In the wake of a U.S. Supreme Court ruling last summer that restricts higher-education institutions—including medical schools—from considering an applicant’s race or ethnicity in admissions decisions, the medical school class that matriculated in the fall of 2023 will be the last that does so with the aid of affirmative action.
That class, recent data from the Association of American Medical Colleges indicates, was more diverse than prior years with some historically excluded racial and ethnic groups making bigger gains than others. For instance, applicants who were American Indian or Alaska Native saw a 14.7% rise in medical school matriculants, while there was a 0.1% drop in Black matriculants.
“While there was general improvement in a number of underrepresented populations, the overall trajectory is not nearly steep enough,” according to David Henderson, MD, the AMA’s vice president for equity, diversity and belonging in medical education. The diversity trajectory in the wake of the affirmative action ruling, Dr. Henderson added, is likely to change in a way that negates any recent gains.
As for the road ahead, Dr. Henderson offered some insight on how organized medicine might act to stem the chilling effects of the high court’s ruling.
Rapid action is paramount
The road toward a physician workforce that is representative of the nation it serves is a long one.
The diversity work begins with medical school admissions, and it has downstream effects. For instance, at the current rate of increase in diversity in graduate medical education, depending on the specialty, it will take between 35 and 93 years to reach parity with the general population of our nation. Those figures, from a study published in 2021, are sure to be affected by last summer’s ruling striking down affirmative action.
As to the impact the ban may have on reversing progress related to physician diversity, Dr. Henderson pointed to discouraging data from California, where affirmative action has been effectively banned in higher education since 1996. Recent data, he noted, shows a 40% drop in diversity in admissions to California public universities.
Notably, the Supreme Court’s 6–3 ruling on affirmative action in higher education does not affect tribal colleges and universities, which are open-door institutions and required to collect information about students’ enrollment in federally recognized Native American tribes.
To sustain any of the momentum surrounding physician workforce diversity, the time to act is now, Dr. Henderson said.
“We have a fairly narrow window between now and the next four years when the effect of affirmative action will no longer be present, and we need to move quickly,” he noted.
As stakeholders in medical education aim to refocus efforts to move toward developing a physician workforce capable of meeting the health care needs of all individuals and communities across the U.S., key conversations will take place around three key areas: medical school admissions, equity in assessment, and funding sources of graduate medical education.
In the coming months, the AMA will gather medical educators for a series of meetings that aim to turn the current predicament into an opportunity.
“The goal of these conversations is to develop a list of recommendations of ways that the organizations that oversee and support medical education can help us continue to move toward creating equitable educational environments, and developing a workforce that is capable of meeting the health care needs of our increasingly diverse society,” Dr. Henderson said. “So it's an effort by medical education to try to understand and articulate some of the changes we need to make and then to collaborate with the organizations that oversee medical education to get their assistance in moving some in moving some of that agenda forward.”
When considering outputs from the meetings, Dr. Henderson offered that a near-term goal that encompasses all three areas for change is a reframing of the discussion.
“We are trying to help drive, and there are other people sort of pushing us in the same direction, the conversation away from a discussion about diversity to one more about equity, particularly health equity,” Dr. Henderson said. “Because health equity has real consequences, and it has real roots.”
“Changing medical education in a way that creates the health care workforce we need is really crucial and, before or after the Supreme Court Ruling, that has always been a primary goal of medical education. It needs to continue to inform everything we do.”