The news that the Department of Justice is supporting a case against affirmative action at Harvard has led me to reflect on my 38 years of experience in admissions at a New York medical school.
When I started out in the late seventies, affirmative action legislation had already been in place for a decade. One of its goals was to create color-blind admissions policies so students of color would not be discriminated against in gaining entrance into the academic community, a critical rung on the ladder of achievement in this country.
That seemed simple and fair. But attitudes were different back then, right? Admission to medical school for people of color was a rare occurrence. Well, not much has changed. In 1974, African American enrollment for first year medical students was 7.5%; incredibly, by 2016 it had fallen to 7%. Hispanic enrollment was 1.3% in 1971 versus 6% today, a relatively modest increase, given the more than 45-year gap between the enrollment periods. In 2016, a little more than 7 percent of first-year medical students were African-American and 6 percent were Hispanic; an additional 2 percent self-described as Multiple Race/Ethnicity.
We now better understand that this discrepancy is the result of circumstances that need to be addressed well before admissions committees convene—and that these circumstances still overwhelmingly disadvantage people of color.
But all of us together can correct the problem, incrementally, by action and attitude.
For example, if we spent more time providing rural and inner-city children with a better early science education, and made sure that opportunities for exposure to STEM (science, technology, engineering and math) were readily available, we might move the needle. And if medical schools adopted local high schools and provided a medical school playground in which students could observe and learn and be awed by research, and see the difference that physicians make in everyday lives, we might make some progress.
But in the meantime, we must decide on the applicants we have.
There are students of all races and ethnicities who come from economically disadvantaged backgrounds and some who are from newly immigrated families. They can’t afford private tutors and expensive preparation courses for the Medical College Admission Test (MCAT), as some of their competitors can. Many have to spend their time outside class working to help support themselves and their families, or taking care of their younger siblings—all of which should earn them extra consideration. They don’t have the luxury of free time for studying, or one-week trips during winter or summer breaks to third-world nations to prove to us how dedicated they are to humanity.
Sitting in an admissions interview, I find myself inspired by students who have overcome great odds. Maybe they want to make a change for the people in their neighborhoods; or they want to give back and protect the people they see in their community clinics. Should we trade those students for ones with higher grades and MCAT scores, playing a simple numbers game that might help us achieve a higher rating from U.S. News and World Report?
We’ve accepted all kinds of students at Einstein, as have our colleagues at other medical schools—people of color; older students; poor students; disabled students; lesbian, gay, bisexual, transgender, queer and intersex students; people with lower scores on admissions tests; people who are wealthy; people with very high scores—and I can tell you that we can’t predict who will rise to the top when given the opportunity to put into practice their hearts’ desire to be healers. But motivation counts.
Another consideration in this complicated dialogue is the value to society that a diverse healthcare workforce brings. There is a documented benefit to individuals who have access to doctors who look like them and who innately understand the cultural determinants of health. And there are benefits for all students who attend racially diverse medical schools in terms of their comfort in dealing with patients from backgrounds other than their own.
These are complicated issues, and the present concern that admissions committees are not acting in a fair and equitable manner is understandable. Unfortunately, even in a medical school, the admissions process is not a science. No individual applicant is like another; that’s what the notion of “holistic admissions” is all about. We’re creating a new quilt with each accepted class, and the shapes, sizes and colors vary every year. We don’t see the finished product for many years after graduation, but occasionally, years later, a faculty member who might be perceived as the product of “affirmative action,” and who was once one of our own medical students, joins the admissions committee and we see the difference that person has made on the job and in mentoring young people in the neighborhood ― and we are incredibly proud.