Why Affirmative Action Still Matters in Medicine. And Probably Always Will…

I am an emergency room physician who has worked at Atlanta’s Grady Memorial Hospital for 17 years. I am also the first black woman to ever be hired as  a faculty member, and thus have had the opportunity  to teach students and doctors in training.  Given that 85% of the patients of the 120,000 patients that cross our threshold annually are black, my hiring carried enormous symbolic weight.

Beyond the symbolism, I’ve found a real effect on patient care. There are a few earlier studies which suggest that patients prefer doctors who look like them if given the opportunity.

Though we can’t yet confirm that physicians and patients of the same race improve health for minorities , we can still argue that increasing diversity in the healthcare professions is a worthy goal.  We must move to a place where physicians can comfortably care for people of all cultures and patients can feel comfortable being cared for physicians from different cultures.

In my own experience, African-American grandmothers, mothers, sisters, aunts all want to give me a hug when they see me walk in the room to treat them or their loved ones: “Go ahead sister,” they might say, “we’re so glad and proud to see you”.   I have also had many black patients tell me they were more comfortable talking with me about their history of abuse or addiction.  That kind of rapport leads to better care and a healthier population.

If the Supreme Court had ruled in favor of Abigail Fisher in Fisher vs. The University of Texas today, which they did not, opportunities for physicians of color who could establish that rapport might have been significantly diminished.

To eliminate or significantly weaken affirmative action, which would have been the result of a Fisher victory, would deal a significant blow to the ability of undergraduate programs to recruit and create a diverse student population—some of whom will continue on to medical school. To be sure, that blow would weaken medical schools nationwide.

The American Association of Medical Colleges, the organization that includes all 138 accredited U.S and 17 accredited Canadian medical schools, nearly 400 major teaching hospitals like Grady also agree. The organization appealed to the Supreme Court to uphold the Grutter v Bollinger case.

Fisher’s case contends that she was denied admission to the University of Texas in because she is white. She and the groups that brought the case were asking for the Supreme Court’s ruling of ten years ago on this matter, in the case of Grutter v. Bollinger to be overturned.

In this landmark case, the United States Supreme Court upheld the affirmative action admissions policy of the University of Michigan Law School. Justice Sandra Day O’Connor, writing for the majority in a 5-4 decision, ruled that the University of Michigan Law School had a compelling interest in promoting class diversity.

There is clear evidence that Justice O’Connor was correct.  In a review of multiple studies and noted in The Rationale for Diversity in the Health Professions: A review of the Evidence, minority patients tend to relate better to practitioners of their own race or ethnicity.

Dr. Joseph Betancourt, a senior scientist and program director at the Multicultural Affairs Office at the Massachusetts General Hospital, and an expert on culture and race, argues that doctors must be “culturally competent,” meaning that they a familiar with the cultural norms of their patients in order to better understand their health beliefs and behaviors of their patients. He emphasizes that doctors who are familiar with the cultural norms of their patients can better offer or explain the care those patients need.

It is estimated that by 2015 there will be a shortage of 63,000 physicians in the United States, a number that is projected to rise to 130,000 by 2025.  This two-fold increase in the physician shortage would affect people of all races but mostly Black and Hispanic Physicians of color because the percentage of aspiring black and Hispanic physicians of color admitted to medical school has had minimal change in the past 30 years—affirmative action which impacts admission to college and universities is necessary to have any hope of raising those numbers.

In 2012, only 15% of students in U.S. medical schools and 23% of nursing students were underrepresented minorities, while such minorities comprise 36% of the total U.S. population. By 2042, people of color will be the majority population in the US, making cultural competence even more important.

Twenty years ago, I graduated from Howard University School of Medicine, a historically black institution with many classmates who look like me. But while historically black institutions like Meharry, Morehouse, and Howard are vital institutions, they do not produce enough African-American graduates to fill our growing needs, nor should they be the only institutions that produce African-American physicians—and we need physicians of all races and ethnicities.  To return to the pre-affirmative action standards would only hurt us all. We can’t turn back the clock.

Sheryl Heron, MD is an associate professor in emergency medicine at Emory University and a Public Voices fellow with The OpEd Project. She practices at Grady Memorial Hospital in Atlanta.

16 replies »

  1. It’s funny to me that when we think about Med School the only criteria some think should be considered is MCAT and GPA…yet when we look at Fortune 500 companies and see only 23 are headed by women, or Barrack Obama is the only non-white male to be President we don’t think that’s strange. I bet there are some women, Asians, Blacks or Latino’s with higher GPA’s and SAT scores than George Bush. I bet Larry Bird’s 40 time and vertical were not off the charts, but he’s one of the best basketball players ever. Joe Montana’s measurable were probably not the highest ever. My point is that medicine like everything else should have a holistic basis and look at the whole applicant. A person is more than a simple statistic. When you get a blood transfusion-thanks Charles Drew…..If you have open heart surgery, thank Daniel Hale Williams and Vivien Thomas. If you get a kidney transplant, thank Samuel Kountz..all were African Americans and pioneers in Medicine. One could argue perhaps more diversity would save lives.

  2. Let me get this straight: We should take less qualified people into our medical schools even though they will be responsible for people’s lives? Just in the name of diversity? What ever happened to judging people based on character and qualifications?

  3. Louise Donga, your compromise exposes an ignorance or blindness to the purpose of Affirmative Action in higher education: to get in the door to school. What would be the purpose of sharing “lower credencials” entering school when the education that students receive once they are in school is no less challenging and significant than any other student, and what matters is the completion of the education, residency, and subsequent experience?

    Would you consider asking your current doctor what their MCAT score was unless they were what you might presume to be a minority? And what if – heaven forbid – a *special admit* was a) not a RACIAL minority, and/or b) their MCAT scores are not actually reflective of their confidence in their specialty 20 years down the road?

    Overall, Zeppefeldt-Cestero’s story should be a goal of any medical practioner. If if is more common from someone who relates better to a patient for cultural reasons, all the better.

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  5. I propose a compromise: Practice AA if you want, but let’s have truth in labeling. If MDs were admitted to medical school with lower credentials than their peers based on skin color or ethnicity, tell potential patients about that. For some, it may be worth the tradeoff, to get someone who is more culturally competent, sympatico, whatever.

    Others may think that entering credentials like MCAT and GPA don’t matter that much. So they too could feel free to pick doctors who were “special admits”.

    Personally, I think that for many areas of medicine, MCAT and GPA *are* predictors of the kind of skills needed. So that way, I could pick a doctor who was selected based on credentials not skin color.

    What’s wrong with that compromise plan?

  6. I highly applaud Dr. Heron’s must-read article regarding the necessity of a diverse health workforce that democratically represents the patients it serves. In addition to the fact that a more inclusive network of health professionals addresses public health’s favorite buzzword, “cultural competence,” this approach also moves the U.S. health care system towards “structural competence.” Patients not only feel more comfortable sharing their personal stories of struggle with physicians that look like them, but it is much more likely that their health conditions due to economic and environmental causes will be better understood and addressed. “Structural competence” can only be fully achieved in the U.S. health care workforce when medical and nursing schools not only select a more equitable pool of students with regards to race, but also with regards to socioeconomic background. Because a physician or nurse who lives in the same housing conditions or has experienced violence in their neighborhoods can truly understand how to address the actual root causes of disease for their patients.

  7. Having recently graduated from medical school and served as national president of the American Medical Student Association (AMSA), I could not agree more with Dr. Heron. With millions of previously uninsured Americans gaining “access” to health care services under the Affordable Care Act, there is a growing body of evidence that supports the need for a diverse health professional workforce to really address the significant and unconscionable health disparities in our country.

    Moreover, it is important not to underestimate the value and benefits of diversity for trainees and the learning environment. As a medical students and residents, so much of our education is shaped by our peers. With the rise of team-based care models in medicine, opportunities for students to work with peers from backgrounds different than our own promote cultural competence and help ensure students are prepared to provide high quality care to all patients as health professionals. Affirmative action and holistic review are critical to realizing these goals. As a new physician, I hope that the courts – as well as our legislators – continue to recognize the importance of preserving affirmative action and holistic review.

  8. ezra klein’s shadow,

    Presumably, you meant that graduates of Howard (and similar schools) had a higher rate of malpractice that graduates of other schools. By the way, I would appreciate seeing a reference to the article.

    I think that statistic is probably meaningless. In my metro area, plaintiffs attorneys are desperate to get cases into a city court, rather than the court in a suburban county. That is because city juries tend to view malpractice as akin to a person “hitting” the lottery. (Because of this, my group has closed all its city locations and no longer staffs any of the city hospitals that we used to.)

    So if African – American doctors work in urban locations – which I assume they do – they run a higher risk of malpractice. The best predictors of malpractice risk are: 1) Specialty 2) Geography.

    Nice try, no cigar!

  9. Having completed our 13th Annual Healthcare Diversity Awards last Friday, where my 90 year old Puerto Rican mother was honored with the Founders Award, I was I was reminded how difficult it was to find her a PCP that she was comfortable seeing and who “looked” at her when he spoke. Finally, we found a PCP, who just happened to be African-American. Not only did he “look” at her when he spoke but he actually meticulously reviewed her medications, took time to speak and listen to her and, something I’ve never experienced, he helped take her coat off, and at the end of her exam, walked her, hand-in-hand to the elevator. She felt so uniquely treated like a “person” for his kindness and time. It reminded her when she was younger and “house calls” were the norm. She feels an instant connection with him. I say all this because diversity in the health workforce is needed now more than ever with the implementation of the ACA. Our communities of color should expect both the same level of care and outcomes as other Americans. As Chair of the Roundtable of Professional Hispanic Health Associations and President of the Association of Hispanic Healthcare Executives, this is a goal we all share; appropriate access, cultural & linguistic competency , positive outcomes and respect from providers/administrators who reflect our patients. As you said, we can’t turn back the clock.

  10. In an era when we have a black president in his second term, i think we’ve moved past this discussion. (Although Paula Dean-gate certainly begs the question of how much has really changed). Race in medicine is so much more complicated of an issue than it used to be. What do we do about Asian patients who only want to see to see doctors of their own ethnicity? Crochety patients in the Midwest who give their South Asian doctors grumpy attitude. (I’m sick and tired of foreign doctors. Send me an American. A shock to my New Jersey born and raised Bruce Springstee quoting Desi doctor friend.) Doctors offices in Texas and California who informally screen out Latino patients on the basis of their last names? Rodriguez? Hernandez? Sorry there’s an eight week wait.

    I vote we drop official rules and let institutions adopt policies that make sense for their own constituencies.

  11. There was a study that came out a few years back showing that the historically african american medical schools like Howard have a much higher rate of medical malpractice than the other med schools did.

    My question to Dr Heron is why do your african american patients deserve a lower standard of care in the name of “diversity”? Do you walk into the room and say “yes sister, I am a woman of color but you should be warned that graduates of my medical school have higher rates of medical negligence”

  12. What a bunch irresponsible nonsense. I don’t care what the doctor looks like. All I care is that he or she is competent and qualified to make decisions affecting my health. Ya dig…sister?