U.S. medical schools will look different in most states, many observers say, after the U.S. Supreme Court’s landmark ruling that it is illegal for colleges to use race as a specific factor in admissions decisions.
The court’s decision against affirmative action policies at Harvard University in Massachusetts and the University of North Carolina at Chapel Hill has also prompted graduate and professional programs, including medical schools, to seek alternative legal ways to recruit a diverse student body.
Affirmative action in higher education is the practice of considering factors such as a student’s race, gender identity and age — qualities that historically were a basis for discrimination — when deciding who to admit. Until June 29, the high court had consistently ruled that race could be considered among other factors in the college admissions process. Even so, nine states banned it.
“What we found is that race-conscious admissions in higher education is a really essential tool to be able to support colleges and universities trying to recruit and retain racially diverse student bodies,” says Julie Park, associate professor in the College of Education at the University of Maryland College Park.
Next Steps for Medical Schools
Many experts say that progress medical schools have made enrolling more Black and Hispanic students, in particular, will backslide.
[READ: How Does Affirmative Action Affect College Admissions.]
Dr. David J. Skorton, president and CEO of the Association of American Medical Colleges, says the organization will follow the law while continuing full speed on efforts to diversify the health care workforce.
Skorton points to a 2022 study published in the Annals of Internal Medicine finding that 21 public universities in eight states with affirmative action bans from 1985 to 2019 reported a nearly 5 percentage point decrease in underrepresented racial and ethnic groups in their medical school classes within five years of the ban being instituted.
At the same time, enrollment among those groups increased 0.7 percentage points across 32 public medical schools in 24 states without affirmative action bans.
Skorton says the AAMC will learn from medical colleges in states that had already abolished affirmative action and yet succeeded in diversifying their med school student bodies.
For example, the University of California at Davis, which fell under the ban on affirmative action at public colleges in California passed by voters in 1996, has continued to recruit a diverse student body and was ranked No. 3 among the most diverse medical schools by U.S. News for 2023-2024. Instead of using affirmative action, the school has students answer questions about their education, family life and income, and assigns them a score on a socioeconomic disadvantage scale — a process that other medical schools are now considering.
For other medical schools affected by the recent Supreme Court decision — like Western Atlantic University Medical School in the Caribbean, which admits American, Canadian and international students — it is uncertain how future admissions operations will change.
[READ: Why There Are No Safety Schools in Medical School Admissions.]
Joseph Flaherty, the medical school’s president and chief medical officer, says Western Atlantic has a large number of minority students applying and wants to continue to select successful students.
“There’s certainly other areas that will reflect diversity in a more general way, but also include more minorities while doing so,” says Flaherty, who also is a professor in and chair of the school’s psychiatry department.
Future medical students could see changes to admissions such as prompts for applicants to discuss their background in personal statements and other application materials rather than a specific question about race.
Some medical students, like Veronica Mize, fear that pipeline programs and other initiatives to increase underrepresented medical school students may also be in jeopardy.
Mize, president of the Student National Medical Association and a student at Mercer University School of Medicine in Georgia, says as a Black woman, she was plugged into the med school pipeline through the Multicultural Association of Prehealth Students as an undergraduate at Baylor University in Texas.
“That’s where I got a lot of my information about college, medical school, what I needed to be doing to get there,” she says. “I’m also a (first-generation college student), so my reaction to the decision was, ‘What happens to that pipeline, what is to protect that pipeline from crumbling?'”
Potential Effects on the Practice of Medicine
Experts say the Supreme Court decision could affect the number of doctors of color in the future and the quality of medical treatment for patients of color.
“The country is getting more diverse by the day, and therefore doctors need to interact with people from much more diverse backgrounds,” Skorton says.
Existing health inequities will worsen with fewer doctors of color in health care, Skorton contends, adding that racial diversity in health care can close inequalities in patient care.
Black mothers continue to have a higher rate of pregnancy-related complications than white mothers, for example, according to the Centers for Disease Control and Prevention. Another recent study indicates that Alaska Native, American Indian and Black women have the highest maternal mortality rates and the biggest increases in those rates since 1999.
In other racial disparities, Black men are more than twice as likely as non-Hispanic white men to die of prostate cancer, according to a University of Michigan Health Rogel Cancer study. And Hispanic and Black children hospitalized with myocarditis or cardiomyopathy heart conditions are more likely than white children to die, according to a 2021 study.
Patients of color have better experiences when they are treated by doctors who look like them, experts say. The end of affirmative action in medical schools can also cause greater doctor shortages, specifically among doctors of color, in underserved communities, Skorton says.
The U.S. medical system is already facing a physician shortage, which is estimated to grow to 124,000 doctors by 2034, according to the AAMC.
Focus on Early Recruitment
To recruit a diverse medical student population and bolster the number of minority doctors, Flaherty predicts universities will have to reach out earlier to high school students.
[READ: Ways Medical School Applicants Can Show Diversity Beyond Race, Ethnicity]
“Those high schools will have outreach to grade schools, so let’s build a pipeline. You’ve got to build it before college so students are prepared to take the biochemistry and biology needed and physics to go to medical school,” he says.
If the shift to no race-based admissions leads to fewer students of color attending elite undergraduate universities, that will subsequently affect the pool of applicants applying to medical school.
“What we’ve seen from the states where affirmative action bans have been passed is that typically, especially Black and Brown students are kind of shifted into institutions that tend to have fewer resources,” says Park, who has published research on affirmative action and was a consulting expert on the Students for Fair Admissions Inc. v. President & Fellows of Harvard College case, one of two on which the Supreme Court made its recent ruling.
In med school, the opportunity to learn from a colleague who has a different background is invaluable in terms of understanding how to treat people of different races and ethnicities, Mize says, particularly when providing health care.
“To my fellow medical students, I want them to remain encouraged,” Mize says. “I want them to remember why they wanted to be a doctor because chances are it wasn’t for the money. It wasn’t for the lack of sleep or the debt. Although this may seem like a step back, it isn’t because we’re still going to continue to do the work to best advocate for our patients and change the health care narratives in America.”
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What?s Next for Medical Schools After Ban on Race-Conscious Admissions originally appeared on usnews.com
