That's the thing, I'm not sure the 3.9 has failed to learn those skills. The student with the 3.6 and the 3.9 would both make good doctors, and once they get in

That's the thing, I'm not sure the 3.9 has failed to learn those skills. The student with the 3.6 and the 3.9 would both make good doctors, and once they get into med school, the attrition rate (at an elite program) is typically below 1%. But med school is designed, in part, to ensure that many of the people who would make good doctors are not allowed to do so. I'm not saying that is the only function of the AMA's control over credentialing, it is also there to train doctors and ensure quality. But the AMA clearly engages in cartel-like behavior This is done to limit new entrants, artificially reduce competition, and pump up salaries for the cartel members. The student who cheated a 3.6 up to a 3.9 probably knows the material very, very well. I don't excuse the cheating, but I do insist that we recognize the broken system that rewards it, and specifically recognize the widespread harm that happens when organizations like the AMA engage in cartel like behavior.