It wasn’t long ago that the U.S. News & World Report rankings were the agreed-upon arbiter of prestige and quality in medical schools. Sure, you could quibble with their results, or their methodology… but at the end of the day we all begrudgingly conceded that only USNWR could decide which schools were better than others.
But a lot’s changed over the past two weeks.
Starting with Harvard, the majority of the Top 20 medical schools per U.S. News have since announced that 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 USNWR rankings, and the ecosystem of medical school admissions at large.
So you know what that means.
Yup, that’s right. It’s time to break it down, Winners & Losers™️ style.
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WINNER: The medical Ivy League.
While all of the departing schools have released statements cataloguing their numerous (and legitimate) reasons for departing USNWR, 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 might change their mind?
So one after another, the medical Ivies have decided that playing USNWR’s game isn’t worth it. They’re taking their ball – and their top 20 ranking – and going home.
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LOSER: NYU.
No school has risen faster in the USNWR medical school rankings than the NYU Grossman School of Medicine. Fifteen years ago, NYU was a solid top-50 medical school. Last year, it ranked #2 in the country.
NYU’s meteoric rise coincides with dramatic structural improvements fueled by a massive influx of cash, and I’ve talked to a couple of pundits who believe the would have eventually taken the #1 position in USNWR even if the medical Ivies had continued to participate.
NYU may still seize the top spot… but their victory won’t be as sweet if the schools they wanted to beat say they’re not playing any more.
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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.
USNWR’s transformation from the nation’s third-favorite weekly news magazine to the kingmaker of academics is best chronicled by Malcolm Gladwell. But suffice to say, these days the entire USNWR business is built around ranking one thing or another.
USNWR 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 even more. Want to advertise to potential students on the U.S. News rankings? You better believe that’ll cost you. But if you just want to use the USNWR badge on your own marketing materials, you can – but yeah, it’ll cost you.)
The less attention people pay to their rankings, the more it hurts USNWR’s bottom line.
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WINNER: Ranking entrepreneurs.
Even if the USNWR 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 USNWR exodus. To maintain legitimacy, whatever methodology U.S. News uses must yield something that approximates the rankings that 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!
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LOSER: Educational consultants.
Schools pay five- and six-figure fees to consultants to analyze the USNWR algorithm and recommend strategies to maximize their ranking. My guess is that these folks will pivot even harder into supporting LCME accreditation or improving DEI metrics.
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WINNER: Campbell’s law.
Whatever variables USNWR – or their upstart competitors – decide to use in their next generation ranking methodology, I can tell you this much: schools are gonna chase it.
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 than the old.
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LOSER: The MCAT.
Historically, among the most impactful variables in the USNWR ranking formula has been the MCAT 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, USNWR prioritized MCAT scores because they (and their infamous reputation scores) allowed them to put a thumb on the scale and ensure the final rankings maintained face validity.
Regardless, the primacy of the MCAT in USNWR stabilized the primacy of the MCAT in admissions. Now, schools are more free to interpret MCAT scores in a manner more consistent with their predictive ability.
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PUSH: Honesty.
It’s well known that schools sometimes get a little loosey-goosey with the data they submit to USNWR.
But whether the depreciation of the USNWR 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.
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WINNER: The USNWR Best Hospitals rankings.
Many institutions who 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 rankings. 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 the salaries of a whole team of metric-chasers.
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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 USNWR 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 being ranked by USNWR.
In 2016, citing the perverse incentives and flawed methodology, the deans at Uniformed Services University pulled their school out of the USNWR rankings. Most osteopathic medical schools and HBCU-affiliated medical schools – knowing that the deck was stacked against them – have also declined to return the USNWR survey in recent years.
These OGs can celebrate being on the right side of history… even if history doesn’t remember their contributions.
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WINNER: Medical school missions.
Are medical schools really in a one big competition with each other to be The Best? Or do schools serve different populations, meet different societal needs, and have different aspirations?
But the primacy of the USNWR 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.
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Note: A version of this piece originally appeared on MedPage Today. There’s also a video on the Sheriff of Sodium YouTube site.
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