How healthcare may be affected by the Supreme Court’s affirmative action ruling

By Michelle Andrews

KFF health news

Doctors fear that a Supreme Court ruling handed down on June 29 will have far-reaching effects not only on the diversity of doctors and other health professionals in training, but ultimately on patient care as well.

The decision found it unconstitutional for colleges and universities to use race as a factor in student admissions, which will affect enrollment decisions in public and private educational institutions, including medical schools.

Like other academic institutions, medical schools have long factored race into admissions decisions. The schools have operated on the principle, and there is considerable evidence that they are right that a more diverse workforce of doctors does a better job of treating different patients.

The decision demonstrates a lack of understanding of the fundamental benefits of racial and ethnic diversity in educational settings and a failure to recognize the urgent need to address health inequalities, said in a statement by David Skorton, president and CEO of the Association of American Medical Colleges, and Frank Trinity, its chief legal officer.

Chief Justice John Roberts wrote the majority opinion. He found that the Harvard College and University of North Carolina defendant admissions programs violate the Equal Protection Clause of the 14th Amendment, which prohibits racial discrimination. The decision overturned decades of legal precedent that had allowed colleges and universities to evaluate prospective students based on their race, as well as factors such as academic records and test scores.

In a dissent, Associate Justice Sonia Sotomayor wrote on behalf of the three liberal justice courts that the ruling solidifies a superficial rule of color blindness as a constitutional principle in an endemically segregated society in which race has always mattered and continues to matter.

What does the ruling mean for medical schools?

The decision could have serious repercussions, say medical educators.

The AAMC, which represents more than 500 medical schools and teaching hospitals, filed an amicus brief with the court arguing that diversity in medical education literally saves lives by ensuring that doctors, nurses and other health care professionals can competently care for an increasingly diverse population.

Diversity in healthcare professionals helps increase the confidence of students, interns and clinicians to work with patient populations that differ from their identities, said Norma Poll-Hunter, senior director of workforce diversity at the AAMC.

While it’s impossible to predict the full impact of the court ruling, looking at some of the nine states that already have race-conscious college admissions bans may provide clues. An analysis of bans in six states found that medical school enrollment of students of color who were members of underrepresented groups decreased by about 17 percent after the bans were instituted.

And the patients?

At this point it’s hard to tell.

Although the United States has one of the most advanced medical research and clinical care systems in the world, blacks and some other minorities often fare worse than whites in a number of health care measures. Their life expectancies are shorter: 65.2 years for American Indians and Alaska Natives and 70.8 for blacks in 2021, versus 76.4 for whites, according to KFF. Black and AIAN infants were about twice as likely to die as white infants, and women in those minority groups had the highest rates of pregnancy-related mortality in 2021.

Research shows that people of all races tend to prefer seeing doctors similar to them in race or ethnicity, according to Poll-Hunter. When patients are of the same race as their provider, they report higher levels of satisfaction and trust, and better communication.

When patients are of the same race or gender as their provider, they may also have better health outcomes, research shows.

For example, in a study of 1.8 million babies born in Florida hospitals between 1992 and 2015, black newborns were half as likely to die when treated by black doctors than when their doctors were white. Research has historically focused on white infants with white doctors, said the study’s lead author, Brad Greenwood, a professor of information systems and operations management at George Mason University.

To the extent that physicians in a social outgroup are more likely to be aware of the challenges and problems that arise when treating their group, it stands to reason that these physicians may be better equipped to treat patients with complex needs, according to the study.

However, the solution isn’t to try to ensure that all Black patients are seen by Black doctors, Greenwood said.

Jim Crow medicine will not solve this problem, he said, referring to laws enacted in the 19th and 20th centuries that enforced racial segregation.

Ensuring a diverse medical base can improve care for all patients, including those from marginalized groups. As you increase diversity, diversity of opinion increases the scope of how people think about things and express best practices, she said.

Do no harm?

Do No Harm, a group of medical professionals and policymakers who oppose race-aware medical school admissions and other policies that incorporate identity-based considerations into health care decision-making, says race-aware admissions it’s about discrimination, not about diversity.

Our view is that everyone who enters health care should be the most qualified, said Stanley Goldfarb, who chairs Do No Harm’s board of directors. It doesn’t matter gender or race. The only thing that matters is that they are good ethical people and good at what they do.

Goldfarb cited studies that showed no relationship between racial or ethnic concordance and communication quality and inconclusive evidence for patient outcomes.

The first class of medical school to be affected will be the class of 2028. Some experts have suggested that medical colleges and schools could adopt policies that factor in family income or wealth when determining who to admit. After California banned racist admissions in 1996, the University of California-Davis medical school reversed its process to place less emphasis on MCAT scores and grades and more on socioeconomic measures, according to Stat News.

Poll-Hunter, with the AAMC, is not convinced. There is no substitute or proxy for race, he said. The reality is that in the United States we have such a history of exclusion, displacement and colonization that we cannot ignore the reality of race.

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