How medical schools are considering race after the Supreme Court limited affirmative action in admissions

When a U.S. Supreme Court ruling this summer sharply restricted colleges from considering the race of their applicants, admissions season was well underway at medical schools, seven of which are in the Philadelphia area.

Many aspiring physicians already had sent in their first-round applications to medical schools at the University of Pennsylvania, Thomas Jefferson University, and more than 100 others nationwide, using standardized forms that allowed them to indicate race and ethnicity. Yet in its June 29 ruling, the court’s majority said schools could no longer use those answers when deciding which applicants to accept.

How that ban will work in practice is unclear, as admissions officers are still allowed to consider how a candidate’s life and character were affected by race — provided that the person brings up the topic in essays and interviews. Medical schools say they have been doing this for decades, taking the race of applicants into account as part of a broader practice called holistic review.

But when they sift through thousands of applications this summer and fall, the institutions that train U.S. doctors will be under close scrutiny, as they are among the first schools to grapple with the new legal landscape. Undergraduate programs don’t review most of their applications until the winter, making decisions in the spring.

For an inside look at how the process will be different for medical schools this year, we spoke to two deans at Cooper Medical School of Rowan University and the former admissions director at Jefferson’s Kimmel Medical College.

Undergraduate institutions cite a variety of reasons for seeking diverse student bodies, among them the pursuit of equity and improving the overall quality of education.

Medical schools say they have an added incentive: healthier patients.

Research suggests that when patients and their physicians have a similar background, they respond better to treatment, said Annette Reboli, the dean at Cooper.

“There can be greater trust, a better connection, and better outcomes,” she said.

This is especially true for Black patients and others from groups that are underrepresented in medicine, the Association of American Medical Colleges wrote in a brief filed with the Supreme Court.

“Diversity literally saves lives,” the AAMC wrote.

In one study of 1.8 million births between 1992 and 2015, Black infants under the care of Black pediatricians were more likely to survive than if their pediatrician was white. Other studies have found that Black physicians are better at evaluating the pain levels of Black patients, and therefore better at prescribing the appropriate dose of medication.

That doesn’t mean people should only see physicians who look like them, Reboli said. Medical students and physicians should come from a variety of backgrounds — racial, ethnic, cultural, socioeconomic — so they can learn from each other’s life experiences and be aware of what challenges their patients may face, the dean said.

“Diverse teams tend to be more innovative and more creative,” she said.

When the Supreme Court published its ruling, medical school deans quickly consulted their attorneys about how to adapt, as thousands of applicants already had sent in the AAMC’s standardized, 20-page primary application form, hoping to enroll in 2024.

On the very first page, under the heading of biographic information, there are spaces labeled “racial self-identification” and “ethnic self-identification.”

At Cooper, that section of the form will be hidden from admissions officers, said William Kocher, the school’s senior associate dean for admissions.

Other medical schools are expected to do the same, said Elizabeth Y. Brooks, the former admissions director at Jefferson’s Kimmel College of Medicine. The information will continue to be collected in future years to satisfy state and federal reporting requirements, but for the admissions process it will stay off-limits.

Brooks worries that as a result, schools will enroll fewer students from underrepresented populations.

“If they make it blinded,” she said, “I bet you the classes are going to look very different.”

To judge from the experience of eight states that have previously banned affirmative action, that prediction may be on target. In 21 medical schools in those states, enrollment from underrepresented racial and ethnic groups dropped from 14.8% to 10% after such bans were implemented, according to a study in the Annals of Internal Medicine.

Kocher is more optimistic, citing what happens in the next phases of the admissions process: a secondary round of applications (each school devises its own, with essay questions) followed by interviews.

That’s when medical schools can assess how an applicant’s character was affected by race or ethnicity, if they choose to highlight that, Kocher said. For example, their background might have led them to become more empathetic and resilient, among other intangibles that make a good doctor.

“It’s not just checking a box,” he said.

But admissions officers must tread carefully, AAMC lawyer Heather Alarcon said in a July 10 webinar. Barred from explicitly considering the race of applicants, medical schools also cannot use certain indirect methods to achieve the same goal.

“If you start encouraging your admissions officers to search for certain words or affiliations in an application so that you can figure out the applicant’s race, you’re still considering race in a way that this court’s probably not going to uphold,” she said.

Still, there are other ways that admissions officers can achieve diversity in their student bodies. The University of California Davis has done so by assessing the socioeconomic status of applicants, according to STAT, a media outlet that covers medicine and life sciences.

Medical schools also can attract a more diverse pool of applicants by investing in pipeline programs — efforts to expose students to the medical professions as early as middle school.

For medical school applicants of any background, the odds are daunting.

Cooper typically gets 5,000 applicants, of which 350 are invited for interviews, starting in August, for an eventual class of 112 students, Kocher said.

To bolster their applications, students from underrepresented minority groups should be thinking throughout their undergraduate years about how their background informs their desire to become a physician, said Brooks, who left Jefferson in 2017 and now advises medical school applicants from disadvantaged backgrounds.

Any good premed adviser can tell them that, but some colleges do not have a premed advisor, she said.

“You need to make sure your personal statement talks about your journey,” she said. “But if someone doesn’t tell me that, I’m just going to write a generic statement that my grandmother had cancer, and that’s why I want to be a doctor.”

Above all, be honest and candid, just as any applicant would. Don’t try to exaggerate some aspect of your ethnic background (or any biographical detail, for that matter) to impress an interviewer, she said. A Jefferson applicant once told Brooks how she enjoyed keeping her heritage alive by speaking Tamil, which she described as a uncommon language.

Brooks, who is of Indian descent, happens to speak Tamil, so she knew it was spoken by tens of millions of people worldwide. She then asked the applicant a few questions in the language, and they were barely able to respond. Oops.