Affirmative Action Bans and Enrollment of Students From Underrepresented Racial and Ethnic Groups in U.S. Public Medical Schools
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Affirmative Action Bans and Enrollment of Students From Underrepresented Racial and Ethnic Groups in U.S. Public Medical Schools. Ann Intern Med.2022;175:873-878. [Epub 3 May 2022]. doi:10.7326/M21-4312
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Unintended Consequences of Well Intentioned Equity
It should not be surprising that the percentage of “underrepresented” students in public medical schools has decreased during the ten year period following implementation of an affirmative action ban in certain states as recently reported by Ly et.al. in the Journal. (1). The authors in their introductory paragraph reference the Association of American Medical Colleges (AAMC) 2021 Fall Applicant, Matriculant and Enrollment data tables (2) in their claim that Blacks and Hispanics remain underrepresented in medical schools relative to their proportion in the overall U.S. population. Indeed, as of the latest available data for 2021-2022 extracted from the AAMCs Table A-9, those students identifying as solely Black are 13% underrepresented at 11.5% of matriculating students versus 13% of the population. Those identifying solely as Hispanic appear at first blush to be markedly underrepresented by 120% at 8.5% versus 19% of the U.S. population (3). A closer look at the data, however, reveals that many Hispanics also identify as Black or White, possibly related to the 27% reported incidence of interracial marriage among the Hispanic population (4). If those Hispanics identifying as Black or White are also considered, then Hispanics are 35%, not 120%, underrepresented at 14% of students versus 19% of U.S. population (3). Examination of the same table, moreover, strongly suggests over the past five years that a gradual shift in student demographics from a white majority to peoples of color has occurred, apparently despite the existence of affirmative action bans on medical student admissions.
Interestingly, two racial groups, one the majority, and the other another minority are conspicuously left out of their discussion. Among those students identifying as a single race only, Whites are themselves now 15% “underrepresented” at 52% of matriculating students versus 60% of the U.S. population (2,3). Has anyone suggested that affirmative action be applied to White applicants? Asians, on the other hand are 360% overrepresented being 28% of matriculating students and only 6% of the population (2,3). Could this be meritocracy in action? Should Asian applicants, apparently being overwhelmingly qualified, nevertheless as an “overrepresented” group be the target of application discriminatory behavior going forward so as to better achieve parity between student representation and the overall U.S. population? Do you see that in our best efforts to achieve absolute “equity,” we could end up in a very dark place.
REFERENCES
Disclosures:
Michael Zema MD
Author Response to Zema
Zema points out that the student body population at U.S. medical schools appears to be diversifying over the past several years.1 We are heartened by this change. However, we note two caveats. One, recent research suggests that changes to the collection of data on race and ethnicity by the Association of American Medical Colleges, which allowed students to choose more than 1 race and/or ethnic group, may make it difficult to interpret absolute trends in diversity.2 It is critical to note that our study examined relative trends—trends in diversity of medical schools in states with affirmative action bans relative to schools in states without such bans—and so controlled for these data collection changes. Therefore, the suggestion by Zema that White individuals are underrepresented in medicine is immaterial to our study approach, which focused on changes in the percentage of students who identify as being from particular minority groups within the same medical school over time. For Zema’s concern to affect our approach, it would need to be the case that the way in which students self-report race and/or ethnicity varies systematically with the timing of affirmative action bans between ban and non-ban states. We think this is unlikely.
Second, although increased matriculation at medical school by students from racial and ethnic groups underrepresented in medicine is an important intermediate step, without support, such students can be lost during medical school and residency on their way to becoming a practicing physician.3 This is one of several reasons why, for example, the proportion of physicians who are Black men has remained unchanged between 1940 and 2018.4
Although not the focus of our study, we also believe that it is important for future work to examine subgroups of Asian American students to examine which subgroups might be underrepresented in medicine. Increasing the number of physicians from these subgroups may improve the care delivered to these populations.5
References
Disclaimer: The views expressed in this manuscript are those of the author and do not necessarily represent the views of the US Department of Veterans Affairs or the US government.
Disclosures:
Dr. Jena reports receiving (in the last 36 months) consulting fees unrelated to this work from Bioverativ, Merck/Sharp/Dohme, Janssen, Edwards Life Sciences, Novartis, Amgen, Eisai, Otsuka Pharmaceuticals, Vertex Pharmaceuticals, Celgene, Sanofi Aventis, Precision Health Economics, and Analysis Group. Dr. Jena also reports receiving (in the last 36 months) income unrelated to this work from hosting the podcast Freakonomics, M.D., from book rights to Doubleday Books, and from speaking fees from AAE.