We have a critical shortage of doctors and nurses in Canada. Almost a quarter of our population can’t find a family doctor. Wait times for seeing a specialist, getting medical imaging and surgical dates continue to climb, with only Band-Aid solutions being proposed by the federal and provincial governments. We desperately need to expand medical schools and the licensing of highly qualified foreign medical graduates.
So it was welcome news to hear that 94 undergraduate medical students and 105 postgraduate students (residents) will be entering the newly established Toronto Metropolitan University School of Medicine when it opens in September 2025. The city of Brampton, Ont. donated a former civic centre along with $20 million in funding for renovations in order to make the school happen.
However, it was highly disturbing to learn that admissions to the new facility will be driven by a culture-war philosophy that will dilute the quality of medical practice.
There’s no doubt that diversity in medicine helps to optimize care and provide better outcomes for the differing needs of Canada’s highly diverse population, which includes many individuals disadvantaged by their geography as well as racial and economic inequality. But TMU is going about it the wrong way. Its admissions policy will focus on DEI (diversity, equity and inclusion) rather than quality.
TMU’s plan is to reserve 75 per cent of its enrolment slots for “equity-deserving” students — Black and Indigenous applicants and others who meet “equity-deserving” criteria including students who identify as members of the 2SLGBTQ+ community, those who are “racialized” and individuals “with lived experiences of poverty or low socio-economic status.” It will accept a minimum grade point average (GPA) of 3.3 (B+) — or even less for select Black and Indigenous applicants — and then use GPA only as an application criterion, not as a selection criterion. By comparison, the University of Toronto’s Temerty Faculty of Medicine requires a minimum GPA average of 3.6 for undergraduate applicants (although average acceptance is now 3.95).
The MCAT (Medical College Admission Test), which is a standardized, validated test used by almost all medical schools in North America to evaluate broad knowledge and critical decision-making skills — qualities essential for a physician — will not be an important consideration for admission at TMU. The university considers the MCAT biased and racist despite it being the best standardized test available.
Let’s analyze TMU’s assumptions and their validity
TMU assumes that all white applicants are advantaged and over-represented when compared with the general population.
The 2021 Census found that close to 70 per cent of Canadians identified as being white. The largest racialized groups in our population that would receive preferred admission at TMU include South Asian (7.1 per cent), Indigenous (five per cent), Chinese (4.7 per cent), Black (4.3 per cent) and Filipino (2.9 per cent). It is difficult to get Canada-wide statistics for diversity in medical admissions. However, according to a 2016 report from U of T’s Temerty Faculty of Medicine, about 25 per cent of the students were Chinese, thus far from being under-represented. South Asian students accounted for 16 per cent. Although it said Indigenous and Black Canadians were still “woefully under-represented” at 2.0 per cent and 1.0 per cent respectively, it had programs aimed at improving that representation.
The medical schools most focused on increasing Indigenous enrolment are based in Alberta and Northern Ontario. The hope is that graduate physicians trained close to home will go to work in the under-serviced communities they came from. Residents of First Nations also need much improved general education, better mental health facilities and better economic opportunity to improve their ability to enrol in medical schools.
Gender is no longer an issue at medical schools. Women now make up close to 60 per cent of admissions in Canada. In fact, at TMU’s new medical school, it could well be white males who will be severely under-represented when compared with the general population.
TMU wrongly thinks it will level the playing field for students from low-income families. But it does not yet have the funded scholarships for students in need that other universities have. The University of Toronto has the philosophy of helping students find resources. Its admissions policy looks for the best and the brightest yet tries to increase diversity through special streams and increased financial support. It does this without sacrificing quality. It also rewards commitment to advocacy as expressed through community service, leadership skills and academic productivity including publications. TMU doesn’t appear to care much for any of these important qualities.
What do we need in a medical school?
We need effective strategies to improve health outcomes by dealing with unmet needs, and increasing efficiency and innovation of care delivery. Our current health-care system usually doesn’t deliver on availability and also doesn’t adequately address mental health issues and the need for greater prevention of disease. We lack innovative strategies to improve access and to reduce disease burden and its costly care. We need to modernize the medical curriculum to refocus on these needs and incorporate innovations in learning methods and the use of AI to guide decision-making.
TMU’s approach to its new medical school highlights the failings of culture warriors. It sees the solution to increasing diversity as lowering standards and avoiding meritocracy. It risks training a generation of physicians who won’t perform at a high level, and are unlikely to create the research that drives the discovery of the life-saving treatments of the future. Medicine continues to require high skill levels with a focus on critical thinking and problem solving.
The Canadian people deserve better than what TMU has to offer. Governments should know better and not fund its hypocrisy, and patients need to vigorously complain that TMU won’t solve their unmet needs. They are not now and never will be the future of medicine.
National Post
Dr. Harry Rakowski is an academic Toronto cardiologist and commentator.