their medication, living paycheck to paycheck, stressed from waiting every day for the other shop to drop (emergencies, sickness, etc.). I'd argue no, unless that training provides extensive living experience in their shoes. Why is this important? As their doctor, you are providing care that will need to be tailored to their circumstances, otherwise they will not be able to adhere to your treatment plan due to their circumstances getting in the way. No matter how hard they try. When the selection process is unfortunately biased in favour of selecting for those who are well-off, which is apparent when you see most current practicing physicians, this becomes a systemic problem.
Yes, many selection systems naturally select for people who can jump through the predetermined hoops, no matter how arbitrary they may be. But does this truly assess a person's competency or their ability to be competent as a doctor? How well can you jump through a hoop if your leg is lame? Similarly, many people are afflicted with poor situational circumstances that prevent them from displaying so-called competency.
Yes, Canada is blessed to have schools that try to recognize and serve their local population (Western with its SWOMEN program), including different eligibility criteria used. There may be a school that caters to each kind of applicant and they will have their niche of opportunity. Unfortunately, due to the sheer level of competition, applicants simply cannot afford to apply to that one school and realistically expect to get in. A successful applicant is usually the one who has the ability and the means to jump through as many hoops as possible and satisfy the criteria of many schools. Through attrition, this means that less fortunate applicants are lost as potential doctors, who may have provided a valuable perspective due to different experiences.
Let me put it to you this way. A black kid grows up a poor neighborhood with a struggling family. Somehow, against all odds, they are convinced that they can be a doctor despite not being able to afford classes or time to study or the means to travel to volunteer. Due to their poor circumstances, they work under the table (illegally) doing odd irregular jobs (A McDonalds position would be lucky) to support their family, and consequently they have a low GPA in university and limited experiences that admissions likes or finds palatable. They can't afford to take the MCAT twice or the Casper. They never learned French. They decide to apply to UofT, which has a program for black students. However, due to the sheer number of people vying for the same spot, they don't get in. And so we lose a potential doctor who could have served their neighborhood and recognize what it's like growing up in their situation.
Yes, my perspective is limited and I should not try to assess applicants by their involvement in one activity. They may have really given it all in other domains of their lives and were not able to do the same in mine. However, my point is that Medical Schools are vulnerable to that exact same bias. Many of these schools also view applicants through a similarly limited perspective (though better than mine), which does not fully capture the applicant's potential and activity.
Ultimately, I am heartened to see recent changes like Ottawa's low SES initiative, but I'm concerned that medical schools are not adapting quickly enough to the needs of their communities.