Socioeconomic background, exam performance, and probability of medical school application among all MCAT examinees, 2017 to 2019

The Medical College Admissions Test (MCAT) remains a significant barrier for students from low socioeconomic status (SES) backgrounds, with performance disparities driven by unequal access to resources rather than by differences in aptitude. Holistic admissions practices seek to contextualize exam performance alongside other essential pre-medical competencies such as resilience, empathy, and scientific inquiry. Evidence shows that students with middle-tercile MCAT scores who demonstrate these qualities will succeed in medical school and beyond. However, only those who apply can benefit from such holistic review. Little is known about application behaviors at this pivotal stage, when examinees must decide whether to apply with their achieved MCAT score. This study examines the relationship between socioeconomic status, MCAT performance, and application probability. This study analyzed de-identified Association of American Medical Colleges (AAMC) data for all MCAT examinees between 2017 and 2019, including sociodemographic characteristics and total MCAT score. The outcome was allopathic (M.D.) medical school application status through the 2021 application cycle, allowing examinees at least two full years to apply. The AAMC parental education and occupation (EO) indicator stood as a proxy for SES – ranging from EO-1 (less than college degree, any occupation) to EO-5 (doctoral degree; executive, managerial or professional occupations). Socioeconomic disadvantage (SED) was defined as EO-1 and EO-2. Middle- or top-tercile MCAT scores were achieved by 51.8% of examinees with SED (middle, 33.2%; top, 18.6%) compared with 73.1% of examines without SED (middle, 34.4%; top, 38.7%). The probability of applying to medical school was closely tied to MCAT performance, and regardless of SES, the probability of application with any given MCAT score was similar. While most top-tercile performers (92 to 94%) applied, a much lower proportion of middle-tercile performers (78 to 80%) applied. Socioeconomically disadvantaged MCAT examinees infrequently score in the top tercile where application rates are uniformly high. Those with acceptable, middle-tercile performance may under-appreciate their academic achievements through economic adversity, as over 20% do not apply to medical school. Targeted interventions are needed to promote application and maximize the impact of holistic review.