The recent ruling of the Supreme Court of the United States (SCOTUS) to eliminate race-conscious decision-making from college admissions is being openly challenged by the medical establishment. The American Association of American Medical Colleges (AAMC), the Medical Board of California, and the John A. Burns School of Medicine (JABSOM) at the University of Hawaii (among others) are continuing efforts to diversify education and medical staffing despite a 6 to 3 ruling of the Supreme Court prohibiting consideration of race and ethnicity in admissions decisions.

The AAMC was quick to act and step into the ring. On June 29, 2023, the same day SCOTUS reversed long-standing affirmative action admission policies at Harvard and the University of North Carolina, the AAMC said they were “deeply disappointed” with the Supreme’ Court’s verdict, writing, in part: “We remain committed to enhancing health professional education and practice by emphasizing critical thinking, innovation, effective communication with all patients, and increased access to patient care for an increasingly diverse population … We will work together to adapt following today’s court decision without compromising these goals. The health of everyone depends on it.”

The Federation of State Medical Boards (FSMB), which considers itself the “voice” for state medical boards, actually began addressing diversity, equity, and inclusion initiatives before SCOTUS weighed in. The FSMB formed a task force in 2021 to “address systemic racism, implicit bias, health equity in medical regulation and patient care.” Legislation soon followed in California that mandated “continuing education courses … that includes the understanding of implicit bias [defined as] the attitudes or internalized stereotypes that affect our perceptions, actions, and decisions in an unconscious manner … and often contributes to unequal treatment of people based on race, ethnicity, gender identity, sexual orientation, age, disability, and other characteristics.”

Individual medical schools also entered the fray. The John A. Burns School of Medicine (JABSOM) at the University of Hawaii issued a Statement on SCOTUS Race-Conscious Admissions Ruling affirming that they will not be deterred from their many diversity initiatives and programs encapsulated in their vision, mission, and values. JABSOM embraces diversity and inclusion as part of their shared Hawaiian, Asian, and Pacific values, promoting the recruitment and retention of students, faculty, and staff, who are representative of the diverse population of Hawaii, where whites are in the minority.

JABSOM’s goal is similar to many other medical schools, including my alma mater the Lewis Katz School of Medicine at Temple University, which incorporates community members on the admissions committee to ensure a diverse representation of students. Temple’s associate dean of admissions commented: “There is a unique community in North Philadelphia. A big part of a medical student’s education is providing care within this community and learning to understand the people who live in our community and the challenges they face.”

Attracting and admitting minority medical students will increase the supply of minority physicians in impoverished areas. People of all races tend to prefer to see physicians who are similar to them in race or ethnicity, and when patients are of the same race as their providers, they report higher levels of satisfaction and trust and better communication and health outcomes. Race-conscious admissions seemed to have achieved their desired effect: the percentage of minorities entering medical school has increased the past several years. Not surprisingly, an analysis of affirmative action bans in six states found that medical school enrollment of students of color who were members of underrepresented groups fell roughly 17 percent after the bans were instituted.

JABSOM’s class size is relatively small, approximately 75 to 80 students. Its 2019 entering class enrolled 68 (88%) Hawaii and Pacific Island residents and 9 (12 percent) non-residents from the mainland and Canada. Ten percent of students were white. Of the total 1980 medical school applicants, the overwhelming majority – 1682 (85 percent) – were non-residents, giving an undisputable advantage to the residents of Hawaii and the Pacific Islands due to the high rejection rate of out-of-state students (about 50 times more likely to be denied admission).

Although U.S. News & World Report ranks JABSOM #16 in best medical schools for primary care, for all its student and employee diversity pipelines and partnerships, the school ranks only #80 for diversity. JABSOM doesn’t even rank among the top 100 schools in most graduates practicing in rural or medically underserved areas, negating the school’s raison d’être to train individuals from disadvantaged socioeconomic and/or educational backgrounds who ostensibly have a stronger commitment to serve in geographical areas of need.

As for the continuing medical education requirement in California, two physicians and the conservative organization Do No Harm have filed a lawsuit seeking a permanent injunction to stop the medical board from implementing implicit bias training, claiming that an instructor cannot be compelled to “espouse the government’s favored view on a controversial topic,” further noting that “[e]ven assuming sufficient evidence exists that implicit bias in health care is prevalent and results in disparate treatment outcomes, there is no evidence-based consensus that trainings intended to reduce implicit bias are effective.”

Do No Harm is a group of medical and policy professionals who oppose race-conscious medical school admissions and other policies that incorporate identity-based considerations into health care decision-making. According to the website of Do No Harm, the group has filed a number of lawsuits or complaints “to combat the influx of discriminatory and divisive ideologies in medicine,” including a minority scholarship program in Arkansas that excludes white and Arab-American applicants, Project Hope and its journal Health Affairs for excluding whites from a fellowship, Pfizer for excluding whites and Asians from its fellowship, and the Biden administration for “injecting a race ideology into medical regulations.”

All this acrimony raises the concern that medicine is headed toward troubling times. It is entering an unsettling and tenuous state where every action that embraces diversity has an equal and opposite reaction, more vocal and certainly less civil than the previous one. The blowback can be seen not only in the anti-woke movement but also in ordinary citizens who feel discriminated against: more than half (55 percent) of white Americans say that, generally speaking, they believe there is discrimination against them today, according to a poll taken in 2017 by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health.

The survey sampled 3,453 adults; 902 were white. Interestingly, 84 percent of whites believed discrimination also exists against racial and ethnic minorities. Indeed, people from every racial or ethnic group surveyed said they believe theirs faces discrimination — not only whites, but African-Americans, Latinx, Native Americans and Asian-Americans.

Most notably, while a majority of whites in the poll felt discrimination against them exists, a much smaller percentage said that they have actually experienced it. The most insightful thing I can say is that discrimination is different when you experience it than when you talk or think about it. I may have grown up white and privileged in suburban United States, but whenever I visit Hawaii – at least two times a year – I quickly realize I am a minority. I wouldn’t have stood a snowball’s chance in hell gaining admission to JABSOM because I do not look like the population they aim to teach and serve and I do not share their same lived experiences. Nor could I count on SCOTUS anymore to bolster my chances of being admitted.

This essay is cited in the KevinMD record on race and medicine.

Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia, PA. His forthcoming book is titled Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine.