It wasn't long ago that the U.S. News & World Report were the agreed-upon arbiter of prestige and quality in medical schools. Sure, you might quibble with their results or their methodology, but at the end of the day we all begrudgingly conceded that only U.S. News could decide which schools were better than others.
But a lot has changed over the past 2 weeks.
Starting with , the majority of the top 20 medical schools per U.S. News have announced they'll no longer contribute data to the rankings.
This mass exodus raises many questions about what this means for the schools that left, the schools that stayed, the longevity of the rankings, and the ecosystem of medical school admissions at large.
So, you know what that means. Yep, that's right: It's time to break it down, "Winners & Losers" style.
Winner: The Medical Ivy League
While all of the departing schools have released statements cataloguing their numerous (and legitimate) reasons for departing the U.S. News rankings, make no mistake, this was ultimately a strategic decision for each of them.
Maintaining a top position is difficult. It requires ongoing and careful attention to the ranking formula and strategic decisions about how to maximize performance in each dimension. For medical school deans, the whole process is expensive -- and tiresome.
And what do the most prestigious medical schools have to gain by helping U.S. News rank them? Not much. If the average person already believes that, say, Stanford is a better medical school than the University of Pittsburgh, why provide data to U.S. News that could be used to change their minds?
So, one after another, the medical Ivies have decided that playing U.S. News' game isn't worth it. They're taking their ball -- and their top 20 ranking -- and going home.
Loser: NYU Grossman School of Medicine
No school has risen faster in the U.S. News "Best Medical Schools" rankings than NYU Grossman. NYU was a solid top-50 medical school just 15 years ago. Last year, it in the country.
NYU's meteoric rise coincides with dramatic structural improvements fueled by a , and I've talked to a couple of pundits who believe the school would have seized the #1 position next year even if the medical Ivies had continued to participate.
NYU Grossman may still seize the top spot -- but their victory won't be as sweet if the schools they wanted to beat claim they're not playing anymore.
Loser: U.S. News & World Report
Quick question: When's the last time you looked to U.S. News & World Report for news or reporting on anything other than rankings?
Yeah, I can't remember, either.
U.S. News' transformation from the nation's third-favorite weekly news magazine in the end days of print media to the kingmaker of academics is by Malcolm Gladwell. But suffice to say, these days the entire U.S. News business is built around ranking one thing or another.
U.S. News has successfully monetized most everything around their rankings. If you're an applicant and you want to see the full rankings, it'll cost you $29.95. If you work for a school and want more detailed data for visualizations, historical trending, or benchmarking versus your peer institutions, that'll cost you . Want to to potential students in the U.S. News rankings? You better believe that'll cost you. If you just want to use the U.S. News & World Report badge on your own marketing materials, you can do that too. (But it'll cost you.)
The less attention people pay to their rankings, the more it hurts U.S. News' bottom line.
Winner: Ranking Entrepreneurs
Even if the U.S. News rankings disappeared entirely -- which they won't -- they'll just be replaced by another ranking system. We have an insatiable desire to rank things. The medical Ivies can withhold their data, but they can't keep people from having an opinion -- or trying to make a buck.
Of course, any startup will have to compete with the old boss because U.S. News isn't going anywhere. They may lose some of their legitimacy, but they'll just reconfigure their formula to exclusively use data acquired from public sources and carry on as usual.
(And don't think for a minute that this didn't occur to the medical Ivies leading the U.S. News exodus. To maintain legitimacy, whatever methodology U.S. News uses must yield something that approximates the rankings consumers expect...so all these schools will remain at the top of the list. Better yet, if they do slide a few places, now they have a ready defense: "U.S. News? Pah! We don't even submit data to them anymore!"
Loser: Educational Consultants
Schools pay five- and six-figure fees to consultants to analyze the U.S. News algorithm and recommend strategies to maximize their ranking.
My guess is that these folks will pivot even harder into supporting Liaison Committee on Medical Education (LCME) accreditation or improving diversity, equity and inclusion (DEI) metrics.
Winner: Campbell's Law
Whatever variables U.S. News -- or their upstart competitors -- use in their next-generation ranking methodology, I can tell you this much: some schools are going to chase it.
: "The more any quantitative social indicator is used for social decision-making, the more subject it will be to corruption pressures and the more apt it will be to distort and corrupt the social processes it is intended to monitor."
In this case, Campbell's law isn't just a winner -- it's friggin' undefeated. We can only hope that any new metrics will lead to less pernicious chasing.
Loser: The MCAT
Historically, among the most impactful variables in the U.S. News ranking formula has been the Medical College Admission Test (MCAT) scores of entering students.
On its face, this always struck me as a curious analytic decision. After all, what can scores on a test that students take before they enter medical school tell you about the quality of education that students receive once they're enrolled?
In practice, U.S. News prioritized test scores because including the MCAT (and the infamous U.S. News ) allowed them to put a thumb on the scale and ensure the final rankings maintained face validity.
Regardless, the primacy of the MCAT in U.S. News stabilized the primacy of the MCAT in admissions. Now, schools are more free to interpret MCAT scores in a manner more consistent with their .
Push: Honesty
It's well known that schools sometimes get a little they submit to U.S. News.
But whether the depreciation of the medical school rankings will be a victory for honesty is unclear. Most of the departing schools have announced they'll put detailed information for applicants on their own webpages. But whether those data will permit an apples-to-apples comparison or just enable more fudging has yet to be seen.
Winner: The U.S. News 'Best Hospitals' Rankings
Many institutions that dropped out of the U.S. News medical school rankings have been careful to note that they're not dropping out of the "Best Hospitals" . Several spokespersons try to draw a bright line between the school and the hospital rankings, arguing that the latter provides a valuable service to patients and families and uses more defensible methodology.
I, for one, am skeptical that the Best Hospitals tortured regression models provide any more meaningful insight than their educational rankings. Maybe the hospital administrators just have more stamina for metric chasing than their dean counterparts. More likely, the payoffs for winning the hospital rankings are simply higher. If you can shift even a few patients who need expensive surgeries or complex care (like transplant or oncology) to your "Best Hospital," you can pay for a whole lot of metric-chasing.
Winner: The OGs
To whatever extent this moment in history will be remembered by future generations, it'll likely be recalled that Harvard was the leader who broke medical schools out of the U.S. News rankings.
Sure, Harvard was the first domino to fall in this final cascade -- but they're far from the first school to conscientiously object to these rankings. In 2016, citing the perverse incentives and flawed methodology, the deans at Uniformed Services University of the rankings. Most osteopathic medical schools and historically Black college and university (HBCU)-affiliated medical schools -- knowing that the deck was stacked against them -- have also declined to return the U.S. News survey in recent years.
These OGs can celebrate being on the right side of history -- even if history doesn't remember their contributions.
Winner: Medical School Missions
Are medical schools really in one big competition with each other to be The Best? Or do schools serve different populations, meet different societal needs, and have different aspirations?
The primacy of the U.S. News rankings makes it harder for schools to pursue missions that aren't captured by the metrics. Maybe now schools will have a little more breathing room to pursue goals in physician training that aren't easily reduced to a single number. And maybe -- just maybe -- when they do, their graduates' future patients will win too.
is a pediatric nephrologist and an opinionated commentator on medical education and training.