FP Report -- February 1999
Attacks on affirmative action threaten medical school diversity
First came Proposition 209 in California in 1995. Then a federal court
ruled on the Hopwood case, affecting Texas, Louisiana and Mississippi in 1996.
Voters in Washington state continued the trend in last November's election. The
result: elimination of affirmative action, creating major obstacles in the
quest for diversity on medical school campuses.
Kris Okumu and Viet Le, medical students at the
University of California/ Davis medical school work at a clinic in an
underserved community.
(Photo: University of California/Davis Medical School)
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Many minorities are accepted to medical school based on standard admissions
criteria without special consideration of race. But critics say the bans send a
negative message to minorities considering a career in medicine and exacerbate
gaps in the health care system. Since 1996, minority applications to medical
schools have dropped by 19 percent in California and 22 percent in Texas,
Louisiana and Mississippi. Nationwide, minority applications decreased for the
second straight year in 1998.
"Even if the numbers showed nothing, the rulings are very
chilling," said Herbert Nickens, M.D., vice president for community and
minority programs at the Association of American Medical Colleges.
"Minority students, for historical reasons, are relatively sensitive to
the climate in which they're operating. I think people clearly perceive the
anti-affirmative-action agitation as an anti-minority agitation."
Why should medical schools pursue diversity? Nickens said the answer is
multi-pronged and includes the following:
- The quality of medical education is enhanced when physicians-in-training
can learn in groups with people of different genders and races.
- Minority medical researchers are more likely than nonminorities to study
cultural issues and take an interest in issues affecting underserved groups.
- Diversity among students and faculty members helps to illustrate the need
for health care in a cultural context.
- Research shows that minority physicians are more likely than nonminorities
to provide care for minority and disadvantaged populations and practice in
underserved communities. And minorities from underserved areas are more likely
than other minorities to do so.
Those who attack the use of affirmative action tend to emphasize two
claims: Unqualified students are gaining admission to medical school and
reverse discrimination is keeping better-qualified nonminority students out,
Nickens said.
Robert Davidson, M.D., M.P.H., professor of family and community medicine
at the University of California/Davis, said reverse discrimination is an issue
society must weigh, but his data debunk the claim that affirmative action leads
to the production of low-caliber physicians. Davidson led a 20-year
retrospective study of students admitted to the UC/Davis medical school. He
measured academic progress, national board examination scores, graduation
rates, residency evaluations and practice characteristics and compared the
results between students accepted under regular admission criteria and those
accepted under affirmative action or other special consideration.
His findings, published in the Oct. 8, 1997, Journal of the American
Medical Association, included graduation rates of 97 percent for regular
admissions and 94 percent for affirmative action admissions and no differences
in the residency experiences. "We also found that of our graduates, a much
higher percentage of minority students were likely to go into primary
care," Davidson said. "There is an implication in much of the
anti-affirmative action rhetoric that somehow we are producing inferior
products. At least at this school over the last 20 years, that proves
absolutely false."
Unable to ask medical school applicants to reveal their race, admissions
committees in states with affirmative action bans have devised much more
complicated ways to ensure a diverse student population.
"What most schools have done and what we've done here is develop a
very broad set of criteria that we're using for our admissions," Davidson
said. "Certainly GPAs and MCATs are part of that, but a whole series of
other issues are now included in a very lengthy secondary application."
Applicants receive preferential points for criteria such as having parents
who didn't graduate from high school, growing up in an underserved community,
overcoming barriers to graduate from college and working a certain number of
hours while in school.
"The charge to the admissions committee is to select individuals who
will produce a broad diversity among the student body, who are capable of
meeting the rigorous academic demands of the school, and who are likely to
produce the types of physicians we want with good communications skills and a
commitment to service," Davidson said.
"I think people clearly perceive
the anti-affirmative-action agitation as
an anti-minority agitation."
-- Herbert Nickens, M.D.
FP Report is published by the
AAFP News Department. Copyright © 1999 by
American Academy of Family Physicians.
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