What the end of affirmative action means to a fourth-year medical student

When the U.S. Supreme Court released its landmark ruling overturning the use of race-conscious college admissions, LaShyra Nolen was on clinical rotation. For Nolen, a fourth-year medical student at Harvard Medical School, the news sent a chill down her spine even though she had been anticipating it. “It felt very lonely,” said Nolen, who is Black and the first in her family to get a bachelors of science degree and attend medical school.

The court’s decision effectively ends affirmative action at U.S. colleges and universities. Many medical education leaders view the ruling as a seismic shift in the American higher education landscape.

Affirmative action made its way into U.S. public policy in the 1960s, as many majority white schools began admitting minority students. The goal was to address historical racial imbalances in schools, and to create a more equitable and diverse educational environment. But now many universities will have to change their admission programs to remove race-conscious policies — which will significantly affect the admission rates for Black, African American and international students.

STAT asked Nolen about what affirmative action has meant to her, and about the wider impact of the Supreme Court ruling on medical education and a post-affirmative action America. The conversation has been lightly edited for length and clarity.

Affirmative action has been an important public policy in getting Black students and students from other underrepresented groups into public colleges and federally funded private schools across the United States. Can you tell me what this has meant to you?

I am a descendant of enslaved people and a first-generation medical student. Growing up, I didn’t have access to generational wealth. I remember I was so sad when my mother couldn’t afford to pay for me to attend SAT classes because they were very expensive. What affirmative action has meant to me is that it gave me a platform to apply to opportunities, including medical school, scholarships and grants — and to be considered for admission and looked at holistically as a candidate.

Affirmative action allowed me to walk into rooms that I would never have had the opportunity to walk into. And, in every room that I’ve been, I add value; I bring perspectives that would otherwise have not been there. It has allowed me to be seen as who I am and what it’s taken for me to be where I am. It allowed me to excel because I was able to be put in these spaces.

How did you feel when you got news of the Supreme Court affirmative action ruling?

On that afternoon, I was on clinical rotation when I heard the news about affirmative action being gutted. I felt very lonely. I was supposed to be preparing for a presentation. But I spent 30 minutes texting my friends about it and how I was feeling. I wanted to get a virtual hug, a reassurance from my community, because no one around me was talking about it. All I heard were clicks of keyboards. While I do think that medical care must go on, I sometimes wish that we could pause and acknowledge that the care we provide sits within the context of a country in a heavy socio-political atmosphere. So, in that moment, it just felt very lonely for me and frustrating to have to sit with that and perform my duties as a medical student.

How will this action affect prospective medical students from Black communities and other groups who are dismally underrepresented in medicine?

I worry what it might do for their confidence. We need more Black doctors and I worry that they’re now going to see this and go: What’s the point? Because, for example, the MCAT is the hardest test that I’ve ever taken in my life and they’re very expensive, costing over $1,000. It also takes a lot of time to study for the tests. So, if you are living with a single parent or don’t have access to intergenerational wealth, like many descendants of enslaved people don’t have, how are you supposed to put aside those eight to 10 hours a day that are required to study? Affirmative action allowed the consideration of race as a way of understanding these unique challenges that students from underrepresented backgrounds face. Without that, I am afraid that a lot of students are going to be overlooked and many prospective students might anticipate the fact that they’re going to be overlooked and decide not to apply.

When we look at how many folks in medical school are wealthy, often they’re daughters or siblings of physicians, it’s just a very unequal field. What affirmative action attempted to do, even though it was imperfect, is try to level the playing field. I hope that institutions can find a way to really try to see the richness of students from minority and marginalized backgrounds, so that they can gain admission to medical school, because that means the world to our patients.

What else are you worried about?

I am very worried about the precedent that this case would set. A lot of the conversations that I have seen focus on what this means for our laws. But I am deeply worried about the socio-political climate that it will create. I am afraid that this decision is going to stoke up hate and racism against Black people and students and create an unsafe environment for minorities across the U.S. It will undo a lot of progress that has been made in our fight for justice and health equity.

What can be done?

This is an opportunity for us to make sure that historically Black colleges and universities (HBCUs) get the support they need to continue producing Black physicians in the country. For example, I am excited to see that Charles Drew University, which is the first HBCU medical school that will be on the West Coast, just accepted their first medical students.

For a very long time we have focused on institutions like Harvard. How about looking into institutions that have been educating Black physicians for decades but have largely not been recognized and supported. We need to understand that the majority of Black physicians will be trained in HBCUs. I have great friends who have been to those schools; they’ve had great experiences and I am proud of the doctors that they’re becoming.