Even ignoring nepotism, the med school process is far from a meritocracy. Step exams are functions of how many hours people were willing or able to put toward a test to a large extent. Med school prestige gives insanely unfair advantages to students over those of lower ranked schools. Publications are often functions of who you know or have access to and how productive they are. Clinical grades are fairly arbitrary and measure more how much people liked you rather than how well you performed. I say this as someone graduating soon from a “top” school with high board scores. I’ve come to realize how these things mean so little in terms of my ability to be a doctor or perform during residency. I think people want to have faith in a game with objective points, but the points aren’t as objective or meaningful as we’d like to believe, and so they certainly don’t provide for a purely meritocratic process.