Though the future of affirmative action remains in question, pre-med students are decisive: According to a Kaplan survey of over 245 pre-med students, 80 percent agreed it is important for the American medical profession to be demographically representative of the general patient population.
Kaplan’s survey comes in the wake of an April decision by Texas Tech University to no longer use race or national origin as a part of their holistic medical school application process. The decision finalized the 14-year investigation into a complaint against the school stating the use of race in the admissions process is in violation of Title VI of the Civil Rights Act of 1964. Currently, eight states have a ban on affirmative action — including Michigan. Together, these eight states educate about 29 percent of all U.S. high school students.
For the University of Michigan’s 2018 school of medicine class, 20 percent are categorized by the University as “underrepresented in medicine.” According to second-year medical student Zoe Curry this relatively low number is a hindrance to change.
“It seems that this number is actually higher than the national average too, which is a reality that I and many of my classmates find unsettling,” Curry said. “A lot of my concern centers on the culture of medicine as a whole, and how hard it is to challenge traditional structures of teaching and assessment that don't take issues of diversity into account.”
In a different Kaplan survey, medical school admissions officers graded themselves on recruiting and admitting students from different backgrounds. Nearly 88 percent of admissions officers graded themselves with “A,” “B” or “C,” while only about five percent went so low as “D” or “F.”
Steven Gay, assistant dean of admissions at the University Medical School, told The Daily he was unable to give the school a diversity grade as the goal for greater diversity is constantly evolving.
“Our goal is to bring in a class that has most special medical students in the country,” Gay said. “One of the core tenants of that being the best group of young physicians is their diversity on any level. Whether it comes from socioeconomics, to their extensive and profound experiences, to the distance that they travel, to the things that they inspire to do. One of the things that is actually very clear, shooting for a specific GPA and MCAT score does very, very little to guarantee you a class that will fulfill the goals and the vision of the institution … I don’t think it’s something that I will ever be able to sit back to say, ‘See, we did it.’”
Though the number of Black men earning college degrees has grown, the number of Black men entering medical schools is smaller in 2015 compared to 1978, with 1,410 in 1978 and only 1,337 in 2015. For Gay, this low number of African Americans pursuing medicine does not come as a surprise. With a lack of opportunity and exposure, Gay said unrepresented minority students will not consider medicine as a career path.
“Simply put, you’re seeing few African American males in our college as well,” Gay said. “I think the number one reason is that opportunities and equity have become much more difficult in our society for a number of different classes of people.”
David J. Brown, associate vice president and associate dean for Health Equity and Inclusion, agrees with Gay that there are numerous barriers that both restrict and discourage unrepresented minorities from applying to medical school.
“It starts early in the academic development of Black males with unconscious biases from negative stereotypes in the media, low-resourced schools, advisors who do not recognize their talents and discourage or redirect them from studying medicine, the lack of Black male physician role models and at times, the lack of financial resources,” Brown said.
Of the medical schools surveyed by Kaplan, 82 percent of the admissions officers expressed their concern over this trend, and more than half — 55 percent — are implementing programs to recruit more African American students and other underrepresented minorities.
Similarly to the admissions officer survey, the University has a multitude of pipeline programs to prepare high school students, undergraduates and even recent college graduates for the health sciences field. The Leaders and Learners Pathway program is comprised of three residential academics which expose students to a multitude of health science careers and disparities. Additionally, the Medical School partners with Wolverine Pathways, a year-round college readiness program for students seventh through 12th grade from the greater Detroit area.
Gay believes these programs are a vital way to encourage high school students to pursue a career in medicine who may not have otherwise.
“Those programs work to increase opportunity and exposure,” Gay said. “Let’s say that you go to a high school in the Upper Peninsula, and that high school has 200 students. Unless you actually give those students exposure to the field of medicine and the opportunities that are available, they may not know or think they qualify in that field of possibility. Because they’re in the U.P. and 95 percent of people are farmers. They think they should be a farmer. They don’t have the opportunity to be exposed and thus it isn’t an option. I was an athlete when I was young, I would’ve played soccer if I had been exposed to it—but having never been exposed to it, I didn’t think about it. That’s what pipeline programs do, they take areas where the exposure is limited and broaden the understanding what it takes to be a part of it.”
Petros Minasi, director of pre-medical programs for Kaplan Test Prep, said diversity is not only one of the biggest issues in medical education, but also in the profession as a whole. According to the Association of American Medical Colleges, only 5.7 percent of medical school graduates in 2015 were Black or African American, and only 4.6 percent were Hispanic or Latino. Yet, in 2017, the number of women enrolled in medical school exceeded the number of male applicants.
Minasi suggests these disparities are important to consider when talking about healthcare access and doctor-patient relationships.
“As a whole, we are a very, very rapidly changing country in terms of demographics, especially in the patient population,” Minasi said. “We are now at in time where more Americans are covered by health insurance, which means there is going to a bump in people seeking medical help from doctors. There is definitely research that shows that people of color are more likely to seek help from doctors that share a similar background because it promotes a culture of trust and communication.”
As a part of the University’s Global Health and Disparities track, Curry examines the way in which social inequalities are relevant in each patient interaction and how these adversities impact the care doctors provide. With a lack of diversity in medicine, she believes this may cause marginalized groups to avoid seeking health care, even if they do have a means to access and pay for it.
“Often, discrimination comes in the form of unconscious bias and microaggressions, and for that reason, it is less obvious and much harder to eliminate among medical students and other clinical trainees,” Curry said. “By having a diverse care team, patients can feel supported in knowing that their providers come from a variety of backgrounds and hopefully have a greater ability as a whole to provide empathetic, unbiased care to all … While this is definitely a controversial topic, I think it is entirely understandable for a person who has experienced discrimination in health care to try to protect themselves from that in the future by building trust with a provider they are comfortable with.”
This discrimination, Curry said, can even lead to physical harm of a patient by way of refraining from pursuing an experimental treatment, suggesting a screening test or giving pain medication.
“This can lead to worse outcomes for minorities — particularly Black and Hispanic populations — with regard to a staggering number of conditions, from ACS (acute coronary syndrome) to cancer,” Curry said. “For example, black women and white women get breast cancer at about the same rate, but black women die from breast cancer at a higher rate than white women. While it would be easiest to chalk this up to a genetic explanation, the reality is that breast cancer is detected at earlier stages in white women and is therefore more curable. This suggests to me that the role of insurance covering preventive screenings and whether physicians who suggest such screening to patients with or without bias are essential factors at play here.”
Though the University is unable to consider race and ethnicity in admissions, Gay assures the admissions teams will holistically—and as accurately as possible—examine each candidate in order to create a stronger and more dynamic class.
“There is no perfect candidate for medical student,” Gay said. “A class learns from itself, and the class learns from the strengths of the individuals around them, and having folks who distinguish themselves in many of those areas or all of those ares, or in one of those areas to a much greater extent than anybody else, will contribute to the learning community that will make these folks the best physicians they can be.”