Health

Affirmative Action Bans would be devastating for patient care

Opinion
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Second Opinions

— A pending Supreme Court decision could erode progress on improving diversity in medicine

by
Sally Mahmoud-Werthmann, MD

November 26, 2022

A ban on affirmative action will have devastating impacts on patient care. Diversity is not just a “nice” thing to have. In just 20 years, the combined minority population is set to become the majority in the U.S. Yet today, Black, Hispanic, and Native American groups remain grossly underrepresented in medicine relative to their proportions in the U.S. population. Within academic medicine, this underrepresentation has intensified over time. Across nearly all specialties and ranks, Blacks and Hispanics are more underrepresented now than they were in 1990. The lack of racial and ethnic diversity in the physician workforce hampers efforts to provide high quality and equitable care to our increasingly diverse patient population.

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

Faced with this dire public health problem, we should be doing our utmost to increase the volume of underrepresented doctors in medicine because 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 physician workforce that is racially and ethnically diverse. Certainly, increasing physician racial and ethnic diversity is just one part of a multipronged solution, but it is an integral one that cannot be ignored.

Physician diversity also improves quality of care, especially for patients of color. Mounting evidence suggests that when patients and doctors share the same racial or ethnic background, patients are more likely to experience improved communication, opt for preventative health services, follow their doctor’s treatment plan, and are generally more satisfied with the care they receive. Another study suggests that the mortality rate for Black newborn babies is cut in half when they are 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 health systems to urgently diversify the physician workforce.

Within this context, it is particularly concerning that even though more than 30% of the U.S. 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 U.S. population is exponentially increasing, the physician workforce is diversifying at a much slower speed. At the current rate, it could take some medical specialties almost 100 years for Black and Hispanic physician representation to match that of the U.S. population. The U.S. physician workforce does not mirror the increasingly diverse population to whom it renders care and is not on track to do so for many years to come.

With the Supreme Court poised to ban affirmative action in higher education, all progress made to improve racial and ethnic diversity in medicine, albeit slow, will be crushed. We’ve already seen a model for how this would play out: state affirmative action bans had disturbing impacts on the physician pipeline. One study compared the numbers of underrepresented medical students in states where affirmative action bans were in place and states that did not have such bans. In the year before the bans were implemented, underrepresented students made up an average of 14.8% of the total enrollment of those states’ public medical schools. Five years later, enrollment of underrepresented students at those schools had declined by nearly 40%. Should a nationwide ban on affirmative action follow a similar trend, there could be significant obstacles in place to improving representation 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 must make a long-term investment to increasing the racial and ethnic diversity of the physician workforce. Banning race-conscious admissions will only exacerbate the dearth of underrepresented groups in medicine, threatening the health of our increasingly diverse patient population. Physicians are uniquely positioned to advocate 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 Social Emergency Medicine Fellow at Stanford Hospital.

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