The medical community was rocked by the United States Supreme Court’s (SCOTUS) decision in Students for Fair Admissions (SFFA), Inc. v. President and Fellows of Harvard College and SFFA v. University of North Carolina, et al. The ruling essentially banned race in consideration for admitting students to colleges and universities. Several medical schools and professional organizations retaliated by vowing to continue affirmative action practices, or at least figure out ways to comply with the ruling while maintaining diversity among students. I’ve searched the Internet and collected a half-dozen of the most emphatic responses from the aggrieved parties.
1. The John A. Burns School of Medicine (JABSOM) at the University of Hawaii, a well-known champion of diversity, equity, and inclusion (DEI) initiatives and programs, issued a Statement on SCOTUS Race-Conscious Admissions Ruling proclaiming: “The U.S. Supreme Court’s decision related to affirmative action in higher education will not deter us from our vision, mission, and values.” JABSOM’s interim dean said they intend to analyze the Supreme Court’s ruling to determine what changes, if any, will be required to adhere to it.
2. The Association of American Medical Colleges remarked how “deeply disappointed” they were 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 [June 29, 2023] court decision without compromising these goals.”
3. Thomas J. Nasca, MD, president and CEO of the Accreditation Council for Graduate Medical Education (ACGME), wrote, “It is important to note that the ACGME standards do not require race-based affirmative action to achieve diversity, and this [Supreme Court] decision does not require programs and institutions to change their resident selection practices.” The ACGME reaffirmed its commitment to practices that help develop a diverse physician workforce.
4. Stanford University’s medical school leaders commented: “While we adjust to this new environment in a manner that conforms with the law, we want to emphasize that Stanford Medicine firmly believes in the transformative power of diversity, in all dimensions. It fosters perspectives and experiences that enrich our medical knowledge, it enhances the care we provide, and ensures that tomorrow’s breakthroughs benefit all. While the ruling changes the landscape of university admissions, it does not change our resolve or our values.”
5. U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra observed: “The Supreme Court ruling … weakens efforts to make higher education more accessible to members of historically underrepresented groups…This ruling will make it even more difficult for the nation’s colleges and universities to help create future health experts and workers that reflect the diversity of our great nation. The health and wellbeing of Americans will suffer as a result.”
6. Jesse M. Ehrenfeld, MD, MPH, president of the American Medical Association (AMA), said in a statement that the Supreme Court’s decision “undermines decades of progress centered on the educational value of diversity, and will reverse gains made in the battle against health inequities. This ruling restricts medical schools from considering race and ethnicity among the multiple factors in admissions policies and will translate into a less diverse physician workforce,” further noting that “this court ruling deals a serious blow to our goal of increasing medical career opportunities for historically marginalized and minoritized people.”
Other medical organizations jumped on the affirmative action bandwagon, including the American College of Physicians, the American College of Obstetricians and Gynecologists, and the American Psychiatric Association. Many physicians even took to Twitter (now “X”) to decry the SCOTUS decision, saying the ruling would set back decades of progress and harm diversity and health equity efforts. Indeed, the Supreme Court opinion comes just when the percentage of minority students entering medical school has risen over the past couple of years.
However, a vocal minority of physicians believe that admission to medical school should be based on merit alone. They fear that the Supreme Court’s ruling will prompt workarounds, including the possible the elimination of the Medical College Admission Test, or MCAT, long considered the gold standard for deciding admissions yet favoring whites and Asian Americans. Stanley Goldfarb, MD, a nephrologist and board chair of the conservative physician organization Do No Harm, was quoted as saying, “Medical school does not exist to ameliorate society’s problems. It exists to create competent physicians.”
To determine the potential impact of SCOTUS’s ruling on medical schools’ selection process, The Philadelphia Inquirer interviewed two deans at Cooper Medical School of Rowan University and the former admissions director at Thomas Jefferson’s Kimmel Medical College — two of seven medical Schools in the Philadelphia, Pennsylvania area. The consensus was that schools might end up enrolling fewer students from underrepresented populations — a fact already borne out by research in states that have previously eliminated race and ethnicity from consideration in admissions.
Even before the SCOTUS ruling, discussions about racial and ethnic diversity in medical schools were dominated by legal and policy concerns. A JAMA article discovered that many medical admissions leaders were confused about selection criteria and unsure how to proceed in the absence of clear legal guidelines, knowing that affirmative action could become history. Among 37 schools participating in a qualitative survey, various interpretations of diversity emerged, challenges to increasing racial and ethnic diversity were noted, and multiple strategies were necessary to overcome DEI barriers.
Undoubtedly, medical schools will continue to use those strategies to maintain diversity in the classroom and exam room. Some include evaluating medical school applicants holistically and employing health pathways that are tantamount to a “pipeline” to disadvantaged K-12 students to stimulate their interest in medicine.
An up-and-coming tool used to diversify medical school classes is the socioeconomic disadvantage scale, or SED, developed by Mark C. Henderson, MD, associate dean for admissions at UC Davis School of Medicine. UC Davis is ranked #3 in diversity by U.S. News & World Report despite the fact that California banned affirmative action in 1996. The school gives every applicant a score from zero to 99 that considers the applicant’s family income, parental education, whether applicants come from an underserved area, whether they help support their families, and other life circumstances. Admissions decisions are based on that score, combined with the usual portfolio of grades, test scores, recommendations, essays, and interviews. Legacy students would not fare well under this system.
The most recently admitted UC Davis medical class contains 133 students, with 84 percent coming from “disadvantaged” backgrounds — 14 percent are Black and 30 percent are Hispanic or Latinx, according to the school’s matriculant data. “Word has gotten out,” noted a recent New York Times article, “about the UC Davis scale.” Approximately 20 schools reportedly “recently requested more information” about the process, the Times piece noted.
By diversifying, schools may improve medical performance and outcomes, and graduate students more willing to practice in underserved communities. However, according to U.S. News & World Report, JABSOM, for example, doesn’t rank among the top 100 schools whose graduates practice in rural or medically underserved areas, although their website claims otherwise. Apparently, overcoming hardship and tasting success early in medical school impacts some students’ altruism and career plans.
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.