Posted on 03/12/2003 8:49:09 AM PST by LurkedLongEnough
March 4, 2003 — Editor's Note: In a special communication published in the March 5 issue of The Journal of the American Medical Association, Jordan J. Cohen, MD, argues in favor of affirmative action or altering admissions criteria to facilitate minority enrollment in medical schools. A pending decision from the U.S. Supreme Court could have "catastrophic consequences" on medical school admissions, according to Dr. Cohen, president of the Association of American Medical Colleges (AAMC) in Washington, D.C.
After the the University of Michigan won lower court victories upholding its policies of race-conscious decision-making in higher education admissions, these lower court rulings were appealed and are now under review by the U.S. Supreme Court. On Feb. 18, 2003, the AAMC filed an amicus curae ("friend-of-the-court") brief supporting the use of race and ethnicity as admissions criteria promoting diversity in the entering medical school class. Oral arguments are scheduled for April 1, 2003, and a decision is anticipated before July 1, 2003, the end of the current U.S. Supreme Court term.
The AAMC brief notes that reliance solely on academic credentials would dramatically decrease the number of minority medical students. Very small percentages of underrepresented minority applicants score as well on the Medical College Admissions Test (MCAT) and have as high a grade point average (GPA) as most white and Asian applicants. Factors contributing to this disparity may include poorer quality primary and secondary schools, lower parental education levels, and stereotypic attitudes that hinder academic performance.
However, the AAMC hopes that medical school admissions officers can identify other qualities of mind and spirit enabling minority applicants to become physicians. More than 90% of underrepresented minority students who are admitted to medical school graduate. Medscape's Laurie Barclay interviewed Dr. Cohen to learn the main points of the AAMC's position on the court case.
Medscape: Please comment on the potential effect of the pending Supreme Court decision regarding the constitutionality of race-conscious criteria in higher education admissions policies.
Dr. Cohen: The impact could be momentous if the Supreme Court chooses to uphold the decision, allowing medical schools to pursue their objective of admitting a cohort that can provide the best possible care to an increasingly multicultural and multiethnic society. On the other hand, if the Supreme Court decides that affirmative action in medical school admissions is unconstitutional, our profession and society will suffer a devastating blow. We are very far from the medical profession representing the cultural and ethnic composition of our country. All physicians have to be culturally conscious, to understand how different ethnic groups react to illness and to medical care. We can't prepare medical students for that without settings in which they can learn from peers and mentors of different racial and ethnic backgrounds. They can't learn from a textbook how to be culturally competent.
Medscape: How can we balance racial diversity against academic credentials in deciding on medical school admissions?
Dr. Cohen: No one gets admitted to medical school unless the admissions committee feels that that student has the potential to become a qualified, compassionate physician. No one would countenance the admission of unqualified candidates. For balance, we need to look at many other qualities besides academic performance, like leadership, altruism, interest in serving others, communication skills, and other noncognitive skills. Could we do a better job of identifying these humanistic qualities in all applicants? The admissions committees are constantly trying to improve their sensitivity in selecting students attuned to cultural factors. Race and ethnicity are some of the factors reflecting wide diversity which should be considered.
Medscape: What is the evidence to suggest that minority students from underprivileged communities return to serve those communities? Might providing financial incentives to serve in these communities be more likely to attract graduating physicians from all backgrounds?
Dr. Cohen: Individuals from underrepresented minorities choose to settle and practice in underserved areas, often returning to those areas where they came from initially. I don't know the statistic off the top of my head of how many do that — whether it's close to half or less than 10%, I really couldn't say.
There are already some financial incentives for students to begin their practice in areas where there are significant disparities in access to healthcare. I don't mean to imply that physicians who are not from underrepresented minorities could not fill this gap. However, many patients prefer to have concordance between themselves and their physicians in terms of racial and ethnic background, and they tend to be more likely to accept opinions and advice from their doctors when this type of concordance exists. Not that we necessarily have to have a one-to-one match, but we need to have a physician workforce that allows patients to choose a physician with whom they feel comfortable.
Medscape: Your article suggests that increasing the diversity of the research workforce can accelerate advances in medical research and public health. Are there statistics on what percentage of minority vs. nonminority students elect research as opposed to clinical careers?
Dr. Cohen: There is a significant deficit in the proportion of underrepresented minorities who choose research careers. There is a paucity of physician-scientists in all groups, but especially in the underrepresented minorities.
Medscape: In that case, might we end up with more researchers if we admit more, rather than fewer, students who are not from underrepresented minorities? Might academic credentials be a better predictor than race or ethnicity of choosing a research career?
Dr. Cohen: No, not at all; if we have more underrepresented minority students in the pipeline, there are more who can funnel into research careers. It seems to me that individuals from underrepresented minorities are more likely to identify disparities in healthcare or other issues pertaining to differential access or response to interventions because of their own interests, background, and experience. I have no real evidence to support that, but it just makes sense to me.
Medscape: Could research on racial and ethnic predictors of disease be better promoted by changing priorities in research funding?
Dr. Cohen: Certainly we should consider changing the research agenda. There is no question that affirmative action medical school admissions policies are not the only way to address disparities in healthcare.
Medscape: If GPAs and MCAT scores of underrepresented minority students still lag behind those of whites and Asians, should the issue of affirmative action be addressed earlier in the education process? Might greater emphasis on improving academic performance in earlier years allow underrepresented minorities to be better represented in medical schools even without affirmative action admissions policies?
Dr. Cohen: The problem is the paucity of academically well-prepared underrepresented minority students. These problems affect kindergarten to twelfth grade, and maybe even as early as preschool. We need to devote much more attention to this if we're going to allow underrepresented minority students to reach their full potential. But until we address this, we will need tools like affirmative action programs. Hopefully in the future there will be equal numbers of well-qualified applicants competing for medical school admission from all ethnic groups, and then affirmative action will no longer be needed.
Medscape: You write that affirmative action in medical school admissions can "help fulfill our country's ideals of fairness, justice, and equity." Might nonminority applicants who are rejected from medical schools despite excellent academic scores and other credentials feel that these ideals are not being fulfilled by affirmative action policies?
Dr. Cohen: You mean so-called reverse discrimination? There are more than twice as many applicants to medical schools as there are places in the first-year class, so most students who apply don't get in. But there are far fewer underrepresented minority students who even apply. So to argue that many places are taken from well-qualified whites by underrepresented minority students is absurd. It's just a bogus argument that doesn't hold water.
Medscape: Is there anything you'd like to add in closing?
Dr. Cohen: Just to say that there is a great deal resting on the Supreme Court decision. If medical schools can't use affirmative action admissions policies, the whole society will suffer as a result. We need to identify a physician workforce that can meet the needs of an increasingly diverse population. If we can't, we'll fail to meet our responsibilities to society.
Medscape: How do you think the Supreme Court will decide?
Dr. Cohen: I think these arguments are very persuasive, and I am guardedly optimistic that the Supreme Court will agree.
JAMA. 2003;289:1143-1149
Reviewed by Gary D. Vogin, MD
Laurie Barclay, MD is a staff writer with WebMD.
Medscape Medical News is edited by Deborah Flapan, a news coordinator at Medscape. Send press releases and comments to news@webmd.net.
Only the academic morons think this way. In the field doctors know better. Read about the guy who received Bakke's place if you want a real horror story. That guy was a butcher.
Maybe its because numbers dont discriminate and cant be accused of discriminating. There's no subjectivity in 2+2=4. It either is or it isn't. If you dont study, the numbers dont come out.
This is just one way to show these hypocrites dont really mean what they say.
The AMA is a socialist union controlling -- actually RESTRICTING -- the number of students admitted to American Medical Schools. Consequently, most doctors you run into today are immigrant "graduates" from foreign institutions.
Adding more disaster to American medicine, are the unnatural socialized -- government controlled -- medicine schemes such as Medicare.
The AMA, and socialist politicians, have collectively sabotaged American medicine.
The free-market American medical system I grew up with was wonderful. Doctors were free to practice wisely, to set their own prices -- and those price structures were set to accommodated all; rich, poor and indigent.
Uh, I prefer my doctors with heavy emphasis on cognitive skills, thanks.
Idiotic policies like this will make people distrust black and hispanic doctors - for good reason.
They already have! (And, it's a sad state of affairs for QUALIFIED minorities.)
Nice choice of words. < /sarcasm >
The minority student admitted to medical school in what the Supreme Court ruled reverse descrimination in the Bakke case later was subject to numerous malpractice claims for gross incompetance.
I think it is racist to claim that minorities cannot score as well on tests (except Asians). What about areas where white students are the minority? Do they score lower? Shouldn't colleges find out if you are a minority in your community, rather than just asking your race, if they think it is all about that?
Are these people saying that the state of being in the minority group automatically causes lower scoring, or are they saying that some races and ethnic groups just aren't as smart as others? I'd be mad if I were black and the government treated me as if I just couldn't perform as well.
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