Inclusivity that reevaluates: Assessing meritocracy

A meritocracy (merit, from the Latin meritum, meaning “deserve, earn,” and -cracy, from the Greek krátos, meaning “rule” and “strength”) is a system in which an individual's advancement is based on performance measured by examination or demonstrated through achievement. Economic goods and political power in a meritocracy are awarded based on individual talent and effort, not according to wealth or social standing. While the term was coined in 1958 by British sociologist Michael Dunlop Young in his satirical book, “The Rise of the Meritocracy,” the concept itself isn't new.

In “The Republic,” written in approximately 375 B.C., Plato argued for a system of government in which a person's birth does not necessarily dictate their fate. In Imperial China, around 200 B.C., the Han Dynasty adopted the principles of Confucianism in placing nobility of virtue above nobility of blood and based political appointments on individual merit, regardless of wealth or status. Anyone who passed a rigorous examination could become a government officer, a highly coveted position. The British East India Company implemented a similar practice for its administrative positions in 1833. In the United States, meanwhile, the Pendleton Civil Service Reform Act in 1883 mandated that competitive exams, rather than political connections, be used to award government jobs.

The Merriam-Webster Dictionary defines “meritocracy” as “a system, organization, or society in which people are chosen and moved into positions of success, power, and influence on the basis of their demonstrated abilities and merit.” In the book “Education and Sociology: An Encyclopedia,” Thomas B. Hoffer writes that the “most common definition of meritocracy conceptualizes merit in terms of tested competency and ability, and most likely as measured by IQ or standardized achievement tests.” One common example today would be the college degree.

However, despite its definition, the playing field in a meritocracy is not always level. As Janny Scott and David Leonhardt wrote in a May 15, 2005, article in The New York Times, “Merit has replaced the old system of inherited privilege, in which parents to the manner born handed down the manor to their children. But merit, it turns out, is at least partly class-based. Parents with money, education and connections cultivate in their children the habits that the meritocracy rewards. When their children then succeed, their success is seen as earned.”

In his book “The Meritocracy Trap: How America's Foundational Myth Feeds Inequality, Dismantles the Middle Class, and Devours the Elite,” Yale law professor and author Daniel Markovits argues that meritocracy is “a pretense, constructed to rationalize an unjust distribution of advantage.” In an interview with Sean Illing published by Vox in 2019, he went on to elaborate that in this system, people from poorer backgrounds can't compete and their children can't compete because they can't come close to spending the same amount as a wealthy family on education.

A second harm, according to him, is that “elites have remade jobs in a way that destroys the middle class by eliminating the high-paying positions for people who lack technocratic expertise.” Finally, he stated that meritocracy “adds a kind of a moral insult to this economic exclusion because it frames what is in fact structural inequality and structural exclusion as an individual failure to measure up, and then tells you if you're in the middle class, the reason you can't get the great high-paying job is because you're not good enough.”

Emilio J. Castilla, PhD, a professor at MIT's Sloan School of Management, has explored how meritocratic ideals and human resources practices like pay for performance play out in organizations, and he's come to some unexpected conclusions. As Marianne Cooper described in a Dec. 1, 2015, article in The Atlantic, Dr. Castilla found that “women, ethnic minorities, and non-U.S.-born employees received a smaller increase in compensation compared with white men, despite holding the same jobs, working in the same units, having the same supervisors, the same human capital, and importantly, receiving the same performance score. Despite stating that ‘performance is the primary [basis] for all salary increases,’ the reality was that women, minorities, and those born outside the U.S. needed ‘to work harder and obtain higher performance scores in order to receive similar salary increases to white men.’”

In our world of medicine, this sounds all too familiar. Time and time again we hear of students of African-American or Latinx descent who don't have the same leg up to begin with, and so the proportion who are successful physicians in the workforce is far less than other ethnic majorities. We hear of gender disparity in the workforce leading to women physicians being overlooked for promotions, pay parity, and raises. Physicians who are international medical graduates don't make it to leadership positions in academic institutions or even academic promotion at the same rate as their other colleagues, all in our espousal of meritocracy. In an Academia and Medicine article published in Annals of Internal Medicine in August, the authors suggest several opportunities for medical schools in the U.S. to take more steps to work against structural racism and to level the playing field for all applicants, such as prioritizing interventions to reduce reliance on standardized tests to predict future success and eliminating racially biased performance metrics.

Both the profession as a whole and ACP as an organization are called on to highlight the challenges of meritocracy and how this system might spuriously lead us to amplify biases, divide us, and make us less inclusive as a medical community. My illustrious colleagues Robert M. McLean, MD, MACP, and Douglas M. DeLong, MD, MACP, provided a blueprint for what we must do in a bold open letter published by MedPage Today on April 23:

“Avoid microaggressions in our daily personal interactions and call out those that we observe in others; watch our words carefully; try to imagine walking in the shoes of others; redouble our efforts to mentor students, residents, fellows, and peers who are not white men; don't dismiss the feelings or perceptions of others because we cannot ever fully understand the experience of other genders or individuals with non-white skin. … Doing anything less means we are enabling a tacit perpetuation of the status quo.”