How to (Legally) Diversify the Healthcare Workforce

— Alternative approaches are key following the SCOTUS ruling on race-based admissions

A photo of a grid of diverse physicians of varying ages, races and genders.
Lazarus is an adjunct professor of psychiatry and a regular commentator on the practice of medicine.

The American Medical Association (AMA) has long recognized the benefits of a diverse student population in classrooms and exam rooms. Thus, it was no surprise that following the Supreme Court of the United States' (SCOTUS) decision to virtually ban race and ethnicity as factors for admitting students to colleges and universities, several medical schools and professional organizations announced their continued commitment to diversifying the healthcare workforce: The John A. Burns School of Medicine at the University of Hawaii, the Association of American Medical Colleges (AAMC), and the Accreditation Council for Graduate Medical Education (ACGME), to name a few.

To determine the potential impact of the SCOTUS ruling on medical schools' selection process, the Philadelphia Inquirer interviewed two deans at Cooper Medical School of Rowan University and the former admissions director at Thomas Jefferson's Sidney Kimmel Medical College -- two of seven medical schools in the Philadelphia area. The consensus was that schools might end up enrolling fewer students from underrepresented populations -- a fact already borne out by research in states that have previously eliminated race and ethnicity from consideration in admissions. However, the officials hinted that there may be ways to overcome the new colorblind requirement enacted by SCOTUS, sharing the same sentiments as the AMA, AAMC, and ACGME.

For example, during a recent webinar with medical school leaders, David Skorton, MD, CEO of the AAMC said: "Nothing in the Supreme Court decision on race conscious admissions compels us to deviate from our mission or deviate from our goals of diversifying the healthcare workforce." The AAMC has outlined specific strategies that it hopes will permit medical schools to continue to diversify while complying with the SCOTUS ruling.

Chief among those strategies is what the AAMC calls a "holistic review," an alternate way of assessing an applicant's capabilities by considering their experiences, attributes, and academic metrics in combination with consideration of how the applicant will contribute to the school's mission, goals, and learning environment. In addition, the AAMC suggests developing "pathways to health professions" in K-12 schools by engaging community educators, administrators, and learners, and equipping underrepresented young people with healthcare competencies.

The University of Pennsylvania Perelman School of Medicine in Philadelphia and the University of Chicago Pritzker School of Medicine are among an increasing number of medical schools heavily invested in attracting a more diverse pool of applicants by establishing "pipeline programs" -- efforts to expose disadvantaged students to the medical professions in middle school and high school. The earlier in the educational curriculum the better, according to Reynold Verret, PhD, president of Xavier University in New Orleans, the only historically Black catholic university in the U.S. Verret was quoted in JAMA as saying: "The genius of America is in the second or third grade right now." However, he noted, educational disparities in K-12 schools persist decades after desegregation.

Of course, there is no reason not to extend relationship building to diverse undergraduate institutions and community-based organizations. Medical students themselves can fulfill this role by serving as school ambassadors and reaching out to specific populations and encouraging them to apply to medical school, mentoring individuals along the way.

In lieu of a "check list" that ticks off an applicants' race and ethnicity, the AAMC recommends paying close attention to application essays, which often contain content relevant to students' lived experiences and may include experiences or perspectives related to the applicant's race and ethnic background. Certain desirable features may be evident in students' essays, such as whether the student:

  • Grew up in a medically underserved area
  • Demonstrates eagerness to engage with medically underserved populations
  • Looks forward to studying health inequities
  • Speaks multiple languages
  • Is a first-generation college graduate

Other strategies and tools that can be utilized can be found in the ACGME Equity Matters Equity Practice Toolkit, a learning experience "designed to empower stakeholders with the tools necessary to achieve or enhance cultures of equity." The focus of this program is "how" to achieve and maintain equitable cultures with specific instruction in "acting to dismantle racism" and dealing with implicit bias.

Another tool used to diversify medical school classes is the socioeconomic disadvantage scale. University of California Davis Medical School, ranked #3 in diversity by U.S. News & World Report, gives every applicant a score from 0 to 100 that considers the applicant's family income, parental education, whether applicants come from an underserved area, whether they help support their families, and other life circumstances. Admissions decisions are based on that score, combined with the usual portfolio of grades, test scores, recommendations, essays, and interviews.

Fostering diversity in healthcare leads to innumerable benefits. Attracting and enrolling more diverse students changes the composition of the physician workforce, often resulting in improved health outcomes. By diversifying, schools may be able to graduate students more willing to practice in underserved communities. To the extent that healthcare providers can reflect the demographics and diversity of their communities, patients will feel understood and better represented. Diversity in healthcare enhances the ability to innovate by gaining a variety of perspectives, a particularly important advantage in conducting research and implementing population health management programs. Solutions and ongoing efforts to improve physician workforce diversity are imperative.

Arthur Lazarus, MD, MBA is a member of the editorial board of the American Association for Physician Leadership and an adjunct professor of psychiatry in the Lewis Katz School of Medicine at Temple University in Philadelphia, Pennsylvania. His forthcoming book is titled Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine.