The Supreme Court’s affirmative action decision puts lives at risk

The past several months have been grim for health in the U.S. In December, the Centers for Disease Control and Prevention reported the lowest life expectancy in more than 25 years. Another CDC report in March showed that maternal mortality was on the rise. Yet another report in March found that even children are dying at higher rates than ever before. Devastatingly, all of these studies showed wide racial and ethnic disparities, with Black, Hispanic, and Native American adults, women, and children dying at higher rates than white Americans.

Despite decades of research and advocacy, along with millions of dollars committed to eliminate health disparities, generations of Black and brown patients continue to be mistreated and die from the effects of racism in the U.S. This has continued even amid the recent racial reckoning that sounded the alarm for racism as a public health issue. Time after time, studies have shown that class is not protective. Social status is not protective. And in the experience of our fellow physicians, even being a doctor cannot save you from racism in medicine.

One solution to address these disparities has been to diversify the medical workforce — a solution that was severely handicapped Thursday when the Supreme Court ruled against affirmative action and race conscious admissions.

The latest data on medical school diversity is dismal: 5.7% of all doctors in the U.S. are Black, while 7% are Hispanic, far lower than figures of 13.6% and 18.9% of the general population, respectively. Yet having Black and brown physicians is integral to questioning the status quo in medicine. These doctors are more likely to spend time listening to minoritized patients, provide guideline-recommended care, and understand the health impacts of the racist history of medicine.

Put simply, these doctors literally save lives. In fact, a recent study showed that for every 10% increase in the number of Black primary care physicians in a county, there was a 31-day higher life expectancy for Black individuals living there.

So why have we still struggled to improve physician diversity? We looked to answer this question in our recent study in JAMA Health Forum, where we explored some of the upstream reasons for why there are so few Black, Hispanic, and Native American — also referred to as underrepresented in medicine (URiM) — doctors.

Using data from more than 81,000 students taking the Medical College Admissions Test (MCAT), we found that test takers who identified as URiM were more likely to have parents without a college degree, attend a low-resourced college, have more difficulty affording MCAT preparatory materials, and have pre-medical school student debt. Furthermore, we found that each of these four barriers ultimately decreased one’s chance of applying to and matriculating at medical school, by 17% for Black examinees and 18% for Hispanic examinees.

If these socioeconomic barriers to medical school were not enough, our study also found that URiM examinees were more likely to report that even their college advisor dissuaded them from pursuing a career in medicine. This discrimination against future medical students threatens the lives of our patients. We need more medical students who reflect and understand a diversity of backgrounds and experiences. Ultimately they will fill our hospitals with doctors who will combat the racism that leads to early death from treatable conditions, higher infant mortality, increased chances of dying after surgery, and overall negative experiences with health care.

So, what can be done to improve these numbers in a post-affirmative action America?

First, we must strengthen the use of holistic review in medical school admissions. Factors such as those we observed in our study, including limited household income and access to college resources, disproportionately affect students of color and should be considered as part of a comprehensive admissions review process.

Yet history reminds us that holistic review is not sufficient. In places that have banned affirmative action — including our state of California, where it was prohibited in 1996 — the number of URiM medical students has fallen. While affirmative action may seem like a lost cause now, we have to continue to advocate as doctors against the Supreme Court decision while encouraging our local institutions to take every step allowable under the law.

Second, we have to eliminate economic barriers at every step in the pathway to medicine. Proposed solutions by the Association of American Medical Colleges have included broadening the benefits for their medical school Fee Assistance Program, removing costly medical school application fees (which cost up to $150 per school), and continuing virtual interview options to limit expensive travel. Increasingly, medical schools across the country are investing millions in programs to strengthen the recruitment of diverse students, including the University of Chicago’s Pritzker School of Medicine’s commitment to providing full tuition to 50% of its students.

Finally, we need antiracism training for everyone involved in the medical school application process. Such training will teach the enduring effects of structural racism that lead to barriers in the pursuit of a career in medicine, and help to inform admissions decisions. Admissions committees should also employ rubrics that value applicants’ diverse experiences and use input from the communities that medical institutions serve in the selection process, as recently implemented by the Temple University School of Medicine.

For decades, racist structures have hindered people of color from accruing wealth, education, and the resources needed to enter the field of medicine. In addition, the racism that exists within medicine is actively pushing out minoritized physicians already in the system. The Supreme Court has how established a policy that will keep more individuals of color out of the pathway to medicine. By abolishing race-conscious admissions, we are simply quitting while we are behind.

Jessica Faiz is an emergency medicine physician and a National Clinical Scholars Program fellow at the David Geffen School of Medicine at UCLA. Utibe R. Essien is a general internist and assistant professor of medicine at the David Geffen School of Medicine at UCLA . Donna L. Washington is a general internist and professor of medicine at the David Geffen School of Medicine at UCLA. Each is an employee of the Greater Los Angeles VA Healthcare System. The views expressed here are theirs alone and do not necessarily reflect those of their employer.