change begins now.

Asking someone to join a group - or profession - brings a long list of values and behaviors with them which is why these authors deserve enormous credit for focusing on who gets into medical school rather than what is done to them once they enter. The lack of focus on and applicant's lived experience and community of origin has been peripheral. A singular focus on scores on competitive exams may be one factor behind over 30 years of US medical school matriculants coming from high income families from wealthy urban counties. Cultural, racial, ethnic, and socioeconomic factors affect physician effectiveness, career choice and location of practice. Yet MCAT scores and grade point averages continue to become the keys to the kingdom. One colleague asked many decades ago "what would a 4.0 GPA at a small regional school be the equivalent to at Duke?" Lots of things to talk about in a comment like that.

It should not be a surprise that the US physician workforce look like it does since most of the factors that are related to to a career in primary care are the ones that the authors advocate for including in their recommendations for revolutionary changes in admission policies. Young people with limited life experiences, a record of success, and few experiences with the broad populations of this country increase the potential for misguided expectations and a sense of entitlement in the current products of the admissions process in medical schools. Therefore, the recommendation for reform from this article makes it essential to begin the suggested changes now. The pipeline is very long and the country doesn't have the time to waste.