In Reply: Dr Earnest and colleagues correctly state that attending to justice requires a much broader focus than the beneficence, nonmaleficence, and respect for autonomy that a physician is able to demonstrate at the bedside or in the examination room with an individual patient. They also note that different skills and behaviors are required to address injustice in the health system, a point with which we do not take issue.
What does merit further discussion, however, is the degree of educational redesign that will be required to prepare physicians to function “as a citizen, an advocate, and an activist.” It could be argued that individuals are already being selected for medical schools from a pool of applicants who have developed these skills to a high degree, as indicated by their prior actions and their future intentions. This is illustrated by data on medical school applicants showing that a significant proportion have previously engaged in, and in many cases have led, community service efforts.1 Furthermore, data on matriculating medical students queried after gaining admittance to medical school reveal that these students, when asked, “What types of nonclassroom experiences do you expect to participate in during the time you are also a medical student,” value a commitment to the greater cause of social justice: 88% answered that they expect to participate in community service or activism.2 Students come to medical school primed to think in terms of social justice and then are overwhelmed by the realities of the health care system.