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Marissa Bare Burchette
Professor Groves
English 1102
2 December 2013
Diversity in Medical Education
America is known as the land of the free, and yet it is this same freedom
which we arm ourselves with to create racial boundaries, distinct class levels, and
socioeconomic disadvantages for the less fortunate. This unrelenting theory of
entitlement, of achieving higher than the generation before us, has created a
landslide of prejudice social views. While we are known as the ‘melting pot’ of the
world, our society as a whole places white males on a pedestal. This in no way
indicates that men of Caucasian decent are undeserving of their accomplishment,
but rather, that they this demographic has held a significant advantage in climbing
the career ladder of American history. For one’s race or gender does not define an
individual, but rather their character portrays their true value. Therefore why, in a
country comprised of thirty-seven percent of non-white citizens, does our
government, our universities, and most importantly, our healthcare system severely
underrepresent these minorities?
Medicine is the only universally recognized aspect of society. Illness affects
everyone because it is blind to one’s race, gender, social class, and religion. Our
healthcare system, while flawed, cannot afford to choose which patients to heal or
turn away based upon its own prejudices. The medical field pertains to every
citizen- black, white, man, woman, rich, and poor- we’re all the same. For this
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reason, I would like to focus on the lack of diversity in our medical system. Why,
when each race and gender is equally affected by disease, is this profession not as
proportionately populated? America claims with the movement of racial equality
and feminism, that we are the land of opportunity. That which it fails to mention, is
that these same biases that once kept minorities and women barred from education,
still exist. They now simply exist in a more subtle, microscopic, and yet equally
devastating manner. It’s as if our economy is in a silent war, one now cleverly fought
with passive-aggression to circumvent any accusations of bigotry.
To understand why America’s healthcare system has so fervently struggled
to open its leadership positions to individual’s of various cultural backgrounds and
its female colleagues; one must fully grasp its prejudiced roots by exploring the
history of medical education. The example that stands forthright in the minds of
retired physicians is the famous Allen Bakke lawsuit, in which Bakke claimed that
the University of California at Davis used their affirmative action policies to deny his
entrance into their medical school twice (Sindler 67). Bakke, a Norwegian man with
two engineering degrees and a seven-month deployment in Vietnam under his
repertoire, claimed that his denial from twelve medical schools was rooted in their
preference of choosing minorities through affirmative action policies (Sindler 63).
This created a backlash in white communities in which minority-specific
programs were cut and medical schools were forced to abandon giving applicants
preference due to race (Sindler 69). A modern theory now holds that since the
United States overemphasized making up for years of racism and sexist exclusion
throughout the 1950’s and 60’s, that healthcare professions are more likely to view
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a specific minority or female’s entrance into a medical institution as less deserving
and therefore a glass ceiling is created to keep these ‘underachieving’ applicants
from reaching higher levels of leadership (Gulland).
In the middle of the 20th century, the American government, instead of
implementing school systems and a greater quality of education for women and
minorities, simply lowered the standards for which they must achieve to gain
academic acceptance (Rice and Lewin 201). In 1976, the year of the Bakke vs.
University of California lawsuit, minorities comprised only 8.5 percent of first year
classes while women made significant strides by comprising one-fourth of all
medical school classes (Sindler 53). Comparing these statistics to the present day,
each group’s enrollment has roughly doubled. In this instance, the amount of
women in medicine is fairly characteristic of the population, and yet they are still
severely underrepresented in higher-level subspecialties. For example, women
comprise only 4.3% of orthopedic surgeons, and less than 10% of all neurological,
vascular, and thoracic surgeons, while still severely overpopulating pediatrics,
internal medicine, and obstetrics (AAMC). Meanwhile, minority applicants, due to
the abolishment of affirmative action, have been decreasing throughout the past few
decades. Currently only 12.3% of first year classes are comprised of Hispanic,
African American, or Native American students; most shockingly being that Native
Americans make up less than one percent of this statistic (AAMC). Polls of minority
students in medicine are so low that it is difficult to calculate percentiles of these
groups in various residential specialties. In a field largely dominated by Caucasian
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and Asian American physicians, there is a large deficit in statistical information for
other ethnic groups.
The greatest breakthrough of medicine has come through the admission of
women. Females presently comprise nearly half of all medical school classes, yet
they still only make up a third of all active physicians (Chen). Minorities remain
clearly underrepresented in the healthcare field, which causes one to wonder what
specific socioeconomic barriers are keeping these talented individuals from
entering a career in medicine. Currently, school districts heavily populated with
minority students tend to receive the lowest funds for teaching. Exclusive minority
education programs tend to be highly successful and yet there are not nearly
enough to counteract the overall negligence of the education of the large majority of
pupils (Smith-Barrow). Also special academic programs and educational
opportunities come as a double-edged sword, as some institutions later view this as
giving unfair advantages to certain pupils solely based upon their ethnicity.
If one refers back to history, one recognizes that medical school acceptance
rates have shown a slight decline since the Bakke vs. University of California case,
which resulted in the abolishment of affirmative action. One possible explanation is
that the presumed ‘unfair’ entrance of minorities with lower GPA’s and MCAT scores
during the 1950’s and continuing throughout the late 1970’s has now morphed into
a strong backlash in our modern healthcare system because the older generation of
white-males who continue to control hospital boards and chief surgical positions,
still remember the sting of being unfairly placed beneath minorities and women of
lower academic standing during their years of training. While many of these
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individuals are no longer active in medicine, their funding of medical programs and
their legacy of teaching continues. These retired doctors have accumulated plenty of
wealth throughout their years of service and as many rising physicians are aware,
money drives politics, and politics drives our healthcare system. If older physicians
are more likely to fund hospitals, which retain predominantly white-male
leadership, then white-male leaders are going to be exclusively chosen for spots on
those hospital boards and lead surgical positions.
Still, all of this information derived from multiple research articles, historical
texts, and current AMCA statistics. How can one truly know the cause of this deficit
of diversity in medicine without directly interviewing all medical school applicants
themselves? Clearly this would be an impossible task, but with the help of some
colleagues from a pre-medical summer enrichment program, I was able to form my
own speculations. The Summer Medical Education Program at Duke University is a
six-week program specifically for underprivileged and underrepresented students
whom are prospective medical school applicants. Housing, meal, and travel
expenses are completely covered upon acceptance into the program because the
experience is geared towards exposing undergraduates to various medical careers
and elevating their academic performance in the hopes to diversify the field of
healthcare. The demographic of the program was composed of eighty students from
all across the country, with only five percent of scholars being comprised of the
ethnic majority, Caucasian, and over half the class comprised of women.
Over 90% of the survey was answered by undergraduates whom identify
with a specific minority group, and the results revealed that cost of a medical
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education and the limited availability of resources to prepare for such a rigorous
academic course far outweighed any other barriers. The next greatest concern for
these prospective medical students was found solely amongst female respondents
as the fear of not being able to start a family due to the time commitment of
becoming a physician. Another interesting discovery was that Hispanic students
were more likely to be taking care of a dependent than non-Hispanic
undergraduates. This could be due to the tight-knit family oriented culture many
Latin American country’s possess as it is much more common for Hispanic adults to
remain living in a household with multiple generations of family members. Lastly, a
surprisingly high amount of scholars held almost full-time positions at their work,
preventing them from studying during working hours and decreasing their
academic performance. Yet without their income, many students would not be able
to afford the high cost of a college education, especially knowing that they want to
attend medical school, where the average graduate accumulate $200,000 of debt.
This study revealed that there is far more obstacles preventing minorities
from entering medical school than simply historical bias, although this racism does
tend to reflect greatly in pupil’s everyday lives. With 87% of responders reporting
that they experience prejudice in their academic institution intermittently, with a
much smaller portion reporting that they experience this bias weekly, it appears
that the underlying issue of creating diversity in medicine stems from a struggle
amongst racism and socioeconomic shortcomings. Minorities and women may no
longer be blatantly kept from seeking higher education, but decades of building
medical school tradition around racist and sexist constructs continues to create
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difficulty for those outside of the majority. The only possible solution to diversifying
America’s healthcare is to further encourage and educate those whom are from
varying cultural backgrounds without blatantly handing these ethnic groups special
treatment. Students need to be given equal opportunity and all school systems
should be funded and regulated similarly. We must give out funds to hardworking
pupils based on their socioeconomic need and not only on the color of their skin.
This way lower class students, regardless of ethnicity, will be entitled to leadership
positions once they matriculate. Older physicians and hospital owners would not be
able to use the generalization that someone of minority descent was under qualified
for a position, and this would be seen for what it truly is, which is a disguised form
of blatant racism.
While affirmative action is no longer viable, medical school admissions
should take into consideration one’s socioeconomic status. Many schools are
beginning to employ the holistic review of applications during the selection of their
entering class. This approach views not only grades but also accounts for
extracurricular activities, employment, and social background. I propose that, while
every applicant should complete the appropriate prerequisites for entry into
medical school, admissions committees should judge grades based upon one’s class
level. For example, imagine a pupil of the elite, higher class with plenty of
opportunities for enhancing his academic performance applies to medical school
with an overall GPA of 3.65. If a colleague from a severely underprivileged
community whom worked a full-time job during his undergraduate years just to
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survive applied with the same GPA, then preference should be given to the applicant
of lower economic status.
This would help diversify medical school classes without harming their
educational achievements, as lower class students with slightly lower grade point
averages due to harsh circumstances may even perform better than those whom
have achieved higher grades with lots of extra assistance. This would keep older
physicians from looking down upon minority students because this new policy
would also include the assistance of underprivileged Caucasians and would aid in
balancing both racial and class levels represented amongst new physicians.
Overall, future medical students need to work hard to break away from
prejudices that have lingered in the field of medicine for decades. Medical
institutions and racial and sexist biases were not constructed overnight, and
therefore it will take much persistence and patience to rid the workplace of these
misconceptions. High cost of tuition, limited academic resources, and inadequate
time have placed a great obstacle for the majority of ethnic minorities attempting to
apply to medical school due to longstanding historical racism still causing many
students to be from lower income families and disadvantaged backgrounds (Rice
and Lewin 28). Only time and hard work can destroy these prejudices, and hopefully
this generation’s medical school applicants can further change the treatment of
minorities and women in medicine.
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Works Cited
American Medical Student Association. (2013). Enriching Medicine Through
Diversity. http://www.amsa.org/AMSA/Homepage/Priorities/Diversity.
October 9, 2013.
Association of American Medical Colleges (AAMC). (2013, January 1995-2013).
FACTS: Applicants, Matriculants, Enrollment, Graduates, MD/PhD, and
Residency Applicants Data. https://www.aamc.org/data/facts/. October 9,
2013.
Campbell, N. D., Greenberger, M. D., Kohn M.A., Wilcher S.J. (1982) Sex
Discrimination in Education: Legal Rights and Remedies. Washington D.C.:
National Women’s Law Center.
Chen, P.W. (2012, November 29). Sharing the Pain of Women in Medicine. NY Times.
Retrieved from http://well.blogs.nytimes.com.
Gulland, A. (2001). Ethnic Minority Doctors Skip Glass Ceiling in NHS. London:
British Medical Journal.
Sindler, A. P. (1978) Bakke, DeFunis, and Minority Admission. New York:
Longman Inc.
Smith-Barrow. D. (2003, May 14). 10 Private Medical Schools With the Lowest
Price Tags. US News. Retrieved from
Rice, B., & Lewin M.E. (1994). Balancing the Scales of Oppurtunity: Ensuring Racial
and Ethnic Diversity in the Health Professions. Washington, DC: National
Academy Press.