AAMC Reporter: December 2004

A Word from the President: "Meeting the Diversity Challenge"

Let's review some interesting statistics about the newest medical school class, the one that matriculated this past fall.

First statistic: the pool of applicants from which this class was drawn was 2.7% larger than the previous year's, which also was larger than the year before. It is especially noteworthy that this year's first-time applicants were up nearly 4% over a year ago. So, it looks as if the worrisome downward trend in medical school applicants that characterized the late 1990s may be behind us.

Second statistic: for the second straight year, the applicant pool contained more women than men. Slightly more men than women were accepted, but we now have virtual gender parity among medical students, a remarkable development. My graduating class of just over 160 had a grand total of 7 women; that was in 1960.

Third statistic: compared with last year, more students from minority backgrounds applied and were accepted this year. For example, African American applicants and entrants increased by 2.3% and 2.5%, respectively. For Hispanics, the corresponding numbers were 2.5% and 7.8%. As encouraging as those gains are, we have a long way to go to make up for the ground lost since the demoralizing anti-affirmative action climate of the mid-90s. In 1994, the number of African American matriculants, for example, reached its highest level of 1,309, or more than 8% of the entering class, only to fall nearly 20% over the next nine years to 1,060. This year's entering cohort has 1,086 such students, which represents just 6.5% of the class.

Medicine's racial and ethnic diversity gap remains one of the profession's most glaring deficiencies. Those of you who were present at this year's AAMC Annual Meeting were treated to yet another reminder of the awful price our society is paying for the lack of sufficient diversity among its doctors. Donald Wilson, M.D., Dean of Medicine at the University of Maryland, took the occasion of his AAMC Chair's address to present an eloquent and moving account of the healthcare disparities that plague our minority populations. He predicted, quite correctly, that those indefensible disparities would not cease to exist until our physician workforce looks more like America.

Others outside our community also continue to underscore the need for much greater racial and ethnic diversity in medicine and to call on medical schools to do more to help solve this intractable dilemma. Two such calls were published this year: the Institute of Medicine's In the Nation's Compelling Interest: Ensuring
a Diverse Health-Care Workforce, and the Kellogg Foundation's Sullivan Commission report Missing Persons: Minorities in the Health Professions.

That prestigious groups like these continue to express impatience and frustration with the slow progress we are making is symptomatic of just how refractory this dilemma is. At the risk of being overly simplistic, let me contrast the problem we face in achieving adequate racial and ethnic diversity with what we faced in achieving adequate gender diversity. Once the commitment was made to lower the artificial barrier to women and actively seek to increase their numbers among medical students, admissions committees could simply apply their existing selection criteria in a gender-blind fashion. It still took a few decades to reach gender parity, but little more was necessary than allowing nature to take its course. After all, there were plenty of women applicants who had not been disadvantaged by being educated in inferior K-12 schools.

For minority students, as a group, things are very different. The commitment of admissions committees to increase the number of such students, as genuine and deep as that commitment is, simply cannot do the job in the face of an applicant pool that still contains too few academically well prepared minority students to yield adequate racial and ethnic diversity among matriculants.

Some think that we could admit many more deserving minority applicants if we relied less on MCAT scores in making admission decisions. Here are some facts that should put that canard to rest: medical schools already accept some 85% of minority applicants (Blacks, Hispanics and Native Americans) but less than 50% of other applicants who have a combination of total MCAT scores and GPAs in the mid-range of all applicants. Equally revealing, schools accept some 20% of minority students but only 8% of other students whose total MCAT scores are in the lowest range (i.e., 5 to 22). These data indicate to me that MCAT scores, far from posing an obstacle to the admission of minority students, are often discounted by admissions committees when they identify other qualities of mind and spirit that predict success as medical students and, more important, as caring physicians.

There is no doubt that medical schools must continue to accept as many capable minority students from the existing applicant pool as possible, and must do everything in their power to foster better academic preparation and stimulate greater interest in medicine among minority college students. But it is fanciful to think that we can duplicate with race and ethnicity the success we've had with gender equity until our country takes seriously the need to leave no child behind. As the Sullivan Commission, the IOM and many others have emphasized, the only sure pathway to more diversity in medicine, and to eliminating disparities in healthcare, is to repair the gaping holes in the K-12 educational pipeline and provide every youngster with the educational foundations upon which success in college and medical school can be built.

Medical schools can do only so much. A just society must play its part.

Jordan J. Cohen, M.D.
AAMC President

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