Affirmative action bans had ‘devastating impact’ on diversity in medical schools, UCLA-led study finds
IMAGE: THE STUDY’S FINDINGS ARE TIMELY IN LIGHT OF MEDICAL SCHOOLS’ INCREASING EMPHASIS ON HEALTH EQUITY, INCLUDING A PUSH TO ENSURE GREATER DIVERSITY AMONG PHYSICIANS IN THE WORKFORCE. view more
CREDIT: UCLA HEALTH
Link to abstract
https://www.acpjournals.org/doi/10.7326/M21-4312
New UCLA-led research finds that in states with bans on affirmative action programs, the proportion of students from underrepresented racial and ethnic minority groups in U.S. public medical schools fell by more than one-third by five years after those bans went into effect.
The findings are particularly timely given medical schools’ increasing emphasis on health equity, including a push to ensure greater diversity among physicians in the workforce.
The study will be published May 3 in the peer-reviewed journal Annals of Internal Medicine.
“We know that a more diverse physician workforce leads to better care for racial- and ethnic-minority patients,” said Dr. Dan Ly, the study’s lead author, an assistant professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA. “But we have made such poor progress in diversifying our physician workforce.
“Our research shows that bans on affirmative action, like the one California passed in 1996, have had a devastating impact on the diversity of our medical student body and physician pipeline.”
The researchers examined enrollment data from 1985 through 2019 for 53 medical schools at public universities, focusing on students from underrepresented racial and ethnic groups: Black, Hispanic, American Indian or Alaska Native, and Native Hawaiian or other Pacific Islander. The authors studied medical schools at public universities, not private ones, because states’ bans on affirmative action applied to public postsecondary institutions.
Of the medical schools, 32 were in 24 states without affirmative action bans. And 21 were in eight states that banned affirmative action during that period — Arizona, California, Florida, Michigan, Nebraska, Oklahoma, Texas and Washington. Those states’ affirmative action bans were enacted from 1997 to 2013; Texas’ ban was reversed in 2003.
In the year before the bans were implemented, underrepresented students made up an average of 14.8% of the total enrollment of those states’ public medical schools. By five years later, the research found, enrollment of underrepresented students at those schools had fallen by 37%.
The authors note some limitations to their analysis. The data may have also captured the indirect effects of affirmative action on undergraduate admissions, public discussion of affirmative action bans may have affected medical school enrollment even before the bans were implemented, some students may not have fully identified with the mutually exclusive racial and ethnic groups defined by the study, and the researchers did not assess the possibility that some schools without bans did not consider race or ethnicity in their admission decisions.
But the findings could lead to a better understanding of the lag in diversifying the medical student body and the physician workforce.
“As our country has spent the last two years weaving through the twin pandemics of racial health disparities amplified by COVID-19 and structural racism at large, our findings are critically important,” said co-author Dr. Utibe Essien, an assistant professor of medicine at the University of Pittsburgh. “As we observed, affirmative action bans have resulted in a loss of underrepresented physicians, who could have been at the front lines of caring for vulnerable populations throughout the pandemic and helping to alleviate disparities in care.
“My hope is that our findings will help provide policymakers with the tools to push back against affirmative action bans, not just for the diversity of the physician workforce, but for the equal and just health of our society.”
The study’s other authors are Andrew Olenski of Columbia University and Dr. Anupam Jena of Harvard University.
Affirmative action bans reduce diversity
in physician workforce, impact health
equity
Affirmative action bans reduce diversity in physician workforce, impact health equity
Abstract: https://www.acpjournals.org/doi/10.7326/M21-4312
A study of U.S. medical school enrollment data found that state bans of affirmative action policies significantly impact the percentage of underrepresented minority students enrolled in medical schools, which has important implications for the diversity of the physician workforce. The authors suggest that efforts to improve medical equity for patients should consider medical school admission policies an important target. The findings are published in Annals of Internal Medicine.
Increased diversity in the U.S. physician workforce can improve the health of patients from historically underserved communities. However, the percentage of practicing physicians who identify as being from these groups is low relative to their proportion in the U.S. population. Contributing factors may include state-level bans on the use of affirmative action policies. Few studies have evaluated the impact of these bans on public medical schools, and none have examined their longer-term effects and take into account more recent bans.
Researchers from the University of California, Los Angeles, the University of Pittsburgh, Columbia University, and Harvard University used publicly available data on state affirmative action bans to examine the association between such bans and the percentage of enrollment from underrepresented racial and ethnic groups at 21 public medical schools between 1985 and 2019. The schools were compared to public medical schools in states without affirmative action bans. The authors tracked the reported proportions of four mutually exclusive racial and ethnic groups that are underrepresented in medicine: Black, Hispanic, American Indian or Alaska Native, and Native Hawaiian or other Pacific Islander. They found that affirmative action bans were associated with a 5.5 percentage point decrease in enrollment of underrepresented students relative to control schools. Because underrepresented students accounted for approximately 14.8 percent of medical students in ban schools in the year before ban implementation, the 5.5 percentage point reduction implies an approximately 37% relative reduction in underrepresented students. According to the authors, these findings are important for understanding the overall lag in diverse representation of the medical student body and physician workforce. They also suggest that despite national efforts to improve enrollment diversity, state-level policy related to admissions is a critical factor.
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the lead author, Dan P. Ly, MD, PhD, MPP, please email Enrique Rivero at ERivero@mednet.ucla.edu. To speak with the author from the University of Pittsburgh, Utibe R. Essien, MD, MPH, please contact Sarah Katz at katzsb@upmc.edu.
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Also new in this issue:
Association Between SARS-CoV-2 Messenger RNA Vaccines and Lower Infection Rates in Kidney Transplant Recipients A Registry-Based Report
Ivan Zahradka, MD*; Vojtech Petr, MD*; Istvan Modos, MSc, PhD; Maria Magicova, MD; Ladislav Dusek, PhD; Ondrej Viklicky, MD, PhD
Original Research
Abstract: https://www.acpjournals.org/doi/10.7326/M21-2973
JOURNAL
Annals of Internal Medicine
METHOD OF RESEARCH
Data/statistical analysis
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Affirmative Action Bans and Enrollment of Students From Underrepresented Racial and Ethnic Groups in U.S. Public Medical Schools
ARTICLE PUBLICATION DATE
3-May-2022
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