For a period of time during your medical training, USMLE scores seem to be the only thing that matters. You’ve heard it before: study hard, score well. Devote your life to your dedicated study period, score high, and you can pick whatever residency you please. Your score, it seems, is absolutely everything.
And then all of a sudden, after medical school, the paradigm built around achieving high USMLE scores fades into nothing. Maybe our scores show up on a CV, or play a small part in fellowship applications, but for the most part, they’re vestiges of our training we no longer reference. Patients have no idea what our scores are. Colleagues don’t know. The nurses and ancillary staff don’t know either.
This begs the question: when it comes to caring for patients, do USMLE scores actually matter? If so, are they the most important thing, or are other issues of more practical importance when it comes to patient care?
Let’s examine these questions in detail, starting with whether test scores actually predict patient outcomes.
Do USMLE scores actually predict patient outcomes?
A 2023 study by Norcini et al., “The Associations Between United States Medical Licensing Examination Performance and Outcomes of Patient Care,” aimed to look at the difference in outcomes for five common hospital admission problems across different USMLE scores.
What did they find? In short, doctors who did better on their exams did better for their patients, too. In fact, the better a patient’s doctor did on their licensure exams, the less likely the patient was to die in the hospital.
So, the findings are pretty clear. Better USMLE scores are associated with better patient outcomes. It’s hard to argue against the scientifically published data, but the question now becomes what, exactly, do we do with this information?
Let’s examine this question in the context of other factors that impact the quality of patient care, including a doctor’s bedside manner, overall experience, and the impending physician shortage that will have a serious effect on the healthcare system.
USMLE scores aren’t the only things that matter.
If I were hospitalized, surely I’d want the greatest chance of survival, and the most knowledgeable physician to treat me. But there are so many variables that go into test-taking. And are USMLE scores the only thing that matters when it comes to patient care?
For example, what if you have the most compassionate, empathetic, and experienced doctor, but they struggled 22 years ago with basic biochemistry that plays no part in their day-to-day practice of oncology? Do you care?
I seriously doubt it, and there are more important character traits and exemplary qualities we should be looking for in our physicians, rather than focusing so much on their score.
The physician shortage affects quality of care, too.
In our system of medicine— where you’re assigned a physician and have to take what you can get—we should be happy that the screening process is as rigid and selective as it is.
But this comes at a cost. The Association of American Medical Colleges predicts a physician shortage of 124,000 doctors by 2034.
And, when a patient is sitting in the hospital post-MI, or with a heart failure exacerbation, will they have the gall to ask their physician about their board performance? When looking at the need for more physicians, one might argue that the bar needs to be lower in order to adequately staff clinics and hospitals.
After all, what do extreme shortages mean for patients? Patients are forced to face longer wait times, they must secure harder to obtain appointments, and will struggle to schedule necessary surgery in a timely fashion. It means living with your tumor for a longer period of time. It means sitting at home unable to get a sick visit, or having to face a delay in diagnosis.
What if we lowered the barrier to entry?
Certainly, there are ways to ameliorate this impending staffing crunch. To start, we could increase the number of national residency spots. Mid-level practitioners like NPs and PAs could be granted a wider scope of practice.
What does this mean as far as scores? Rather than an MD or DO seeing you in the office, you’ve got someone who has not taken a physician licensure exam.
Naturally, mid-level providers have their own exams to pass for certification, but these scores cannot be compared to USMLE scores. Expanding the number of residency spots means that more, less qualified (though not necessarily unqualified) applicants will be granted licenses to practice.
So, do USMLE scores matter? Here’s the bottom line.
Ironically, I believe the most salient thing to come from Norcini’s study is that we can’t just focus on USMLE scores. In a perfect world, you can choose your concierge physician and query them to ensure their scores are high enough. But when you need your appendix out while visiting grandma over the holidays in a rural underserved area, you’re gonna take what you can get: a licensed surgeon who has merely passed the necessary exams.
In the US medical system, finding a physician who aced their USMLE exams is a luxury only available to a select few. And certain qualities—like empathy and experience—are also so important when it comes to the quality of patient care.
So, what does this mean for you as a med student approaching your USMLE exams? Study hard for your exams in order to become the best physician you can be. Focus on building your soft skills just as much as your medical knowledge. Your hard work and dedication won’t just pay off when landing a residency program, but also for your patients.
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