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Medical leaders on Thursday reacted swiftly to the Supreme Court’s decision to severely restrict the use of race in college admissions, saying the ruling could reverse decades of progress toward diversifying the nation’s physician workforce — something seen as key to helping end the country’s widespread and deeply entrenched health disparities.
“This ruling will make it even more difficult for the nation’s colleges and universities to help create future health experts and workers that reflect the diversity of our great nation. The health and wellbeing of Americans will suffer as a result,” Health and Human Services Secretary Xavier Becerra said in a statement released almost immediately after the ruling, noting that people of color had been excluded from attending medical school and joining medical organizations for generations. “We need more health workers, especially those who look like and share the experiences of the people they serve,” the statement said.
In 6-3 and 6-2 rulings in cases involving the University of North Carolina and Harvard University, the court ruled that the use of race in admissions violated the equal protection clause of the 14th Amendment, but said nothing prohibited applicants from addressing the issue of race and how it impacted them in their applications.
“Many universities have for too long wrongly concluded that the touchstone of an individual’s identity is not challenges bested, skills built, or lessons learned, but the color of their skin. This Nation’s constitutional history does not tolerate that choice,” the decision read.
In a statement given from the White House, President Biden said he “strongly, strongly” disagreed with the ruling and said he thought many misunderstood what affirmative action meant, saying it did not “allow unqualified students to be admitted ahead of qualified students.” Instead, he said, it allowed race to be used as one of many factors in deciding who among a pool of applicants all qualified for admission would be selected.
He vowed to not let the court’s decision be the last word and said he had ordered the Department of Education to examine the issue. “Every generation of Americans, we have benefited by opening the doors of opportunity just a little bit wider to include those who have been left behind,” Biden said.
The decision was sharply condemned by the American Medical Association, whose leaders said it would “reverse gains” made in the battle against health disparities. Less than 6% of the nation’s physicians are Black and, in the United States, Black people live about six years less than white people.
“While our country grows more diverse, historically marginalized communities have been left behind on nearly every health indicator,” said Jesse M. Ehrenfeld, the association’s president, who added that eliminating health disparities meant investing in and supporting medical students and physicians who are Black, Latino, Indigenous, and LGBTQ+. “This ruling is bad for health care, bad for medicine, and undermines the health of our nation.”
In a concurring opinion, Justice Clarence Thomas wrote, “While I am painfully aware of the social and economic ravages which have befallen my race and all who suffer discrimination, I hold out enduring hope that this country will live up to its principles so clearly enunciated in the Declaration of Independence and the Constitution of the United States: that all men are created equal, are equal citizens, and must be treated equally before the law.”
James Hildreth, the CEO and president of Meharry Medical College, one of the nation’s four medical HBCUs, said the decision showed how out of step the Supreme Court is with the realities faced by many Americans. “The justices think we are living in a post-racial America and nothing could be further from the truth,” he told STAT. “This represents a potentially critical blow to our efforts to make sure the medical workforce is diverse.”
The decision, he said, could harm efforts to diversify the physician workforce by shrinking the pipeline of Black students who attend predominantly white colleges and then apply to a medical HBCU and also cut the number of graduates from predominantly white institutions as well. “It’s our foundational mission to train disadvantaged and minority students, but we’re just one institution,” he said. “There’s no other way to look at this other than it’s a really bad decision.”
Native American medical leaders said the decision could harm efforts to increase the proportion of physicians who are Indigenous beyond 0.4%. “This decision could further undermine the ability of Native health care students to achieve their dream of taking care of our own, just as our ancestors did for thousands of years on this land,” said LukeJohn Day, a member of the Oglala Lakota tribe who serves as president of the Association of American Indian Physicians and is chief medical officer at Zuckerberg San Francisco General Hospital and Trauma Center.
Twitter was abuzz with reaction as well.
“The Supreme Court’s decision to strike down affirmative action, including in professional schools, like medical and nursing, will have detrimental consequences on Black health for generations to come. This is about life & death for us. Today, we are only 5% of physicians,” tweeted physician Uché Blackstock, who said she was devastated for her people, her communities, and her children. “This decision will hasten the deaths of Black people in this country and we already die prematurely.”
“Affirmative action was never a complete answer in the drive towards a more just society. But for generations of students who had been systematically excluded from most of America’s key institutions — it gave us the chance to show we more than deserved a seat at the table,” tweeted former President Barack Obama. “In the wake of the Supreme Court’s recent decision, it’s time to redouble our efforts.”
Those opposing affirmative action called the decision long overdue. Students for Fair Admissions, the group that brought the lawsuits forward and said affirmative action discriminated against Asian students who were often denied admission into schools despite having higher test scores and GPAs than other applicants, called Thursday’s ruling “the beginning of the restoration of the colorblind legal covenant that binds together our multi-racial, multi-ethnic nation.”
At a press conference held in Washington, the group’s leader, Edward Blum, spoke more generally about college admissions, and said his group would be “closely monitoring potential changes in admissions procedures” in upcoming admissions cycles. He also called for the elimination of preferences for children of alumni, faculty, and donors and for admissions preferences for athletes. Others have called such preferences “affirmative action for white people.”
Presidential candidate and pharmaceutical entrepreneur Vivek Ramaswamy said in a tweet that, “Affirmative action is the single greatest form of institutional racism in America today,” and vowed to work to further end the practice in “every sphere of American life.”
The ruling comes as a blow to many, including students, who have been working at their medical schools to increase diversity and improve the climate for students who come from non-white racial groups and poorer backgrounds.
“After having worked as a student leader to increase diversity in medicine and STEM for the past seven years in multiple capacities, I feel so tired and worn out today,” Mytien Nguyen, a Black and Vietnamese M.D.-Ph.D. student at Yale who has published numerous articles on what students from non-traditional backgrounds face in medical school, told STAT. “We’ve always known that the battle for diversity in medicine has been an uphill battle. Today, that hill just got exponentially steeper.”
In California, which restricted the use of race in admissions through a ballot measure, the percentage of Black and Hispanic students in selective colleges such as the University of California, Berkeley, and in medical schools dropped precipitously after the policy change. “I feel sadness because I see the same thing happening across the country that happened in California,” said Mark Henderson, the associate dean for admissions at UC Davis School of Medicine.
Henderson and his colleagues have worked for nearly two decades to successfully diversify medical school classes at Davis by focusing on admitting lower-income students and also improving the climate for students who come from different racial groups and poorer economic backgrounds. “It’s possible for this not to be a disaster, but it will take a lot of commitment from leadership and difficult discussions,” he said.
Henderson predicted that some medical schools would work quickly and urgently to be socially accountable and work on diversifying future classes using strategies allowed by the court, but that others would not, especially those without commitment from top leadership and those with a lot of turnover in admissions leadership. “There will always be the path of least resistance,” he said.
Thursday’s decision was written by Chief Justice John Roberts, with justices breaking along ideological lines — Clarence Thomas, Samuel Alito, Neil Gorsuch, Brett Kavanaugh, and Amy Coney Barrett agreeing and Justices Sonia Sotomayor, Ketanji Brown Jackson, and Elena Kagen dissenting.
Jackson recused herself from the Harvard case because she had served on the school’s board of overseers but in a dissenting opinion wrote: “With let-them-eat-cake obliviousness, today, the majority pulls the ripcord and announces ‘colorblindness for all’ by legal fiat. But deeming race irrelevant in law does not make it so in life. Ultimately, ignoring race just makes it matter more.”
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