July 10, 2023

By Tochi Iroku-Malize, M.D., M.P.H., M.B.A.
AAFP President

The Supreme Court recently handed down multiple rulings that affect family physicians and the primary care workforce. On June 29, SCOTUS severely limited the use of affirmative action in college admissions in a ruling that also could affect medical schools and recruiting efforts by family medicine residencies. A day later, the high court struck down the administration’s student loan debt relief plan, which would have made more than 40 million Americans eligible to cancel up to $20,000 in debt.

There’s a lot to unpack, but right now let’s focus on two important things that did not change: The AAFP supports efforts that reduce the significant debt burden incurred in medical training, and it continues to make progress toward a family medicine workforce that is as diverse as the U.S. population.

It’s worth noting that this work is grounded in Academy policies created by family physicians through the AAFP’s Congress of Delegates and affirmed by that governing body within the past two years. The recent court rulings will not deter our efforts and commitment to diversify the physician workforce and recruit more family physicians.

So where do we go from here?

Relieving Student Debt

The AAFP supported the administration’s student loan debt relief plan, which would have been welcomed by many family physicians because more than 70% of medical students graduate with debt related to student loans. However, even if SCOTUS had let that plan stand, the one-time relief would not have addressed the long-term issues of medical student debt or the primary care shortage in meaningful ways.

The average student loan debt for four years of medical school and undergraduate studies is more than $200,000, and that figure is increasing with the cost of education. We know that growing medical debt exacerbates the primary care physician shortage. That’s why the Academy has called for interest-free deferment on federal student loans during residency, expanding the Public Service Loan Forgiveness program and increasing funding for the National Health Service Corps.

Despite the setback in court, the administration said it has not given up trying to help borrowers, who in October will have to make federal student loan payments for the first time in more than three years. The Department of Education announced a “one-year on-ramp” for borrowers, and that transition period is intended to protect people from “the harshest consequences of missed, partial or late payments,” such as having loans turned over to collection agencies. 

Pressing Forward on Workforce Diversity

The Supreme Court ruled that admissions programs at the University of North Carolina and Harvard College were unlawful because they violated the Constitution’s equal protection clause. In the immediate aftermath, numerous pundits said the ruling “gutted affirmative action” and ended “the consideration of race in the admissions process.”

The reality is more complicated.

Writing for the majority, Chief Justice John Roberts said that individuals must be considered not on the basis of race but on their experiences. However, he conceded that admissions programs may allow applicants to explain how race has influenced their experiences.

Frank Trinity, chief legal officer of the Association of American Medical Colleges, told STAT the SCOTUS ruling actually “boosted” the concept of holistic review. That process, which is outlined in great detail on the AAMC website, considers the whole person rather than just test scores and other data.

In that same STAT article, an assistant dean of admissions at Yale noted that “in making more explicit how a students’ background impacts experience/perspective, schools will have a much easier time defending why race mattered in admitting that person” and that test scores will become less of a comparison point.

Significant changes to the Electronic Residency Application Service give students an opportunity to contribute to a holistic review. This year medical students hoping to match into family medicine residencies will have the opportunity to highlight the characteristics and experiences that make them unique and the challenges they have overcome.

Why does it matter? Evidence is increasingly indicating that a more diverse physician workforce benefits individual patient and population health outcomes. We advocate for a more diverse workforce because it will improve access to care and the quality of care.

The AAFP is working to create a larger, more diverse primary care workforce and collaborates regularly with the AMA, the AAMC, the American Association of Colleges of Osteopathic Medicine and the Accreditation Council for Graduate Medical Education — in addition to student groups like the Student National Medical Association and the Latino Medical Student Association — to increase workforce diversity in medical education. The Academy also engages with elected and administration officials, offers education and leadership opportunities, and has a task force focused on helping create pathways to family medicine for students from underrepresented communities. We’ll share much more about all of our efforts on this topic in the coming months.

The Academy is dedicating its efforts on these issues so the best and brightest future family physicians have both equitable access to medical education and opportunities to pursue their calling. The AAFP will continue to engage deeply and monitor closely all impacts on workforce growth and diversity as they play out in real time.