Diversity in Medical School Admissions

4-5 minute read

Author: Judy Hanrahan, JD, MA

Purpose

To discuss the potential impact of the recent Supreme Court decision on affirmative action in higher education admissions.

Learning Objectives

1. Explain the Supreme Court’s holding Students for Fair Admissions v. Harvard;

2. Recall the three kinds of applicants that holistic review helps identify; and

3. Describe how the effects similar legal rules have impacted racial diversity in higher education.

In Students for Fair Admission v. Harvard, the United States (US) Supreme Court overturned prior precedent allowing colleges and universities to consider applicants’ race and ethnicity in admissions decisions.(1) Schools can no longer use race when considering who to admit, not even as part of an individualized assessment. This puts an end to the common practice of race conscious admissions discussed in a previous edition of this newsletter—Holistic Medical School Admissions where we noted that all US allopathic medical schools use a form of holistic admissions.(2)(3)(4) We further explained,

Holistic review in medical school admissions is an intentional process often used to identify qualified students who have been historically under-represented in medicine, whose unique life experiences will contribute to the medical school class and future physician workforce, and whose goals and values align with the school.(4)

The category “historically under-represented in medicine” is significantly impacted by the Supreme Court’s decision because of medicine’s history of excluding racial minorities—be it through outright discrimination in admission, discrimination in membership to medical societies, or preferences for experiences that are or were unavailable to racial and ethnic minorities.(5) The AAMC Experiences-Attributes-Metrics Model of Holistic Admissions will look different moving forward as the sections highlighted below are excluded, or in the case of citizenship, heavily scrutinized.

Schools will still be able to consider other characteristics in the “attributes” ring above, but many will likely do so cautiously as they consider the cascading effects of the Supreme Court’s holding in the Harvard case.

Interestingly, schools are still allowed to give preference to individuals who are members of federally recognized Native American tribes — as tribal membership, according to prior Supreme Court precedent, is a political, rather than a racial category.(6)(7)

Potential Effects on Admissions

Before the Harvard decision, some schools were already prohibited by state law from considering applicants’ race. California’s 1998 Prop 209 outlawed preferential higher education admissions based on race and several other categories. After its passage the overall enrollment of underrepresented minorities in University of California (UC) schools decreased by 14% but the decrease was most concentrated in the most selective UC schools.(8) For example, UCLA and UC Berkely saw a more than 40% decrease in underrepresented minority enrollment.(8)

Zachary Bleemer, who has extensively studied the aftermath of Prop 209 including various attempts to increase racial diversity through race-neutral means, found that “most common race-neutral alternatives to affirmative action increase Black and Hispanic enrollment far less than affirmative action itself.”(9) Bleemer goes on to note that, “none of these [race-neutral] policies substantially affect universities’ socioeconomic composition.”(9)

Medical schools that used race-conscious admissions practices are concerned about the potential for similar decreases, but the UC schools have had more than 25 years of experience bringing the number of underrepresented minority students back up to pre Prop 209 levels and socioeconomic diversity is a large part of the answer.

UC Davis School of Medicine’s Race-Neutral Admissions

The biggest challenge for the most selective schools appears to be in admissions preferences for legacy admissions and experiences that are more difficult for minority students to access. UC Davis School of Medicine ranks third in student body diversity in the US, but to accomplish this the school had to push “back against alumni, donors, and faculty concerned about the school’s reputation, national rankings, and MCAT scores, metrics that can systematically exclude students of color and those with limited financial means.”(10) A focus on diversity of experiences, socioeconomic status, and first generation college students in medical school admissions will hold the key to ensuring that racial and ethnic diversity in medical school classes do not plummet like the numbers did when California passed Prop 209.

References

1. SCOTUSblog. Students for Fair Admissions Inc. v. President & Fellows of Harvard College. www.SCOTUSblog.com. Accessed April 20, 2022. https://www.scotusblog.com/case-files/cases/students-for-fair-admissions-inc-v-president-fellows-of-harvard-college/

2. AAMC. Aspiring Docs: Holistic review in medical school admissions. AAMC.ORG. Accessed May 3, 2022. https://students-residents.aamc.org/choosing-medical-career/holistic-review-medical-school-admissions

3. Mandery E. After Affirmative Action, Elite Colleges Are About to Become the Villains. POLITICO. Published online July 13, 2023. Accessed August 2, 2023. https://www.politico.com/news/magazine/2023/07/13/harvard-affirmative-action-diversity-00105967

4. Brewster C, Hanrahan J. Holistic Medical School Admissions. Holistic Medical School Admissions. Accessed August 2, 2023. https://preceptor.substack.com/p/holistic-medical-school-admissions

5. Daher Y, Austin ET, Munter BT, Murphy L, Gray K. The history of medical education: a commentary on race. Journal of Osteopathic Medicine. 2021;121(2):163-170. doi:10.1515/jom-2020-0212

6. Indian Law Resource Center. Tribes are governments, not racial classifications | Indian Law Resource Center. Indianlaw.org. Accessed August 2, 2023. https://indianlaw.org/story/tribes-are-governments-not-racial-classifications

7. Morton v. Mancari. US 417, 535 (US Supreme Court 1974). Accessed August 2, 2023. https://www.oyez.org/cases/1973/73-362

8. Bleemer Z. Affirmative Action, Mismatch, and Economic Mobility after California’s Proposition 209. The Quarterly Journal of Economics. 2021;137(1):115-160. doi:10.1093/qje/qjab027

9. Bleemer Z. Affirmative action and its race-neutral alternatives. Journal of Public Economics. 2023;220:104839. doi:10.1016/j.jpubeco.2023.104839

10. McFarling UL. How one medical school became remarkably diverse. STAT News. https://www.statnews.com/2023/03/07/how-one-medical-school-became-remarkably-diverse-without-considering-race/. Published March 7, 2023. Accessed August 2, 2023.