Will Our Healthcare Workforce Ever Look Like America?

The U.S. Supreme Court reversed decades of precedent by terminating race-conscious college admissions policies, ruling in favor of the plaintiff in both Students for Fair Admissions v. University of North Carolina and Students for Fair Admissions v. President and Fellows of Harvard College.

Approximately 2 decades ago, the Grutter v. Bollinger case, in a 5-4 opinion, permitted the limited use of race as an admitting factor to the University of Michigan’s Law School to obtain the essential educational benefits derived from a diverse student body. In the majority opinion, the centrist conservative Justice Sandra Day O’Connor wrote that race-conscious admissions do not “unduly harm non-minority applicants.”

The cases brought by the Students for Fair Admissions jeopardize the diversity and inclusivity of the student body at colleges and universities nationwide, and threaten the development of a more diverse healthcare workforce. Though neither of these current cases nor Grutter were brought directly against health professional programs, admissions committees nationwide will feel the consequences of the Supreme Court’s decision.

Even for health professional programs that don’t rely heavily on affirmative action policies in their admissions process, their pool of applicants come from universities and colleges that do. Over the last several decades, we have made essential but incremental strides in increasing the diversity of our healthcare workforce. A study evaluating current racial and ethnic profiles of ten health professions found that in 2019, Black, Hispanic, and Native American people were underrepresented compared with their representation in the general population. The diversity of the educational pipeline remains considerably below the diversity of the general population for far too many healthcare occupations.

Alternative Methods to Promote Healthcare Workforce Diversity

Given that the Supreme Court now forbids institutions from using race as a method of achieving proportional representation, many institutions will have to turn to holistic evaluations as a strategy to achieve racial and ethnic diversity in higher education. Holistic selection, which is not strictly based on racial proportions, is not a complete substitute for the statistical-based selection provided by affirmative action. It will need to be evaluated for comparability to the effectiveness well-documented by the use of affirmative action.

So, what does a holistic selection strategy look like? Health professional programs will need to focus more on applicants’ extrinsic and intrinsic values. To put it plainly, high test scores, notable letters of recommendation, or high family income do not automatically indicate that the individual will become an empathetic and capable practitioner who is pursuing a path they’re genuinely interested in. A passionate, driven applicant from an underrepresented community with lower test scores may not have equitable access to educational preparatory services, may have lack of professional mentorship, and may experience financial hardship. He or she may, however, possess the motivation, resiliency, and principles to be an effective healthcare professional in their respective field. Accepting applicants into programs by using a holistic lens can reduce biases against marginalized individuals.

Now, more than ever, we also must innovate and foster alternative strategies related to admissions policies that have been shown to generate a diverse student body. This includes mentorship programs, pipeline pathways, scholarships, and strategic community engagement frameworks.

Diversity in the Healthcare Workforce

There will be major consequences to the Supreme Court overturning a precedent that has proven effective in fostering increased diversity, equity, and inclusion in medical training and healthcare delivery. As we evaluate the impact overturning affirmative action will have on medical school admissions and fostering physician diversity, we must double down on this question: Should healthcare practitioners in America look like America?

We have seen, time and again, the answer to this question is unequivocally, yes. The healthcare workforce must look like America.

The U.S. is increasingly diverse: 13.6% of the population are Black, yet only 5% of physicians are Black.

Affirmative action initiatives have resulted in the successful graduation of underrepresented minority physicians and, in so doing, leads to increased access to healthcare for underserved communities.

Bans on affirmative action at the state level — particularly examples of those in California, Washington, Florida, Texas, Michigan, and Nebraska — led to a 17% decline in the first-time matriculation of underrepresented students of color in public medical colleges and universities. This posed significant threats to absolving healthcare crises affecting this country, such as the achievement of parity in healthcare access for all and the provision of culturally concordant care.

The nationwide ban will also decrease the number of primary care practitioners in low-income and rural neighborhoods. Recruitment and retention of primary care providers is challenging without remarkable incentive programs in place and consistent funding by state and federal entities.

Affirmative action helped do what it was intended to do: level the playing field. This should be permitted, allowed, encouraged, and welcomed in a country that prides itself on its supposed egalitarianism. Without affirmative action in admissions decisions, this goal will not be achievable. Instead, this move could deny healthcare to over one million of the nation’s population who desperately stand in need.

We expected that affirmative action would die of a natural death in the future, and we looked forward to the day when it was not needed. Yet, that time prematurely presented itself.

Affirmative action in higher education was more than policies promoting disadvantaged individuals. At the very least, affirmative action symbolized the acknowledgment and attempt to remediate a complex array of social structures, interpersonal interactions, and beliefs against disempowered and oftentimes devalued individuals who are capable of being lifelong learners and productive citizens. They have the power to provide indelible contributions to society and in the delivery of healthcare, if only we give them a fighting chance.

Jamar Slocum MD, MBA, MPH, is clinical assistant professor of internal medicine at George Washington University School of Medicine and Health Sciences, and a hospitalist. Earl Stewart, Jr., MD, is an internal medicine physician in Atlanta, Georgia, and a climate and health equity fellow with the Medical Society Consortium on Climate and Health.