Medical schools typically assess how good their selection process is using metrics such as students’ assessment performance and the success of alumni on later indicators of academic ability and clinical competence, such as Royal College of Physicians or specialty board examinations. Addressing global issues with the maldistribution of doctors and increasing numbers of new medical school graduates choosing not to work in a clinical context requires different measurements of medical school admissions processes, like those related to graduates’ career outcomes (e.g., working in underserved regions and/or working in certain specialties). This shift in focus is not straightforward. Medical education is a complex social system where, intentionally or not, medical schools focus on reproducing cultural, historical, and social norms. Simple solutions are often proposed, but they are insufficient to address these complex drivers. Instead, it is time to step back and think very differently about medical school admissions. In this Invited Commentary, the author proposes new solutions to address these issues, including bringing into the medical school selection process the perspectives of other key stakeholders; increasing collaboration and dialogue across these stakeholder groups; changing the performance metrics by which medical schools are assessed in the global education marketplace; and developing and evaluating new selection processes and tools. Medical schools must engage more reflectively and collaboratively in debates about how to align medical school admissions and meeting the health care needs of the public.