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Medical pundits are predicting that the recent U.S. Supreme Court ruling striking down race-conscious admissions will have for medical schools and the composition of the physician workforce.
The concern is that the high court's decision to restrict public and private higher education institutions from considering an applicant's race or ethnicity in admission decisions will negatively impact medical schools' diversity and the nature of future physicians.
The fear is that gains made over the past few years in achieving gender, racial, and ethnic minority representation among physicians will suffer and possibly be erased, especially as continue to disproportionately favor white applicants over minority ones.
Few in medicine would argue the need for medical schools to recruit more students and hire more faculty that reflect the diversity of the American population. Black, Latinx, and Native American residents make up 30% of the population, but . Although I am concerned about the possible negative consequences of the Supreme Court's ruling, I do not foresee a setback to ongoing efforts to diversify medicine and improve care. Here are my reasons:
1. Race is already known prior to admission. A medical school applicant's race is plainly visible to admissions officers who conduct interviews, whether face-to-face or by video. Even in applicants who are not selected for interviews, many elements pertaining to their identity, including race and ethnicity, can be inferred from their applications, sometimes from their names and often through self-revelatory essays. The point is racial characteristics do not have to be disclosed on an application in order for members of the admission committee to be aware of them.
2. Medical school admissions committees are diversifying. While it is true that historically the composition of admissions committees has maintained a white status quo, there is increasing diversity among faculty participating on admissions committees. This will likely lead to greater diversity, equity, and inclusion (DEI) among matriculating students.
3. Community members sit on admissions committees. Admissions officers are placing greater emphasis on how medical students connect with the community around them. At some medical schools, community members are involved in prospective medical students, and they have a vote on the school's admissions committee. Medical schools are thus in a unique position to reverse racial disparities in the profession by attracting medical students who want to work closely with the community.
4. Internal influences, such as explicit -- or, more often, implicit -- biases are being acknowledged and uprooted from standing committee operations. Implicit bias is a major factor responsible for healthcare disparities, and it prevents faculty and administrators from considering diversity as a needed health intervention. However, after decades-long calls for increasing racial and ethnic diversity in the medical profession, the message finally seems to be getting through. The of Black, Hispanic, and women applicants and enrollees continued to increase at U.S. medical schools in the 2022-23 academic year, according to the Association of American Medical Colleges. And women now outnumber men entering medical school.
5. DEI initiatives are here to stay. There is probably no more pressing initiative today than to increase racial and ethnic diversity across healthcare institutions by including members of Black or African American, Hispanic or Latinx, and Indigenous groups. DEI goals and objectives have filtered down to students, faculty, and admissions committees who, in turn, have developed to eliminate barriers to the advancement of diversity in medical school admissions. Medical leaders' continued removal of inequitable structures and implementation of process changes is a critical step toward achieving racial justice.
I'm optimistic (maybe overly optimistic) that checking a box that identifies one's racial and ethnic origins may no longer be necessary to further our interest in increasing the diversity of the physician workforce -- it clearly is no longer constitutionally permissible. Without the identification of race, what, then, matters most in gaining admission to medical school? What are the factors that really count and will persuade a hypothetically colorblind medical school admissions committee to accept a student? The short answer is a triumvirate of core competencies -- academic excellence, personal character, and lived experience. I believe these will become the new drivers of admission to medical school.
Given the ever-increasing demand for medical careers and the limited number of openings in medical schools, students must demonstrate outstanding scholastic achievement in the physical sciences, social sciences, and humanities. They must parlay this knowledge into the Medical College Admission Test (MCAT) so that the combination of their MCAT scores and overall grade point average (GPA) is compelling and demonstrates an ability to master a wide range of subjects considered a prerequisite for undertaking the vicissitudes of medical school. There are no hard cut-offs in terms of MCAT and GPA scores, but the numbers usually have to sing to admissions officers in order to be granted an interview.
No singular character type portends success in medical school and beyond, just as no specific set of attributes defines a great leader. But what is important is that students demonstrate that they have a well-developed sense of identity and character. Character comes across in the content of primary and secondary essays and personal interviews. Students who are sure of themselves, write with conviction, make good eye contact, shake hands firmly, and readily connect with people surely will stand apart from the competition. Faculty also pay close attention to students' nonverbal behavior and how they carry and conduct themselves during the interview. Successful applicants will have an altruistic sense of purpose and genuine desire to be leaders and change agents in the health professions field.
Most pre-med advisors tell medical students to gain experience in the medical field prior to applying to medical school. While this may be helpful, I'm convinced that non-medical jobs and other types of experience listed on students' resumes will count as much, if not more, than brief forays in a research lab or hospital. In my case, it was working as a at a major league baseball park. In the case of a colleague, it was working as a . There are infinite jobs and experiences outside of medicine that students can use to their advantage on essays and in interviews. Many applicants today have great diversity of experience partly due to the increased popularity of gap years.
A Black medical student transitioning into his fourth year recently asked me for advice. The student was tasked with describing his three most important characteristics. The medical school dean wanted to include this information in a letter to support the students' application to residency programs. The student wrote three brief paragraphs about himself, but he failed to specify the nature of the characteristics that distinguished him, which were 1) resiliency, 2) role model and educator, and 3) crusader for overcoming health disparities.
I'm sure this student will match at their first-choice program. Checking a residency application box is meaningless for someone with his talent.
Arthur Lazarus, MD, MBA, is a psychiatrist.
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