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Doctors divided over use of affirmative action by medical schools

If the U.S. Supreme Court strikes down racial preferences, fewer minority students may get into medical school.

By Myrle Croasdale, amednews staff. June 2/9, 2003.

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Race is not a simple black and white issue when it comes to medical school admissions.

Proponents say the profession has a moral obligation to produce more minority doctors to ease health care disparities and keep pace with the growing minority population and that affirmative action is necessary to fulfill that obligation.

Opponents contend that it's immoral to look at any applicant's race or ethnicity and that schools should admit only the best of the best.

Yet physicians on both sides of the debate agree on one thing: The face of medical education could change dramatically if the use of racial preferences is eliminated by the U.S. Supreme Court.

The high court's decision, expected by July 1, in two cases filed against the University of Michigan and its use of race in admissions is expected to shape admissions for all colleges, including medical schools, for years to come.

"It will be a disaster if there is a judgment that totally eliminates race-conscious decision-making," said Jordan Cohen, MD, president of the Assn. of American Medical Colleges.

The use of racial preferences must be protected, according to the AAMC in its friend-of-the-court brief on behalf of the university. One reason given is that minority physicians are more likely to practice in medically underserved areas, improving access to care for these generally poor, minority communities.

But Sally Satel, MD, author of PC, MD: How Political Correctness is Corrupting Medicine and member of the Washington, D.C.-based think thank American Enterprise Institute for Public Policy Research, argues against the assumption that minority physicians are more likely to return to their old neighborhoods. The study that determined this view was a survey asking "Where would you practice?" not "Where do you practice?" she said.

"To say we'll lower standards for African-Americans because they more frequently go back to African-American neighborhoods is a disturbing argument," she said. "It says we're willing to send second-rate doctors into African-American neighborhoods. It also assumes we're going to have black doctors for black people and white doctors for white people. We shouldn't buy into that."

Dr. Satel qualified her statement, saying she was not suggesting that all black physicians were second-rate, only that with lower entrance standards for minorities, there are minority doctors who are not as qualified as others, such as those who had higher test scores.

The AAMC countered that considering race doesn't compromise physician quality. Once in medical school, the vast majority of minority students graduate and pass their boards, Dr. Cohen said. Lower Medical College Admission Test scores are not indicative of how minority students will perform in medical school, he said.

Numbers stand to plummet

But their scores are clearly lower. And if admissions were based solely on MCATs and grades, the number of minority medical students would plummet, according to the AAMC.

In 2001 the use of racial preferences meant that 1,868 minority applicants were accepted, 11% of total medical school acceptances. Only 537 minority students, or 3% of all acceptances, would have made it in on their scores alone. Even using affirmative action, schools haven't been able to enroll enough underrepresented minorities, Dr. Cohen said.

Critics are not swayed by those arguments, and they say it's time to stop using race as an admissions criterion.

"I think judging on race is immoral," said Mark Schiller, MD, president elect of the Assn. of American Physicians and Surgeons and a psychiatrist with the University of California, San Francisco. "Not treating people equally is unethical, as is discriminating or preferring someone on the basis of race."

David Sundwall, MD, head of the American Clinical Laboratory Assn. and a trustee of Spelman College in Atlanta, a historically black college for women, also opposes affirmative action. "I'm philosophically opposed to the notion to legally mandated affirmative action," he said. "I think there are many of us who worked really hard and got in on merit, who question admission based on race."

Most of Dr. Sundwall's patients at the homeless shelter where he volunteers one day a week are black men who he said don't want to see young black doctors because they presume they aren't as good as white doctors.

"I find that so disheartening," he said.

Some states said no already

California, Louisiana, Mississippi, Texas and Washington already have deemed affirmative action illegal. The results have been mixed.

In California, underrepresented minority applications to the five University of California medical schools fell from 4,165 in 1995-96 to 2,593 in 2001-02 following the end of affirmative action. By 2001-02, the five UC medical schools were each enrolling an average of four blacks, nine Hispanics and no Native Americans.

But Albert Gunn, MD, associate dean of admissions for the University of Texas Medical School at Houston, said they've kept their minority population fairly stable since the defeat of affirmative action in 1996.

They now give special consideration to applicants from federally recognized health professional shortage areas.

The medical school population in 2002 was 3% black and 12% Hispanic, down only slightly from 1995 when it was 4% black and 16% Hispanic.

The U.S. Supreme Court last considered affirmative action in 1978, in the Regents of the University of California vs. Bakke, when it struck down the use of racial quotas but not the use of racial preferences.

Two affirmative action cases are now before the court: Grutter vs. Bollinger, in which a white woman was rejected by the University of Michigan Law School, and Gratz vs. Bollinger, where several whites were rejected by the university's undergraduate liberal arts school.

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