People with disabilities make up about 20% of the population, yet only a tiny fraction of matriculants to medical school have disabilities. Attempts to define core technical standards and competencies have not kept pace with technological changes, diverse specialization, and changing practice options. This has resulted in the inappropriate exclusion of some people with disabilities. Medical schools determine how any qualified applicant, regardless of physical or cognitive ability, can be effectively accommodated and counseled in achieving the most appropriate medical career. A serious effort to redefine the technical standards and core competencies of the 21st century medical education at the undergraduate and graduate levels would likely resolve many of the troubling questions regarding medical students with disabilities. We have made some recommendations to organized medicine for constructing an agenda to address these issues.