A recent agreement between the medical school of Texas Tech University Health Sciences Center and the Trump administration that forces the school to stop considering race as a factor in its admissions processes is a step backward for improving health care in the United States.
The agreement ends a 14-year investigation by the U.S. Department of Education’s Office for Civil Rights into the university’s use of race in admissions. It represents a sharp reversal to the university’s holistic applicant review process, which includes the consideration of race and ethnicity. The agreement is, however, consistent with the current administration’s advocacy of “race-neutral” admission policies as well as its efforts to rescind Obama-era policies on affirmative action.
It is the first agreement between the Trump administration and a school to stop using race as an admissions factor, and comes as new research shows that greater minority representation in medicine can improve health for African-Americans.
While the Texas Tech agreement focuses on medical school admissions, we were interested as researchers and physicians in what happens further downstream: Does a more diverse physician workforce affect patient health?
That question is motivated by policy statements from leading medical organizations such as the American Medical Association, the Association of American Medical Colleges, and the National Academies of Medicine that call for an increase in the number of minority physicians to better reflect the U.S. population and potentially reduce health disparities. Doctors with similar backgrounds to those they serve might be more efficient at building trust and communicating with patients — crucial components to medical care. Yet only around 4% of U.S. physicians are African-American even though this group accounts for 13% of the U.S. population. The gap is even wider for Hispanics, who make up 4% of physicians and 18% of the U.S. population.
With our co-author, Grant Graziani, we designed a study to test whether increasing representation among minority physicians would improve health for minority patients, focusing on the U.S. demographic group with the lowest life expectancy: African-American men.
To do this, we conducted a community-based, randomized controlled trial that recruited more than 1,300 African-American men from local barbershops and flea markets to attend a free clinic we set up in Oakland, Calif. When participants checked into the clinic, they were randomly assigned to see a male doctor who was African-American or non-African-American (white or Asian).
After meeting with the doctor, participants randomly assigned to see African-American doctors were much more likely to take up preventive services, especially those that involved a more invasive procedure like a finger prick for a blood sample or an injection. For instance, there was a 49% increase in blood tests to screen for diabetes and a 71% increase in cholesterol testing among participants paired with a doctor of the same race.
Better communication was the primary driver of the results. During clinic encounters, participants were more likely to discuss their health problems with an African-American doctor, and African-American doctors were more likely to write detailed notes about their patients.
There was no evidence of discrimination by either participants or doctors, something the study was designed to detect. For example, participants selected a similar number of screening tests after seeing photos of their doctor. It was only after in-person consultations that those assigned to African-American physicians chose to have more services. Moreover, patient feedback was consistently positive no matter the race of the physician.
Based on our results and mortality rates from the Centers for Disease Control and Prevention, we calculated that increasing the supply of minority physicians has the potential to reduce the number of African-American men dying from cardiovascular disease by 19%. This is particularly important because cardiovascular disease is responsible for nearly half of the five-year life-expectancy gap between non-Hispanic black and white men.
Profound health disparities exist in the U.S. for many reasons, ranging from lack of insurance to differences in behavioral and environmental risk factors and unequal early life circumstances. Our study shows that increasing the representation of American-Americans in the physician workforce should be included as an evidence-based approach to close these gaps in health outcomes.
More young people of color should be encouraged to pursue the field of medicine. Policies designed to increase diversity in the physician workforce should be protected, not dismantled.
Marcella Alsan, M.D., is an associate professor of medicine and (by courtesy) of economics at Stanford University. Owen Garrick, M.D., is CEO of Bridge Clinical Research, which aims to diversify clinical trials.
STAT deleted this Comment of mine without any explanation so I will post it here again:
“The studies that claim to have shown a difference between racial or ethnic group in MCATs and GPAs have not adequately (or at all) controlled for socioeconomic status as a confounding independent variable. The multivariate statistical analyses are either sloppy or not done at all, and so the empirical claims that have been used to justify Affirmative Action are scientifically specious. Affirmative Action is not only discriminatory, it’s also borne out of a horrendously poor understanding of statistical analysis and scientific rigor. The disparities that exist are socioeconomic, not racial.”
The socioeconomic disparities that exit and continue to exist in the USA, is due to historical discrimination. I would recommend reading more on our history, like red-lining on housing discrimination. We have a system that is racist and favors one group over the others. Please, please stop ignoring the elephant in the room.
The studies that claim to have shown a difference between racial or ethnic groups in MCATs and GPAs have not adequately (or at all) controlled for socioeconomic status as a confounding independent variable. The multivariate statistical analyses are either sloppy or not done at all, and so the empirical claims that have been used to justify Affirmative Action are scientifically specious. Affirmative Action is not only discriminatory, it’s also borne out of a horrendously poor understanding of statistical analysis and scientific rigor. The disparities that exist are socioeconomic, not racial.
The false notion that abolition of Affirmative Action, which is racist to every racial group at its very core, will worsen healthcare equity has absolutely no grounds in empiric evidence and is borne strictly out of a polemical argument characterized by a deeply flawed conception of fairness and a horrendous abrogation of Equality of Opportunity for Equality of Outcome, which was pursued by Communists of decades past with disastrous and murderous outcomes. The exact same arguments and language used to advance Affirmative Action was also used to justify anti-Semitic Jewish quotas in elite American medical schools throughout the 1920s and 1930s – and is well-documented in such works as Yale medical school’s official history. The solution to healthcare inequity is to promote Equality of Opportunity in challenging medical school applicants to strive and work their hardest, not to appallingly insinuate that certain racial groups have to get a preference because of lower academic performance, which in itself is a racist lie that is ungrounded in any sort of empiric evidence.
Agree with this comment wholeheartedly.
That means that the system should have stay as it was back in 1960’s when we had segregated hospitals in the USA; including Chicago all the way down to the deep south?, “The communist decades,” I am guessing is the the time when Medicare was introduce to bring desegregation to hospitals and a path to health equity.
We still have a long way to go, and learn from our past.
This isn’t preventing other races from going to medical school. If anyone works hard enough for it they can do whatever they want. Why should certain races get an advantage? It should only be about the grades, extracurriculars, and hard work they’ve done to get to where they want.
Actually , this article doesn’t make sense. The fact that race will not be considered is a good thing. The things that need to be considered are qualifications and work ethics of the applying candidate. This will actually make for better qualified physicians. Having a school forced to look at a balance of whites, blacks, browns etc. forces decisions that could actually lower the standards. Race , religion, and gender should not be considered or even on the application.
The article makes no sense because the clinical trial it cites has absolutely nothing to do with Affirmative Action. There’s no empiric evidence that any of the physicians involved in the trial got into the medical profession because of Affirmative Action rather than race-blind admissions standards. The authors cited an irrelevant study to justify their polemical arguments.
An argument could be made that there is not enough enthusiasm to become a Dr. in some communities, student loans and schooling can be daunting. Commonly a family friend or relative helps inspire children to go that extra distance. The question that should be asked is what can be done to inspire children from backgrounds that dont have those role models in their life? Answering that would help solve that exact problem more accordingly.
Love how the headline blames Trump, but reading the first paragraph states it was a 14 year investigation. Your bias politics has no place in an important story.
The investigation was conducted after a complaint against affirmative action by a small conservative group; the Trump administration ended this investigation, in favor of this original complaint and likewise, detailed an agreement against affirmative action. Read the original article (or at least more than the first paragraph of this one).
This article should be sent to every dean and admissions office in America. Prevention and treatment are the key. Not the IQ of the doctor. Patient compliance is not based on IQ. Loved the article.
I am interested in hearing what you have to say. I don’t know what I wrote that is stupid. I’m not wrong in writing that blacks/Hispanics have a lower gpa/MCAT scores. That’s a fact.
Tell me about it. It’s hard enough just to find an American born doctor now.
That is interesting, I am assuming “American born doctor” means a “White, real American.”
The reality is that our country is changing, and we will be a minority majority very soon, meaning more brown.
We need to think about how our system may open the door to more equitable not equal, opportunities for all.
That means, how can we reduce poverty and improve that upward mobility that is equal to opportunity, and not racist.
If we don’t, fifty years from now, we will continue to have these kinds of arguments and comments that are discriminatory to many people who come to this wonderful county seeking new opportunities. Just like Don’s ancestors did, unless she is Native American.
Yes, it’s a shame an applicant’s acceptance or dismissal should be based solely on merit and not the superficial. Racists and sexists unite to undo this ghastly policy! #WreckEm
I do believe that we need more minorities doctors in the healthcare field. However, it is wrong that they should get an easier ride to med school simply because of their skin color. If we are saying that med school applications are holistic, and an Asian/white applicant has higher gpa and MCAT than their minorities counterpart, that’s basically implying that minorities excel in other categories, such as life experience, which I totally disagree. Regardless of race and ethnicity, everyone should be judged the same way.
The “superficial” color of my grandmother’s skin allowed physicians to downplay her complaints and misdiagnose her condition — which she paid for by living in a vegetative state for the rest of her life. The “superficial” color of the doctor who saw my similarly-hued cousin saved her life when they correctly treated her for a genetic blood condition, which the senior “merit-based” doctor simply saw as drug-seeking behavior. But please — enjoy your quips and your “merit”…
Sorry to hear about your grandma, but it’s not right to generalize your experience. I can easily say the opposite. I have been seen by both black and white doctors, and I feel no difference between them. I suppose this experience is mostly felt by black patients, which is what the article seems to be suggesting.
I don’t have to “generalize about my own experience,” Jk — there are numerous studies done on the quality of care black and Hispanic patients receive in the US. The largest study done on black women and healthcare in 2007 demonstrated that in every category of economic class, black women received worse care — and that chasm was consistent. Even when money, insurance, access/compliance, and education were not obstacles to the patient-doctor relationship, black women were more at risk from dying from their ailments. So what happened to Serena Williams was actually par for the course for a system conceived under the weight and morass of racism, sexism, and gender identity bias. That one may think that medicine is above the totality of that system merely demonstrates how beguiling and seamless ignorance of inequality imbues the “merited” American character.