Portrait of a diverse medical workforce.

Reviews | An affirmative action ban would be devastating to patient care

A ban on affirmative action will have devastating effects on patient care. Diversity isn’t just a “nice” thing to have. In just 20 years, the combined minority population is expected to become the majority in the United States. Yet today, black, Hispanic, and Native American groups remain vastly underrepresented in medicine relative to their proportions in the U.S. population. Within academic medicine, this underrepresentation has intensified over time. In nearly every specialty and rank, blacks and Hispanics are more underrepresented today than they were in 1990. The lack of racial and ethnic diversity in the medical workforce hampers efforts to provide high quality and equitable care to our increasingly diverse patient population.

By 2034, a shortage of 17,800 to 48,000 primary care physicians is expected. A consistent body of research indicates that a higher density per population of primary care physicians is a strong predictor of better health outcomes and is associated with fewer emergency department visits and hospitalizations. However, the shortage of doctors will not affect us all in the same way. Loss of access to care will affect low-income patients the most in already underserved communities, compounding the persistent geographic maldistribution of the overall medical workforce.

In the face of this serious public health problem, we should do everything possible to increase the number of underrepresented physicians in medicine, as they are more likely to practice family medicine, more likely to practice in underserved areas, and more likely to serve low-income patients. . Underserved communities are particularly dependent on a racially and ethnically diverse medical workforce. Certainly, increasing the racial and ethnic diversity of physicians is only part of a multi-pronged solution, but it is an integral part that cannot be ignored.

Physician diversity also improves the quality of care, especially for patients of color. A growing body of evidence suggests that when patients and physicians share the same racial or ethnic background, patients are more likely to experience better communication, opt for preventive health services, follow the plan of treatment from their doctor and generally be more satisfied with the care they receive. Another study suggests that the mortality rate for black newborns is cut in half when cared for by black doctors. Spanish-speaking patients with diabetes are more likely to have better glycemic control when their doctor speaks Spanish. All of these findings underscore the desperate need for healthcare systems to urgently diversify the medical workforce.

In this context, it is of particular concern that although more than 30% of the US population is Hispanic, Native American or African American, only 11% of physicians identify with one of these groups. While the racial and ethnic diversity of the American population increases exponentially, the medical workforce is diversifying at a much slower rate. At the current rate, it could take nearly 100 years for some medical specialties to match the representation of black and Hispanic physicians to that of the American population. America’s medical workforce does not reflect the increasingly diverse population it serves and is not on track to do so for many years.

With the Supreme Court poised to ban affirmative action in higher education, all progress made to improve racial and ethnic diversity in medicine, however slow, will be reversed. We’ve already seen a pattern of how this would play out: State affirmative action bans have had disturbing effects on the physician network. One study compared the number of underrepresented medical students in states where affirmative action bans were in place and in states that did not have such bans. In the year before the bans were implemented, underrepresented students averaged 14.8% of total enrollment in public medical schools in those states. Five years later, enrollment of underrepresented students in these schools had fallen by almost 40%. If a nationwide ban on affirmative action followed a similar trend, there could be significant barriers to improving advocacy in medicine.

The value of diversity and representation in healthcare is proven and we need to find ways to cultivate it. Now more than ever, our country needs to make a long-term investment to increase the racial and ethnic diversity of the medical workforce. Banning race-conscious admissions will only exacerbate the shortage of underrepresented groups in medicine, threatening the health of our increasingly diverse patient population. Physicians are in a unique position to stand up for what is right for our patients and should urge the court to refrain from taking this action.

Sally Mahmoud-Werthmann, MD, is an emergency physician and Fellow in Emergency Social Medicine at Stanford Hospital.

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