Med Schools Navigate Admissions in New Legal, Political Env

A year and a half after the Supreme Court struck down the consideration of race or ethnicity in college admissions, the medical community awaits a moment of truth.

The Association of American Medical Colleges (AAMC) is expected to soon release demographic data for the class of 2028 — the first to complete an admissions cycle after the landmark decision. Early signs suggest many schools are still trying to build diverse classes and learn from each other, but they are proceeding cautiously amid a new legal and political landscape.

Wide swaths of the medical community had advocated for race-conscious admissions as the Supreme Court deliberated. Many medical schools remain silent on the ruling’s impact, as do several medical student groups and pipeline or pathway programs.

The ruling does not appear to have dramatically transformed admissions practices, medical school officials said, but its ripple effects continue to affect higher education.

Several states have recently banned diversity, equity, and inclusion (DEI) offices in higher education, and many institutions, including medical schools, have faced lawsuits or civil rights complaints for diversity initiatives such as scholarship programs limited to underrepresented minority students.

The momentum against DEI efforts in universities, business, and government is expected to progress during the Trump Administration.

“People are scared. They’re scared of lawsuits, their programs being defunded,” said Mark Henderson, MD, associate dean for admissions at the UC Davis School of Medicine, Sacramento, California, referring to the chilling effect among many medical schools.

Black, Hispanic, American Indian/Alaska Native, and Native Hawaiian and other Pacific Islander students have long been underrepresented in medicine, even with race-conscious admissions.

Experts have warned that ending affirmative action — the consideration of background characteristics such as race and ethnicity — could exacerbate these gaps and health disparities. One study found that 5 years after several states banned affirmative action, enrollment of students from underrepresented racial and ethnic groups dropped by more than one third.

Stanley Goldfarb, MD, chairman of Do No Harm, a legal activism and policy advocacy group opposed to DEI in healthcare, credited the Supreme Court decision for validating his organization’s work. “It just set the table for the idea that what we were doing was going to be consistent with the law of the land,” he said.

Since 2022, Do No Harm has filed or supported 14 lawsuits against healthcare-related organizations and filed 86 federal civil rights complaints against medical and nursing schools for diversity initiatives the organization contended were discriminatory.

Do No Harm supports proposed legislation that would eliminate federal funding for medical schools with DEI offices. Society should be colorblind, and DEI, which racially separates people, is discriminatory, said Goldfarb, contending that medical school admissions “should be based completely on merit and nothing else.” He also challenged the notion that patients who receive care from doctors of the same race have better outcomes, noting evidence that hasn’t supported that conclusion.

Goldfarb said Do No Harm, formed in 2022, has 14,000 members, including doctors, other healthcare workers, and patients. The total figure is a small fraction of the 1.1 million practicing physicians in the United States, but Goldfarb said that membership doubled from earlier this year.

The AAMC declined an interview request but provided a statement from Alison Whelan, MD, chief academic officer: “A diverse physician workforce is critical to provide better care for all. There is strong evidence that having a diverse clinical workforce improves outcomes for marginalized populations. The AAMC supports a holistic approach to admissions that balances pre-requisite academic preparedness with the qualities, experiences, and career aspirations each school identifies as in alignment with its educational mission.”

In the Supreme Court case, a plaintiff challenged race-conscious admissions at Harvard University, Cambridge, Massachusetts, and The University of North Carolina at Chapel Hill. The ruling applies to both private and public universities but did not completely close the door to racial consideration in college admissions: It still allows universities to use holistic review, consider an applicant’s discussion of how race affected their life, and pursue recruitment and pipeline programs.

Even before the ruling, many medical schools had used holistic review — considering a wide range of an applicant’s qualities rather than focusing solely on grades and test scores.

Some schools have looked west to UC Davis School of Medicine, one of the most racially diverse medical schools in the United States despite California’s nearly 30-year-old affirmative action ban, as a model.

Shadi Aminololama-Shakeri, MD, the medical school’s admissions committee chair, said she estimates about 40 schools, mostly medical, have consulted her team on its approach since the Supreme Court decision. (There are approximately 150 allopathic medical schools in the country.) 

The school diversified its admissions committee, changed its applicant interview format to one evidence suggests predicts performance in clerkships, created a scale to assess socioeconomic disadvantage in applicants, and developed programs to attract students who want to work in and have lived experience in underserved communities.

Henderson said the school has not lowered its admissions standards and that the average GPA and MCAT score of its students have remained stable.

With a $60,000 grant from the American Medical Association, UC Davis School of Medicine has teamed up with UMass Chan Medical School, Worcester, Massachusetts, to share strategies with other medical schools on how to build diverse classes without race-conscious admissions.

Tracy Kedian, MD, associate dean of admissions at UMass Chan Medical School, said the school continues its holistic application review and heavily recruits students from underrepresented backgrounds.

She described some changes in the admissions process: No one involved in reviewing applications can see an applicant’s race, but a new question was added, asking applicants to describe experiences with and “understanding of systemic inequality, exclusion, or lack of representation in healthcare” in the United States. Sometimes applicants discuss their own background, but doing so is not required, she said.

Kedian said the proportion of underrepresented students dropped slightly compared with the previous year because the total class size increased.

Nationally, two admission consultancies reported seeing little change in application questions or the process, noting diversity-related prompts and holistic review were common before the ruling and still are. Jessica Freedman, MD, founder and chair of MedEdits Medical Admissions, said racial variation in average MCAT scores of admitted students and in acceptance rates hasn’t noticeably changed for her clientele since the ruling. Neither she nor Shirag Shemmassian, PhD, founder of Shemmassian Academic Consulting, said they changed how they advised students as a result of the ruling.

The ruling’s impact on medical students’ experiences has not been closely examined. But in a member survey about attitudes toward DEI climate conducted in March by the Student National Medical Association, an organization for underrepresented minority medical students, many of the 1600 respondents reported experiencing microaggressions, said Ja’Nia McPhatter, the association’s president and medical student of the University of Pittsburgh, Pittsburgh.

One student, she said, reported, “In my first week of medical school, two White male classmates demanded to know my MCAT scores.”

One in four respondents also reported cutbacks in DEI programs at their institutions. Underrepresented minority students can struggle to feel like they belong, and DEI programs help counter that, said McPhatter.

While many in the medical community accept the benefits of diversity in medical education and clinical practice, others disagree and are increasingly scrutinizing the evidence base.

Evidence has shown that medical students from underrepresented backgrounds are more likely to work in underserved communities, that care from a doctor who speaks the same language as a patient with limited English improves patient satisfaction and clinical outcomes, and that doctors trained in diverse settings feel more prepared to provide culturally competent care.

A widely cited study published in JAMA Network Open found Black patients in counties with higher ratios of Black primary care doctors, even when they were not treated by those doctors, live longer.

Whether a patient and doctor sharing the same race improves health outcomes is unclear. Proponents cite studies showing that minority patients exhibit higher levels of satisfaction and other aspects of patient experience and are more likely to adhere to medication regimens and agree to preventive care with doctors of their own race.

But one influential study suggesting that Black newborns were less likely to die when treated by Black doctors was recently critiqued by a conservative think tank for not controlling for very low birth weight. And a white paper written by Do No Harm examined systematic reviews that did not conclude racial concordance improves outcomes.

In the meantime, medical schools continue to tread cautiously. Kedian of UMass Chan Medical School stressed her legal team reviewed the admission process with “a fine-tooth comb” to ensure it complies with the new law.