In 2015, the Assn. of American Medical Colleges released a startling report statistical: Fewer black men enrolled in medical school in 2014 (515) than in 1978 (542). These 515 black men represented only 2.5% of all medical students in 2014.
Although more recent enrollment figures indicate marginal improvementAmericans who identify as Black, Hispanic, Native American, Native Alaskan, Native Hawaiian, or other Pacific Islander groups remain roughly underrepresented in medicine relative to their proportion in the US population. To negate decades of exclusion of people from underrepresented racial groups, especially black Americans, one strategy used by public post-secondary schools to diversify their student body is affirmative action – considering race and ethnicity as one of many admission factors.
But several states, including California, Florida and Michigan, banned the practice. The conservative majority on the Supreme Court is also poised this year to abandon years of precedent and cancel affirmative action. Our recent research shows that ending the use of affirmative action in medical schools would be catastrophic for the diversity of our medical workforce.
In our recent study in Annals of Internal Medicine, we found that for public medical schools in states that have affirmative action bans in place, enrollment of students from underrepresented racial and ethnic groups has declined by more than a third over the past five years after the ban compared to the year before the ban. Meanwhile, a control group of schools in states that did not enact bans saw very little enrollment change for underrepresented students during the same period.
The decline in the number of physicians from underrepresented groups should alarm us all. The consequences, not only for the equity of economic and professional opportunities, but also for people’s health, are considerable.
the COVID-19[feminine] The pandemic has crystallized the poor quality of care racial and ethnic minority patients receive in the United States, with the worst outcomes hitting these groups disproportionately. But even before the pandemic, it became increasingly clear that having more doctors from underrepresented groups can improve care.
For example, a 2019 study found that black men randomly assigned to receive care from black doctors were more likely to opt for any preventive services offered, such as cholesterol screenings – with implications for reducing black men’s higher likelihood of dying of heart disease – compared to black men who saw non-black doctors. To research also suggests that, on average, black doctors spend more time with black patients than white doctors, and that black patients are more satisfied with their care when their doctors are black. Likewise, a 2017 study of Spanish-speaking Latino patients with diabetes found that patients whose doctors spoke their language had much better control of their disease.
Patients do better when cared for by someone who is more likely to understand their experiences. Previous studies have described medical mistrust, stemming not only from heinous historical events like the Tuskegee Studyin which government officials chose not to give black men proper treatment for syphilis, but also to current interactions with the health system. This mistrust discourages patients from fully accepting their doctors’ recommendations.
These are not absolute truths for all physicians. But policies that reduce the number of doctors from underrepresented racial and ethnic groups — like we found affirmative action bans to do in medical schools — will likely hurt health outcomes for patients from those same groups.
So how can we improve the diversity of the medical workforce and reap the health benefits that come with it? First, at the policy level, we must preserve the use of racially sensitive admissions practices. This means reconsidering state bans on affirmative action where they exist (a 2020 attempt to overturn California’s ban lack, but such efforts could benefit from a new policy manual). It also means understanding and communicating to relevant decision makers the benefits of diversity for health, education and other areas, and identifying policies that undermine this diversity.
Second, at the medical school level, admissions committees must commit to a holistic review of applicants so that no single factor, such as standardized test scores, precludes consideration of a candidate. It will also require increased investment in interventions that minimize the influence of stereotypes that harm candidates. One such intervention would be an approach to implicit bias training that has proven effective for admissions officers.
Third, we must strengthen the the measure and reporting on the racial and ethnic diversity of medical schools and the consequences of the lack of such diversity. US News & World Report released its first ranking such in 2021, evaluating medical schools based on the percentage of enrolled students from underrepresented racial and ethnic groups. But instead of separating these numbers into a separate ranking of “The most diverse medical schools“, the diversity of the student body should be directly integrated into the most viewed ranking of US News of”Best Medical Schools.” Only then will medical schools be fully encouraged to accommodate the racial and ethnic diversity of their students.
Seven decades ago, the Supreme Court ruled in Brown v Board of Education that racial segregation in public schools was unconstitutional. Today, the lives of our patients depend on diversity in our schools – and the positive action to bring us there.
Utibe R. Essien is an Assistant Professor of Medicine at the University of Pittsburgh School of Medicine. Dan P. Ly is an assistant professor of medicine at the David Geffen School of Medicine at UCLA. Anupam B. Jena is a professor of health care policy at Harvard Medical School and host of the “Freakonomics, MD” podcast.