The US Supreme Court this summer effectively banned university admissions officers from giving applicants preferential treatment based on their race.
Many medical school leaders opposed the Supreme Court ruling, claiming the ban will result in less diversity within their student body, a less diverse group of physicians, and poorer outcomes for minority patients.
However, it is not clear that diversity within the medical profession improves patient outcomes – which should be the primary goal of medical education.
In fact, there is evidence that positive action can harm both patients and the trainees themselves.
It is a tenet of belief among affirmative action advocates that a more diverse medical profession benefits patients.
Contradicting the majority ruling, Justice Sonia Sotomayor wrote that affirmative action helps “increase the number of students from underrepresented backgrounds” who become physicians, which in turn “improves access to health care and health outcomes in medically underserved communities.” .
The Association of American Medical Colleges agreed with Sotomayor, saying it was “deeply disappointed” by the majority decision, which “demonstrates a lack of understanding of the vital benefits of racial and ethnic diversity.”
“This decision will accelerate the deaths of black people in this country, and we’re already dying prematurely,” said Uché Blackstock, founder and physician of Advancing Health Equity.
They relate in part to a handful of studies showing that black Americans have better health outcomes when treated by black doctors.
But researcher Ian Kingsbury recently examined the methods of these studies and concluded that “systematic reviews” found “no association” or “inconsistent results” between race/ethnicity and quality of communication, and “inconclusive” evidence for patient outcomes have.
Admissions officials’ obsessive focus on race often results in their ignoring the academic and clinical aptitudes of applicants – with dire consequences for the applicants themselves and ultimately for the patients they treat.
Funding measures aim to give underrepresented groups a head start in the admissions process.
This intentionally means admitting applicants who would likely have been rejected based on their test scores and grade point averages alone.
From 2013-2016, 56% of Black applicants and 31% of Hispanic applicants with below-average scores on the medical college admissions test and a bachelor’s GPA were admitted to medical school, compared to just 8% of White applicants and 6% of Asian applicants with similar grades results grades and GPAs.
It is well documented that “undergraduate GPAs and overall MCAT scores are strong predictors of academic performance in medical school through graduation,” according to a study by the Association of American Medical Colleges itself.
In other words, positive action could help underqualified applicants find a job in medical school.
But it won’t necessarily keep them there.
Black medical students are 10 times more likely than white students to drop out because of academic problems.
It is cruel – not compassionate – to accept students who are unqualified for the intellectual demands of medical school.
It sets them up for failure, saddles them with debt they could have avoided, and wastes resources that could have been used to train qualified applicants who then actually practice medicine.
Worst of all, accepting underqualified students ultimately harms patients.
A 2016 study concluded that “MCAT scores are a predictor of student performance” on both Step 1 and Step 2 of the US bar exam.
These licensure exams, in turn, provide insight into students’ skills in treating patients during their clinical rotations.
“USMLE scores have a positive linear association with clinical performance as a medical student,” states a 2019 study, “even after correcting for gender, institution, and testability.”
The relationship continues after the students graduate, complete their residency and become practicing physicians.
A 2014 study of US-licensed foreign-trained physicians found that “after adjusting for disease severity, physician characteristics, and hospital characteristics, Level 2 performance” was “a statistically significant.” inversely related to mortality”. Each additional screening point was associated with a 0.2% reduction in mortality.”
The purpose of medical school is not to maximize diversity.
The goal is to transform America’s best and brightest students into the most competent doctors, regardless of their race, gender or other demographics.
Doctors hold people’s lives in their hands.
It shouldn’t matter what color those hands are.
Sally C. Pipes is President, CEO and Thomas W. Smith Fellow in Health Policy at the Pacific Research Institute and Founder and Chair of the Benjamin Rush Institute. Her latest book is False Premise, False Promise: The Disastrous Reality of Medicare for All.