Ford demands TMU’s new med school educate qualified students ‘regardless of their race’

Premier Doug Ford is demanding Ontario’s newest medical school educate qualified individuals “regardless of their race or background,” amid backlash over the school’s plan to loosen academic qualifications and screen out prospective students by race or status.

Toronto Metropolitan University’s new medical school in Brampton is expecting more than 5,000 applicants for 94 spots, of which three-quarters will be designated for students who are Black, Indigenous, or from “equity-deserving” groups. The latter include those who identify as LGBTQ, disabled, poor, and “racialized people.” It has also loosened certain common academic requirements.

Those decisions have sparked debate, and Ford’s office told the National Post it has stepped in.

“The government has spoken to TMU about their equity admissions,” Grace Lee, Ford’s director of media relations, said in an email Thursday evening.

“While we are making sure that Ontario students are prioritized for medical school seats in Ontario, medical schools must ensure that qualified individuals fill these seats, regardless of their race or background.”

TMU did not react immediately to a request for comment.

In an interview earlier this week, Dr. Dominick Shelton, the TMU med school’s dean of admissions, talked about graduating from medical school at the University of Toronto more than three decades ago, where he was one of two Black students in a class of 252.

There are many groups in medicine “that traditionally have been under-represented,” Shelton said. “That is an important part of why we (created) all these pathways in order to bridge that gap.”

Alongside the explicit exclusion of anyone who doesn’t fit the equity requirements, the relaxation of certain academic requirements has raised critics’ ire. TMU forgoes the common entry test, and requires applicants only to complete a four-year undergraduate degree of any type with a minimum Grade Point Average (GPA) of 3.3, or B+.

“If you came from an Indigenous community and you have a low GPA, and you couldn’t compete in university, how are you going to compete in medical school?” said Dr. Harry Rakowski, a Toronto cardiologist.

“Does that mean you have to lower your standard of teaching?”

Rakowski said he’s concerned “that there’s a breed of doctors who are under-trained because they’re not pushed hard enough. This accelerates that concern.”

Shelton countered that “there are three (out of six) other medical schools in the province that have lower GPA minimum requirements than” TMU.

Shelton, who is Black, said his decision to apply for medical school was a difficult one. “I didn’t see anyone that looked like me in this profession,” he said. “That was a huge psychological hurdle for me to overcome.”

Shelton, 59, graduated from medical school in 1991. While he “had a great experience” at U of T establishing friendships that continue to this day, Shelton said “there was a part of my experience that was lonely — being one of two Black students in my class. And I was committed, as a result of that experience, to do something about it.”

Applying for medical school is so competitive, there are lots of “highly qualified candidates who never get in and have to give up that dream or pursue their education abroad,” he said.

“We are now tapping into that excellence that just has been left behind. And we are also saying there’s a particular group of equity-deserving students that we are welcoming. We are not lowering standards for them.”

TMU’s application deadline for entry next September is Dec. 2.

“We have no question that we’ll be able to fill those seats,” Shelton said.

The school has also faced criticism for not requiring applicants to write the Medical College Admission Test (MCAT). The university says it is “one of seven Canadian medical schools that does not require the MCAT as it has been widely recognized as a barrier to medical education access and not an accurate predictor of professional acumen and skill.”

There are “inherent biases” baked into the exam, said Shelton.

“But also, there’s no evidence to show that one’s performance on the MCAT correlates with their success as a physician both during their learning years or beyond.”

Many people facing the MCAT take preparatory courses, “which are not cheap,” he said. “Furthermore, for those who can afford it, they take entire summers off in order to study for this exam. So that becomes an equity issue.”

TMU’s med school developed an admissions process that will select “candidates that we know will go on to become excellent physicians,” Shelton said.

The school will also look at applicants’ extra-curricular activities and their “life experiences, particularly the students who come through the pathways,” he said.

“We want to know what are the experiences that have informed the person that you are and that have informed their decision to choose to pursue a career in medicine.”

A study that surveyed 1,388 Canadian medical students in 2018 found that they “were less likely, compared to the Canadian Census population, to identify as Black (1.7 per cent vs 6.4 per cent) or Aboriginal (3.5 per cent vs. 7.4 per cent).”

The cross-sectional study published in the journal BMC Medical Education “found that students at English-speaking Canadian medical schools have, on average, substantially higher socioeconomic status compared to the Canadian population.”

According to the study, a “widening socioeconomic disparity between physicians-in-training and their future population may exacerbate inequities in access to care. A large body of evidence suggests that medical students from traditionally disadvantaged backgrounds, such as those who are part of visible minority populations or have rural or low socioeconomic backgrounds, are more likely to practice in areas with physician shortage.”

The premier announced in March of 2022 that his government would be going ahead with TMU’s school of medicine. This past June, Ford was on site in Brampton to witness the unveiling of signage for the new med school.

“These new seats will help train doctors of the future,” Ford said at the time. “Someone born in Brampton, who went to high school in Brampton, will now be able to go to med school here at this campus.”

The U.S. Supreme Court effectively ended race-conscious admissions last year in a decision invalidating programs at Harvard and the University of North Carolina. “Many universities have for too long … concluded, wrongly, that the touchstone of an individual’s identity is not challenges bested, skills built, or lessons learned but the color of their skin,” Chief Justice John Roberts wrote. “Our constitutional history does not tolerate that choice.”

But Canada’s a different kettle of fish, according to Bruce Pardy, a Queens University law professor.

“In Canada, preferential admission policies are widespread because our laws allow for affirmative action and reverse discrimination,” Pardy said Thursday in an email.

“Provincial human rights codes apply to university admission policies. In Ontario, for example, the human rights code allows for ‘special programs’ that amount to preferential treatment. Our Charter (which probably does not apply directly to university admissions, since universities are not governments) says the same.”

In a follow-up interview, Pardy said discrimination comes when race is taken into account.

“No one claims that there is racial discrimination in the NBA just because the number of white players is not consistent with the percentage of white people in the population,” he said.

Admission policies like TMU’s are “unfair on multiple levels,” Pardy said.

“They are unfair to people who are being excluded because of their race, but they are also unfair to the people who would otherwise get in on their own merits. If you are a Black medical student today these policies disadvantage you because they cloak you with special treatment, even though you didn’t need it and didn’t get it.”

When asked if Canada needs more Black and Indigenous doctors, Pardy responded: “I think we need more doctors who are excellent in Canada. If they are Black and Indigenous, then fantastic.”

Shelton knew TMU was going to see some blow-back regarding its pathways to admission. “There are many people who see our process as disadvantaging them,” he said. “But it’s not about who’s been disadvantaged here, in terms of our application process. It’s about who has been under-represented that, through our equitable process of admissions, that we’re now giving an opportunity to enter the medical field.”

As part of the selection process, TMU wants to know if people are applying from the Brampton area or other communities that don’t have enough doctors. “Evidence has shown that when someone undergoes their education in a particular region, they are more likely to stay in that region and work if there already is a pre-existing connection,” Shelton said,

Brampton is “under-served from a health human resources standpoint,” he said. “And we want to address that need.”

TMU will expose students to a curriculum “that will turn them on to family medicine,” he said, “really show them the joy of practicing comprehensive family medicine.”

The need in Brampton for more GPs is “pretty significant,” Shelton said. “That’s why a lot of people end up in walk-in clinics and emergency departments. Without a doubt it is a major issue and we’re going to be part of addressing that problem.”

TMU’s primary clinical partner is the William Osler Health System. The school has also signed affiliation agreements with Trillium Health Partners in Mississauga and western Toronto, Headwaters Health Care Centre in Orangeville, and the Region of Peel.

Rakowski said TMU recently reached out after he wrote a column critical of the med school’s admissions process. He plans to meet with the university’s president in the coming weeks to stress the need for a mechanism that would ensure graduates wind up serving the communities they came from.

“I would volunteer to work with them,” Rakowski said.

“My point’s going to be, let’s go to government and say, ‘Look, we want this to work. If we really want (graduates to return to their) Indigenous communities, if you want them to work in clinics in Black areas, pay for their education.’”

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