This week, more than 20,000 U.S. medical school graduates will find out whether they've been admitted into residency programs.
The class of 2023 was among the top performers as undergraduates, with a 3.77 mean grade point average and entrance exam scores within the 84th percentile, according to the Association of American Medical Colleges. They have completed core competency training in science, math, and history and completed hours of clinical training. Many have already contributed to medical research.
By most metrics, these graduates have completed one of the most rigorous training programs in higher education. They are now licensed and ready to enter the workforce with specialized knowledge of how the kidneys filter toxins from the blood and how to manipulate adrenergic receptors with medications to control the blood pressure of a patient in shock, for example.
But despite years of efforts designed to diversify the medical field, this group of newly minted doctors still doesn't reflect the nation's racial and ethnic diversity. Approximately 11% of the graduating class is Latino, 9% is Black, and 1% is Native American, according to AAMC data. Nearly 19% of U.S. residents are Latino or Hispanic, 14% are Black, and 1.5% are Native America as of 2020, census data show.
Medical schools have promoted diversity and employed strategies to increase admissions of minority students. Schools have carved out training slots for minority residents, conducted outreach to high school and universities and created needs-based scholarship. They have also instituted implicit bias trainings and established diversity, equity and inclusions programs.
Yet over the past 10 years, the number of Black medical students has increased by just two percentage points and the number of Latino students by three percentage points, while the number of Native American students has barely changed, the AAMC data show. At a this pace, it would take decades to turn out a class of medical students that is as diverse as the general population.
Medical school diversity efforts do not address structural deficiencies that disproportionately affect Black, Latino and Native American people. A pending Supreme Court decision that could undo affirmative action programs may make things more difficult. An analysis of interviews with 39 medical school admission deans published last month by University of California, Davis and University of Minnesota researchers shows that significant reforms are needed to increase the supply of people of color with medical degrees.
"Without such action, calls for racial justice will likely remain performative, and racism across healthcare institutions will continue," the authors wrote. The report states that medical school admissions overemphasize entry exam scores and undergraduate GPAs, and that existing accountability structures make it hard to shift away.
Medical school deans told researchers that the metrics they use predict success in classes and on licensure exams, but conceded that structural disadvantages contribute to lower scores among minority students. Those measures are also used by U.S. News and World Report to rank medical schools, which encourages admission officers to prioritize them, the report says. "If that ranking is important to your institution, then test scores and GPAs have to be very important to the institution," said Dr. Kimberly Vinson, associate dean for diversity affairs at Vanderbilt University School of Medicine. But performing well on tests doesn't necessarily make someone a good doctor, she said.
"Diversity drives innovation and excellence, but also we have to be able to take care of communities. And to do that, our profession has to represent the communities we serve," said Dr. Valerie Parkas, senior associate dean of admissions and recruitment at Icahn School of Medicine at Mount Sinai.
Medical schools have turned to what's termed a "holistic review" process that considers factors outside of academics to increase diversity among their student bodies.
The Icahn School of Medicine considers race, ethnicity, gender and where an applicant grew up in admission decisions, Parkas said. The application process also references students' socioeconomic status and asks questions related to justice, community service, commitment to advocacy, leadership, teamwork and lifelong learning, she said.
Icahn offers alternative pathways to medical school, including an early assurance program called "Flex Med" that accepts college sophomores into its medical program without entrance exams. They also have a program for military veterans, who typically have different training experiences leading up to medical school.
"We are thinking about folks who are coming from a different career and have a different kind of lens and a different set of experiences, that adds to a class," Parkas said.
The study also found that legacy students—those with political or monetary connections—are still prioritized in admissions. A similar, more common advantage exists among students born into families with high levels of social capital, who typically receive more support navigating educational systems and submitting applications. For example, students who have physicians in their families are more likely to apply for medical school because they have help from people knowledgeable about the process, Vinson said.
"If your parent is a doctor, then you likely know all the things that you need to do to be a competitive medical student or a competitive applicant," Vinson said. "But someone like me who was the first person in her family to go to medical school, I didn't have that family knowledge."
Vinson said that healthcare companies and higher education institutions should boost mentorship opportunities, scholarships and other academic resources to build clinical career paths for people from underserved communities. Medical schools should also acknowledge race as a factor in admissions decisions and employ a more diverse faculty, the UC Davis-U of M report concludes.
Employers must also focus on retaining physicians from racial and ethnic minorities in the workforce, said Dr. Robert Higgins, president of Brigham and Women's Hospital in Boston.
To combat the racial prejudice physicians of color experience in the workplace, Brigham and Women's Hospital is implementing implicit bias trainings, attempting to create a more supportive working environment and career pipelines that diversify clinical teams and leadership, Higgins said. Building diversity throughout institutions also can inspire younger generations to seek careers in medicine, Higgins said. "You can't be what you can't see," he said, quoting Children's Defense Fund founder Marian Wright Edelman.
At the same time, everyone is responsible for supporting students and colleagues from disadvantaged backgrounds through opportunity, mentorship and funding, and healthcare organizations need to develop cultures that promote the development and diversity of its workforce, Higgins said. "You have to have role models in the environment that you look up to, who may have similar life experiences, they may have different life experiences, but they are willing to share their time, their energy, their support as you go through the training process," he said.