The U.S. Supreme Court heard oral arguments on Monday in two cases that could eliminate race as a factor in university’s admissions processes. The precedent established in 2003, when the court ruled that race, along with other factors, could be given limited consideration in higher education admissions when necessary to achieve student body diversity, is now in jeopardy. Should the court overturn its earlier ruling, the implications would be felt broadly across all sectors of society — including the health care system.
From my perspective as chair-elect of the board of directors for the Association of American Medical Colleges (AAMC), a position informed by my role as dean of medical education at Georgetown University School of Medicine, the consideration of race as one of many elements in the admissions process is not only appropriate but essential. U.S. medical schools — and health care generally — thrive on the diversity of thought, experience, and perspective made possible by this holistic approach to admissions.
What do I mean here by holistic? The goal of every medical school should be to select a class of doctors who demonstrate not only academic achievement but compassion and the drive to deliver quality health care. In addition to considering standardized testing scores and grades, those involved in admissions want to understand applicants’ character, conviction, and the circumstances that have helped shape their lives. A person’s race inherently affects their perspective — a fact that cannot be denied and must be considered.
I often hear people ask, “Is the admissions process about merit or is it about diversity?” It is about both; they are not mutually exclusive.
An essential part of medical education is for a diverse pool of students to learn from each other’s experiences. They share ideas and search for solutions to make the health system more equitable. At Georgetown, students eagerly volunteer at the school’s student-run health clinics, learning from and helping care for members of under-resourced communities.
The perspectives and values exchanged between students during medical school are put into practice after graduation. A more diverse workforce drives better patient experiences — especially among marginalized groups. A higher percentage of matriculants of color say they intend to practice in underserved communities, where physicians are in greater need. People feel they receive better care and communication from doctors who share their race or gender.
When doctors meet patients where they are and build trust, they are more likely to seek preventive care and openly discuss their health concerns, both of which are important for long-term health.
I know how essential it is for doctors to be proactive about working with overlooked communities. Growing up, I saw racial inequities in health care affect my own family living in very racially segregated communities. When a cousin was injured at home as a boy, he went to his community’s safety-net hospital and waited 28 hours before getting care. I also recall family members talking about pooling money to help another cousin in kidney failure buy a dialysis unit because there were no dialysis facilities in his community. The shortage of physicians in these racially segregated areas contributed to both decreased care and decreased advocacy for standard treatments.
Like many of the students I now have the privilege to teach, I wanted to change this broken system. I wanted to make sure my family members — and others like them — could get care when they needed it. Becoming a doctor was how I could effect this kind of change.
This virtuous cycle — a more diverse medical profession, better care for the underserved, improved health — begins with who is accepted to medical school. Yet there is still a great deal of work to be done to make sure that U.S. medical schools better reflect society.
Data from the AAMC indicate that medical school classes are becoming increasingly diverse, but progress remains incremental. Between 1978 and 2019, the number of Black male medical students stalled at about 3%. As America faces a physician shortage, existing barriers to care will get even higher as resources become more strained among historically marginalized communities.
If the Supreme Court overturns the current precedent, the country must prepare to face the consequences, as California did after banning the consideration of race from university admissions. Medical schools in the state saw a significant reduction in the enrollment of students of color. Harder to measure are the setbacks in patient care that come from a more homogenous student population, but it is certain to be profound.
A tragic error — eliminating race as a factor in admissions — by the Supreme Court would be compounded in numerous ways: in who gets the chance to attend medical school, in the richness of that education, in the quality of care in the country’s hardest pressed communities, and in the health of our families and neighbors.
Denied the ability to consider an applicant’s race, admissions officers might look to a student’s ZIP code or socioeconomic status as court-approved metrics, but these will never tell the full story of a student’s lived experience. Race is an inherent part of that. It should remain a fundamental part of the admissions process.
Lee Jones is a psychiatrist, chair-elect of the Association of American Medical Colleges Board of Directors, and dean for medical education at Georgetown University School of Medicine in Washington, D.C.