Why affirmative action matters in medicine

In late June, the Supreme Court’s ruled to kill affirmative action in university admissions. Affirmative action policies target the racial imbalance in higher education and the effects of disparities experienced by non-white students. Affirmative action went hand-in-hand with holistic review as acceptance committees tried to balance out their incoming classes, ensuring their future students aren’t only academically gifted but also well-rounded people with relevant lived experiences. 

What does affirmative action have to do with healthcare? The Court’s 6-3 decision will have a drastic impact on the diversity of incoming medical school classes and our medical workforce in the coming years. We know from previous research that state bans on affirmative action lead to reduced enrollment from underrepresented groups in medicine. A UCLA study comparing enrollment in states with and without affirmative action bans found the proportion of underrepresented groups dropped by more than one-third over 5 years. 

Why does this matter?

Despite advanced technology, wealth, and a brilliant medical workforce, American public health statistics have not looked great lately. Life expectancy is going down, maternal and child mortality are going up, and chronic disease is on the rise. But not all Americans are affected equally. Non-white, specifically Black Americans, fare worse across numerous measures of health. 

“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.”

– Jessica Faiz, Utibe R. Essein, and Donna L. Washington in STAT News

Physician diversity is one powerful way to counteract these negative trends. A JAMA Network Open study from April looked at Black primary care physician representation in 1618 counties over a decade and found that more Black physicians corresponded to lower mortality rates and reduced mortality rate disparities. Other research has suggested that having a doctor of the same race improves communication, trust, and outcomes, particularly for Black men. However, less than 6% of physicians are Black, less than 7% are Hispanic, less than 0.5% are Native, and progress has been slow. 

Black physicians have also been the ones to push for needed change in how we approach medicine. Dermatology suffers from a lack of training on dark skin, so a Black medical student created a textbook to address the problem. Nephrology is trying to fix a faulty algorithm that has been keeping Black Americans off the kidney transplant list. Oncologists have been working on addressing higher rates of breast cancer mortality in Black Americans for years.

Simply put, more Black physicians means better health outcomes for Black Americans. The Supreme Court’s decision will have negative population health consequences in the coming years. Institutions of higher education will have to be creative to counteract this step backward.