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To Diversify Medicine Post–Affirmative Action, Look to Community Colleges

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The Supreme Court of the United States ruling last year that colleges and universities can no longer take race and ethnicity into consideration as a specific basis for granting admission delivered a significant blow to diversity efforts on campuses nationwide. This ruling applies to medical education, where the lack of a diverse physician workforce is a known factor that leads to health care inequalities.

Without affirmative action, how can we recruit the next generation of physicians to care for people from underrepresented groups more effectively?

One of us, Galvez, is a pediatric hand surgeon, and the other, Padilla, is an obstetric anesthesiologist and critical care physician. Both of us started our long journey to medicine at community colleges, where we were later able to transfer to four-year colleges before entering medical school. We thrived in medical school and know that other people who follow our educational path can be equally successful—but more medical schools have to give community college students that chance.

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In this post–affirmative action era, community college attendance could be a proxy for race and ethnicity in medical schools admissions. Admissions officers need to consider this educational path as a strategy to diversify the physician workforce.

Latinos have  become the largest minority ethnic group in the U.S., and there are not enough physicians of Latino descent to serve them. This is important because of cultural and language differences, but also because, by 2050, it is predicted that roughly one third of Americans will be of Latino descent. Latino physicians comprise only 6.9 percent of the U.S. physician workforce.

As the co-founders of National Latino Physician Day, we posted on X (formerly known as Twitter), calling for medical schools to use community college attendance as a strategy to diversify medical school classes, and in turn, the U.S. physician workforce. Community colleges include a high proportion of premedical students from diverse backgrounds whose lived experience will make them excellent physicians.

This attention to lived experience is critical; the majority of low-income and people of color  receive care in academic medical centers, which, in turn, are overrepresented by wealthy medical students. This creates a stark contrast between the lived experiences of patients and doctors, which may amplify existing disparities in health care outcomes for vulnerable, low-socioeconomic-status patients who are already at a higher risk of suffering worse health care outcomes. A report from the Commonwealth Fund commented on this disparity, citing the importance of “ensuring that medical students and residents obtain appropriate training and experience in providing care to the poor, uninsured, and racial and ethnic minorities.”

Our call for focusing on community colleges was inspired by studies co-authored by Efrain Talamantes, founder of MiMentor, a nonprofit organization dedicated to mentoring low-income students and minority students pursuing a career in medicine (both of us serve on MiMentor’s executive board). In 2014, Talamantes and his colleagues demonstrated that students who attended community college and later enrolled in medical school were more likely to be low-income, to be a member of an underrepresented race or ethnicity and to have parents without a college education. In a follow-up study in 2018, Talamantes et al. showed that doctors with a community college background were more likely to practice in underserved areas.

But the same study also found that medical school applicants who attended community college were less likely than those who only attended a four-year university to be accepted to medical school. The American Academy of Medical Colleges, a professional organization representing medical schools, cited these findings in a news article on its website, noting that advocates hope to “counteract any biases or disadvantages students who attended a community college might face when applying to medical school.”

Community-college-to-medical-school pathways should guarantee medical school admission to students with a community college background. Yet as far as we’re aware, no such programs currently exist.

Some promising efforts are happening at the state level, however. The California Medicine Scholars Program aims to provide community college students with mentorship, resources and financial support in  their pre-med journeys. The program has received more than $12 million in funding from the state of California. Programs like this one help strengthen the pipeline between community colleges and medical school and set an example of how government-funded infrastructure can help low-income community college students become physicians.

Statistically, Latino people and members of other minority groups in the U.S. are more likely to be low-income. This makes paying for higher education and medical school—which can cost hundreds of thousands of dollars—a major challenge. Data from the AAMC show that in the past 30 years, only 5 percent of medical students come from families within the lowest 20th percentile for socioeconomic status, with little fluctuation in this number in the past 25 years. The overwhelming majority of medical students (76 to 79 percent) come from the top 40th percentile.

Creating structural solutions, such as guaranteed community-college-to-medical school pathways, could drastically increase the socioeconomic diversity—and likely the racial or ethnic diversity—of medical school classes. By seeking out community college attendance in medical school applicants, we are more likely to create a socioeconomically varied workforce reflective of the populations that academic medical centers serve.

In the wake of the Supreme Court’s affirmative action decision, we believe medical school applicants from low-income or community college backgrounds should share the personal challenges they have faced in their applications. In recent years, several academic programs have incorporated a “holistic approach” to medical school admissions, which aims to quantify an applicant’s personal struggles, such as academic distance traveled or personal history of poverty.

But this approach can force applicants to relive traumatic life experiences that are often reduced to “overcoming adversity” in an admissions checklist. Using community college attendance instead is a quantitative measurement for the qualitative experience of being less privileged.

As federal agencies provide guidance to colleges and medical schools, we need a confident systemic commitment from our legislators and academic leaders that ensures guaranteed medical school acceptance of students with a history of community college attendance. We need a more diverse workforce in medicine, physicians or otherwise. Rather than letting the SCOTUS affirmative action decision create a roadblock, medical schools have detours they can and should use to meet those goals.

This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily those of Scientific American.


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