Medical professionals predict that the recent US Supreme Court decision striking down racially based admissions will have dire consequences for medical schools and the composition of the physician workforce.
The concern is that the Supreme Court’s decision to limit public and private higher education institutions from considering an applicant’s race or ethnicity in admissions decisions will negatively affect the diversity of medical schools and the nature of future doctors.
The fear is that gains made over the past few years in achieving gender, racial and ethnic minority representation among physicians will suffer and possibly be erased, especially as legacy admissions continue to disproportionately favor white applicants over minority ones.
Few in medicine would dispute the need for medical schools to recruit more students and more faculty that reflect the diversity of the American population. Blacks, Hispanics, and Native Americans make up 30% of the population, but just under 9% of practicing physicians. While I am concerned about the possible negative consequences of the Supreme Court’s decision, I do not foresee any hindrance to continued efforts to diversify medicine and improve care. Here are my reasons:
1. Race is known before acceptance. The race of a medical school applicant is clearly visible to admissions officers conducting interviews, whether face-to-face or via video. Even for applicants who are not selected for interviews, many elements pertaining to their identity, including race and ethnicity, can be inferred from their applications, sometimes from their names and often through self-revealing essays. The point is that racial characteristics should not be disclosed in the application for admissions committee members to know about.
2. Medical school admissions committees are diversifying. While it is true that historically the composition of admissions committees has maintained the white status quo, there is increasing diversity among faculty serving on admissions committees. This is likely to lead to greater diversity, equity and inclusion (DEI) among matriculates.
3. Community members participate in reception committees. Admissions officers place greater emphasis on how medical students connect with the community around them. At some medical schools, community members participate in interviewing prospective medical students and have a voice on the school’s admissions committee. Thus, medical schools are uniquely positioned to reverse racial disparities in the profession by attracting medical students who want to work closely with the community.
4. Internal influences such as explicit – or more often implicit – biases are recognized and eradicated from the operations of standing committees. Implicit bias is a major factor responsible for health disparities and prevents educators and administrators from viewing diversity as a necessary health intervention. However, after decades of calls for increased racial and ethnic diversity in the medical profession, the message seems to be finally getting through. According to the Association of American Medical Colleges, the number of blacks, Hispanics and women applying to and enrolling in US medical schools in the 2022-23 academic year. And women now outnumber men entering medical school.
5. DEI initiatives are here to stay. There is perhaps no more pressing initiative today than to increase racial and ethnic diversity in health care settings by including members of Black or African American, Hispanic or Latino, and Indigenous groups. DEI’s goals and objectives have filtered down to students, faculty, and admissions committees, who in turn have developed strategies to remove barriers to the advancement of diversity in medical school admissions. Medical leaders’ ongoing dismantling of unjust structures and implementation of process changes is a critical step toward achieving racial justice.
I am optimistic (perhaps overly optimistic) that checking a box that identifies one’s racial and ethnic background may no longer be necessary to advance our interest in increasing the diversity of the physician workforce—it is clearly no longer is constitutionally permissible. Without the identification of race, what then is most important in gaining admission to medical school? What are the factors that really matter and will convince an admissions committee at a hypothetical colorblind medical school to accept a student? The short answer is a triumvirate of core competencies – academic achievement, personal character and lived experience. I believe they will become the new drivers of medical school admissions.
Given the ever-increasing demand for medical careers and the limited number of medical school vacancies, students must demonstrate exceptional academic achievement in the physical sciences, social sciences and humanities. They must apply this knowledge to the Medical College Admission Test (MCAT) so that the combination of their MCAT scores and cumulative grade point average (GPA) is convincing and demonstrates an ability to master a wide range of prerequisite subjects to undertake the vicissitudes of medical school. There is no hard cutoff for MCAT scores and GPAs, but the numbers must usually be presented to admissions officers to be allowed an interview.
No single character type predicts success in medical school and beyond, just as no particular set of attributes defines a great leader. But the important thing is that students demonstrate that they have a well-developed sense of identity and character. Character is found in the content of primary and secondary essays and personal interviews. Students who are confident, write with conviction, make good eye contact, have a firm handshake, and connect easily with people are sure to stand out from the competition. Instructors also pay close attention to students’ non-verbal behavior and how they behave and behave during the interview. Successful candidates will have an altruistic sense of purpose and a genuine desire to be leaders and change agents in the health professions field.
Most pre-med advisors tell medical students to gain experience in the medical field before applying to medical school. While this may be helpful, I’m convinced that non-medical jobs and other types of experience listed on students’ resumes will count as much, if not more, than brief forays into a research lab or hospital. In my case, it was a job as a beer vendor at a major league baseball park. In the case of the colleague, it was a job as a foreman in a restaurant. There are endless jobs and experiences outside of medicine that students can use to their advantage in essays and interviews. Many candidates today have a wide variety of backgrounds, in part due to the increased popularity of gap years.
A black medical student entering his fourth year recently asked me for advice. The student was tasked with describing his three most important characteristics. The dean of the medical school wanted to include this information in a letter supporting the students’ application to residency programs. The student wrote three short paragraphs about himself but failed to identify the nature of the characteristics that set him apart, which are 1) resilience, 2) a role model and educator, and 3) a crusader for health disparities.
I am sure that this student will fit the first choice program. Checking the residency application box is pointless for someone with his talent.
Arthur Lazarus, MD, MBA, is a psychiatrist.
This post appeared on KevinMD.