(Reuters Health) – Following state implementation of affirmative action bans, medical school enrollment of minorities in those states decreased sharply relative to states without bans, according to a new study.
The analysis of data from 21 public medical schools in eight states over the period 1985 to 2019 revealed a 4.8-percentage-point decline in racial and ethnic minority enrollment five years after an affirmative action ban went into effect compared to the pre-ban period. In contrast, at 32 matched public medical schools in 24 states without bans, the minority proportion of students increased overall by 0.7 percentage point, the study team reports in the Annals of Internal Medicine.
“The absolute reduction in the percentage of underrepresented students in states implementing a ban corresponded to large relative reductions,” the authors note. “The 5.5-percentage point reduction in underrepresented students (by year 5) associated with ban implementation implies about a 37% relative reduction in underrepresented students.”
“Research shows that when racial and ethnic minority patients see minority physicians, that relationship leads to better care,” the study’s first author, Dr. Dan Ly, an assistant professor in the division of general internal medicine and health services research at the University of California, Los Angeles, told Reuters Health.
“So, the diversity of the physician workforce is essential for the health of our population. These state bans on affirmative action have reduced the diversity of our physician pipeline and therefore harm the health of our patients, particularly patients from racial and ethnic minority groups who already suffer from poorer health outcomes.”
Dr. Ly points to the example of Black patients.
“Studies show that Black patients are more likely to undergo preventive care when treated by Black physicians,” Dr. Ly said in an email. “For example, Black patients are more likely to get the flu shot or be screened for diabetes when treated by a Black physician.”
Moreover, Dr. Ly said, physicians from minority groups are more likely to care for underserved populations and more likely to provide care in underserved areas.
Why is affirmative action needed?
“There are a lot of inequities in education and large disparities in resources available to students from different racial and ethnic minority groups, and this likely leads to leaks in the pipeline from high school student to pre-med college student to medical student,” Dr. Ly said.
To take a closer look at the impact of affirmative action bans, Dr. Ly and his colleagues turned to publicly available data on the racial and ethnic composition of students enrolled at U.S. public medical schools between 1985 and 2019. The researchers focused on four racial and ethnic minorities that are underrepresented in medicine: Black, Hispanic, American Indian or Alaska Native, and Hawaiian or other Pacific Islander.
In their analysis, the researchers accounted for state levels of unemployment, per capita income, and the percentage of those aged 25 and older with a bachelor’s degree.
Dr. Ly and his colleagues found that in states with bans, the average percentage of minority students in in the year before the ban was 14.8% (5% Black, 8.3% Hispanic, 0.7% American Indian or Alaska Native, and 0.2% Native Hawaiian or other Pacific Islander). In control schools in states with no ban, enrollment of underrepresented groups the year before the imputed ban was 7.5% (3.6% Black, 1.6% Hispanic, 1.9% American Indian or Alaska Native and 0.4% Native Hawaiian or other Pacific Islander).
Overall, the adjusted percentage of minority medical school students in states with a ban decreased by 4.8 percentage points five years after the ban was implemented relative to a year before the ban, resulting in a relative difference, or difference-in-differences estimate, of -5.5 percentage points compared with control schools.
“A 5-percentage point drop is huge (that is about a 30% decline in enrollment),” said Dr. Peter Muennig, a professor of Health Policy and Management at the Columbia University Mailman School of Public Health in New York City. “It has implications for both patient care (because underrepresented minorities may be more likely to return to under-served areas) and for medical education (because a diverse classroom environment probably breeds better patient care).”
With that said, Dr. Muennig has issues with the design of the study.
“There should be mixed methods with a deep qualitative dive to figure out what is going on,” he said in an email. “Schools that drop affirmative action often replace it with something else (such as income/hardship determinations).”
Moreover, Dr. Muennig said, the study looks at just 21 schools. “I would want to know what is going on inside the schools themselves,” he said. “What did the discussions look like on admissions committees? Were alternative rules put in place? If so, why were they ineffective at creating a diverse class?”
Another question concerns Asian/South Asian/Middle Eastern students, Dr. Muennig said. “Usually, affirmative action bans produce a decline in white students because white students are the biggest beneficiaries of affirmative action. When Berkeley ran the simulation of a ban on affirmative action, I think that the white students dropped from a near majority to a small minority (like 10% or so). White males in particular are big beneficiaries, so gender plays a role in some cases, too.”
SOURCE: https://bit.ly/3MLCbHU Annals of Internal Medicine, online May 2, 2022.
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