A new study revealed that, since the 2023 Supreme Court ruling restricting race-based affirmative action, there has been a decline in medical school enrollment among individuals who are already underrepresented in medicine. The study was published in JAMA Network Open.
Researchers used data from the Association of American Medical Colleges to assess applicants and matriculants to MD-granting medical schools in the 5 years before the Supreme Court ruling (2019-2023) and 1 year after the ruling (2024). Students who are underrepresented in medicine include those who are Black, Hispanic (alone or in combination with other racial and ethnic identities), and American Indian, Alaska Native, Native Hawaiian, and Pacific Islander.
There were 291,764 applicants to MD programs during the entire study period (2019-2024). Fifty-three percent of applicants were White, 28.83% were Asian, 12.24% were Hispanic, 11.74% were Black, and 1.57% were American Indian, Alaska Native, Native Hawaiian, or Pacific Islander.
Overall, the mean rate of acceptance to medical school was 39.09% during 2019-2023 and 44.31% in 2024 (P <.001). When the researchers compared mean acceptance rates during 2019-2023 to acceptance rates in 2024 by racial or ethnic group, they found that rates were:
- Lower for the group of applicants who are underrepresented in medicine (39.68% vs 38.33%; P =.02).
- Lower for Black applicants (36.06% vs 33.08%; P <.001)
- Similar for Hispanic applicants (42.89% vs 42.97%; P =.93)
- Similar for American Indian, Alaska Native, Native Hawaiian, or Pacific Islander applicants (39.50% vs 39.26%; P =.92)
- Higher for White applicants (40.37% vs 47.47%; P <.001)
- Higher for Asian applicants (38.26% vs 45.19%; P <.001)
- Higher for applicants belonging to other racial or ethnic groups (32.14% vs 37.22%; P <.001).
The researchers noted that there were no differences in acceptance rates by race or ethnicity during 2019-2023. However, in 2024, applicants who were underrepresented in medicine had significantly lower acceptance rates than White applicants (−9.14 percentage point difference; P <.001) and Asian applicants (−6.86 percentage point difference; P <.001).
When the researchers compared the mean 18,304 matriculants during 2019-2023 to the 19,018 matriculants in 2024, they found:
- A 3.56 percentage point decrease in matriculants who are underrepresented in medicine (P <.001)
- A 2.09 percentage point decrease in Black matriculants (P =.01)
- A 1.94 percentage point decrease in White matriculants (P =.009)
- A 1.37 percentage point decrease in Hispanic matriculants (P =.07)
- A 0.24 percentage point decrease in American Indian, Alaska Native, Native Hawaiian, or Pacific Islander matriculants (P =.76)
- A 5.19 percentage point increase in Asian matriculants (P <.001)
- A 0.53 percentage point increase in matriculants belonging to other racial/ethnic groups (P =.43).
The researchers also found that the decreases in matriculants who are underrepresented in medicine in 2024 were concentrated in states without prior state-level affirmative action bans, which suggests an association between the Supreme Court ruling and the demographic changes in matriculation.
After the ruling, there was a 0.10 percentage point increase in matriculants who are underrepresented in medicine in states with existing affirmative action bans and a 6.14 percentage point decrease in states without existing affirmative action bans (P =.001).
The decline in matriculants who are underrepresented in medicine “may have significant and long-lasting implications for racial and ethnic diversity in the physician workforce,” the researchers concluded.
Disclosures: This research was supported by grants from the American Medical Association and National Institutes of Health. Some study authors disclosed conflicts of interest. Please see the original reference for complete disclosures.
