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Medical schools are being told by their lawyers to stop using strategies to diversify classes that are still legally permitted, despite a Supreme Court ruling against the use of affirmative action in admissions. Experts said this response to the court decision, which some called “overzealous,” helped fuel the double-digit decline seen this year in the enrollment of Black, Hispanic, and Indigenous students — and may be a form of discrimination in itself.
“Admissions officers are being advised by lawyers to go beyond what SCOTUS said,” said Mark Henderson, the associate dean for admissions at the UC Davis School of Medicine, where he is credited with diversifying medical school classes despite a longstanding state ban on affirmative action.
Henderson, who has been staying in close touch with other admissions officers around the country as they grapple with the Supreme Court decision, said he is now advising colleagues to push back on legal advice that may be too restrictive. “These physicians and physician leaders, they don’t think they can argue with the lawyers,” he told STAT.
Many medical students, meanwhile, report their schools have already started reducing initiatives, support, and recruitment efforts for underrepresented students. Miracle Rogers, president elect of the Student National Medical Association and a University of Pittsburgh School of Medicine student, said the results of a survey of 1,600 members of her organization found 24% of students said Diversity, Equity and Inclusion efforts were being cut at their schools and that 67% feared further cuts. “Medical students around the country are worried,” she said Wednesday at an event held by the Roundtable on Black Men and Black Women in Science, Engineering, and Medicine.
One medical student told STAT a diversity dinner traditionally held for admitted students from underrepresented groups had been cancelled at a school he visited because of the Supreme Court decision, even though such activities would not violate the law. Others said they feared important pipeline programs that steer underprivileged students toward medical school are at risk.
“People were so concerned about following the law, they were overzealous in my mind versus protecting the most vulnerable students,” said Mary Owen, a member of the Tlingit Nation, the associate dean of Native American Health at the University of Minnesota, and the founder of IHEART, a collaborative effort to increase the number of Indigenous physicians. “Even a slowdown for a moment affects these programs.”
New data released last week from the Association of American Medical Colleges showed the enrollment of Indigenous students declined 22% from last year, while Black student enrollment dropped 11.6%, and Hispanic student enrollment dropped 10.8%, numbers Henderson called “staggering.”
“This was entirely predictable and may just be the beginning of steeper declines,” James Hildreth, president of the historically Black Meharry Medical College, told STAT. “This represents a huge setback. This is not a time for us to reverse course, or lose highly qualified candidates.”
The stark dips in enrollment follow years of stagnating numbers of Black male medical students, whose numbers have not increased appreciably in decades. The drop reduces already low numbers of Indigenous students, who are technically not affected by the Supreme Court ruling since tribal membership is a political and not a racial designation, but may have felt deterred from applying anyway, Owens and others said.
“You’re discouraging an already discouraged population,” said Henderson.
And the numbers may be far worse because of the overreach of admissions committees that are zealously following the law, “sterilizing applications” as one dean called it, and barring activities that are allowed and could continue, many said.
The Supreme Court’s decision in the case brought by Students for Fair Admissions, Inc. is “not eliminating all consideration of race in admissions,” Art Coleman, a lawyer and founding partner of EducationCounsel, which provides legal and policy planning services, said at Wednesday’s roundtable. “In fact, it is expressly endorsing and giving us a very clear road map on how to think about how an individual’s racial experience, perspective, and goals can be considered around diversity aims that the court considered to be commendable and worthy.”
“The landscape is challenging to be sure,” he said. “It’s not … as challenging as it may seem.” Coleman predicted there would be more efforts to restrict DEI efforts on both federal and state levels that would make the effort to diversify the physician workforce harder, but also said pushback could include lawsuits arguing such restrictions violate the First Amendment or Equal Protection Clause of the 14th Amendment.
Ruqaiijah Yearby, a professor of health law at the Moritz College of Law at The Ohio State University, noted that many schools, including the University of North Carolina, did not voluntarily comply to integrate their classes after the landmark 1954 Brown v. Board of Education decision. “Thus, I would argue that universities’ overcompliance with Students for Fair Admissions is an example of discrimination,” she said.
Many medical schools in states that already have affirmative action bans in place, such as Florida, Texas, and California, did not see appreciable declines in admissions of students from underrepresented groups, AAMC data shows. That suggests that processes such as holistic admissions may work to ensure diverse student classes without the use of race.
Many leaders are still developing plans on how to move forward with their admissions. Hildreth said to avoid legal challenges, admissions at his school would focus on how applicants overcame life difficulties and how they might meet Meharry’s mission, which includes advancing health equity and empowering diverse populations.
Renée Landers, an expert in health and biomedical law and professor at Suffolk University Law School, agreed that many lawyers advising medical school admissions committees have been overly conservative in interpreting the court’s decision. She said strong arguments could be made that the use of race in admissions for medical school was legally justified, and similar to an exemption made for military academies which the court said had “potentially distinct interests.” (That lone exemption, puzzling to people on both sides, is the subject of follow-up lawsuits by groups opposed to affirmative action and may eventually undermine the entire court ruling, according to some constitutional scholars.)
A brief filed with the Supreme Court by the AAMC, Landers noted, showed clearly that the diversity of the health care workforce improves health outcomes for all Americans. “I think there’s a case to be made that providing equitable health care is compelling to the national interest,” she told STAT.
She added that another Supreme Court decision, the 2022 Dobbs v. Jackson Women’s Health Organization decision which limited access to abortion, was starting to have a “chilling effect” on applications to medical schools and residencies in states such as Mississippi, Louisiana, Alabama, and Idaho — which she predicted would only worsen as more stories accumulate of women dying after not receiving needed gynecological care.
“It’s going to hollow out the physician workforce [in those states], and harm people regardless of their demographics,” she said.
Rural areas in America already face a looming physician shortage and lack of maternity care. It’s something Don Warne, an Oglala Lakota physician who co-directs the Johns Hopkins Center for Indigenous Health, calls a “ticking time bomb.” One proposed solution has been to train more Black, Hispanic, and Indigenous physicians who are more likely than white physicians to care for medically underserved populations, including many rural white Americans.
Warne wonders what will happen to those populations now. “To those who are anti-DEI, I’d love to hear what their solutions are,” he said.
Many pushed back strongly against the idea — now being celebrated in more conservative circles — that the declining enrollment of Black and Brown physicians shows that medicine is a meritocracy and that deserving students are now being admitted over those less qualified. “I don’t have patience for that nonsense,” said Meharry’s Hildreth.
Medical schools get so many applicants with high MCAT scores and strong grades they could fill entire classes with “people that look like me,” Hildreth said, but they do not. The Wayne State University School of Medicine risked losing accreditation after admitting only five Black students to its roughly 300-person class (less than 2%) in 2014, despite being located in the predominantly Black city of Detroit. Studies show more than half of medical students come from households in the nation’s top income bracket and 20% have parents who are physicians. “It’s not a level playing field,” Henderson said.
Hildreth’s own experience is illustrative. While an undergraduate at Harvard, he got a sharp response when he told his mentor, a white Harvard medical resident, he wanted to apply to Johns Hopkins for medical school. “He said, ‘Let’s just save your money, they don’t take Black students.’” It was 1978.
Hildreth ended up applying after all, after receiving a letter from Levi Watkins, a Black cardiologist at Hopkins that said he’d been identified as high achieving, and asked him to apply. The school that year admitted 18 Black students, including Hildreth, into a class of 120. “Why?” asked Hildreth. “Because someone put in the effort to identify students who were qualified.”
One bright spot in the data, medical leaders said, is that applications for some underrepresented groups increased this year, showing that the court’s decision did not deter many Black and Brown students who seek to become physicians.
One of those is Gabriel Cuilan, a first year medical student at the University of Michigan. Cuilan, whose mother immigrated from the Dominican Republic, grew up in the Bronx and attended a magnet school in Manhattan that required a commute that could run more than an hour. When he had to attend an early baseball or basketball practice, he left home at 4:30 a.m.
Despite his stellar grades, he was told by a guidance counselor he didn’t have what it took to go to a private college. He didn’t listen and ended up getting a full academic Questbridge scholarship to attend Bowdoin, where he played on the baseball team and majored in chemistry. It was his first wake-up call. His classmates had stock portfolios, parents who were lawyers, and summer homes on Cape Cod.
He was determined to become a doctor, he said, after seeing his mom serve as a medical interpreter for his many neighbors and relatives, who spoke only Spanish. “There was one Spanish-speaking doctor in the Bronx and there would be four-hour waits just to see him,” Cuilan said. “There is a lack of physicians who look like me and who can speak multiple languages for their patients.”
Cuilan said he didn’t think much about the affirmative action decision when it came out in June 2023. He was too busy taking his MCATs. He scored in the 90th percentile. When he applied — a little late in the rolling admissions cycle because he retook his MCATs — he started getting concerned he might get less consideration because his application came in later and because of the Supreme Court decision. “To me, it’s a double whammy,” he said.
There were ups and downs, waitlists and rejections, but Cuilan was admitted into a number of highly selective medical schools, including the University of Michigan, which offered him a full scholarship and living expenses. He’s thrilled, though he can’t help but wonder where else he might have been accepted if the Supreme Court decision hadn’t been in effect. “Honestly, I think it did affect decisions,” he said.
Still, he’s at a top school that will prepare him well for a possible career in orthopedic surgery, a field that remains among the least diverse in medicine. “A lot of people from diverse backgrounds use sports to help themselves and their families,” he said, “but when they get injured they don’t have a doctor who looks like them.”
STAT’s coverage of health inequities is supported by a grant from the Commonwealth Fund. Our financial supporters are not involved in any decisions about our journalism.