Details on the decision

SCOTUS ruled on two cases — Students for Fair Admissions v. President and Fellows of Harvard and Students for Fair Admissions v. University of North Carolina. In both cases, Asian American students claimed their admission chances were harmed by affirmative action policies.

The court's decision was written by Chief Justice John Roberts with Justices Clarence Thomas, Samuel Alito, Neil Gorsuch, Brett Kavanaugh, and Amy Coney Barrett agreeing while Justices Sonya Sotomayor, Elena Kagan, and Ketanji Brown Jackson dissented.

In the decision, the court said it had previously "permitted race-based admissions only within the confines of narrow restrictions. University programs must comply with strict scrutiny, they may never use race as a stereotype or negative, and — at some point — they must end."

Since the admissions programs at Harvard University and the University of North Carolina "lack sufficiently focused and measurable objectives warranting the use of race, unavoidably employ race in a negative manner, involve racial stereotyping, and lack meaningful end points, those admissions programs cannot be reconciled with the guarantees of the Equal Protection Clause," the decision said.

However, the decision clarified that if applicants wish to write about how their racial identity "affected the applicant's life, so long as that discussion is concretely tied to a quality of character or unique ability that the particular applicant can contribute to the university," that would be acceptable.

The decision ended by stating that nothing in it "should be construed as prohibiting universities from considering an applicant's discussion of how race affected his or her life, be it through discrimination, inspiration, or otherwise. But, despite the dissent's assertion to the contrary, universities may not simply establish through application essays or other means the regime we hold unlawful today."

Reaction

The decision comes as many medical schools have made attempts to increase the number of students from underrepresented communities and help them overcome obstacles to entry, including MCAT testing, STAT reports.

Some experts, including Advisory Board's Monica Westhead, have noted that considering race in admissions is vital to creating a diverse physician workforce representative of the communities it serves, which research has shown can improve patient care.

For example, a 2023 study by the U.S. Department of Health and Human Services found that the life expectancy of Black individuals increased by one month for every ten percent increase in the number of Black primary care physicians. As demonstrated, a diverse workforce improves access and health outcomes for patients seeking physicians with a similar or shared identity.

Advisory Board's recently published 2023 data update on the physician workforce notes that as it currently stands, much of the physician workforce continues to be largely white and comprised of men. Representation of all identities in the physician workforce is vital for addressing health inequities.

"Efforts to do away with affirmative action undermine decades of progress in creating a diverse physician workforce and will reverse gains made in the battle against health disparities," said Jesse Ehrenfeld, president of the American Medical Association (AMA). "We cannot back down from efforts to boost the growing representation of talented and highly qualified medical students from historically marginalized groups."

Former AMA president Jack Resneck Jr. said an "accumulating and substantial amount" of medical research shows having a diverse workforce benefits patients.

"This is really, again, about race-conscious admissions processes that allow [race] to be taken into account along with ... performance in college, volunteer experiences, leadership experiences, test scores," he said. "To all of a sudden say, here's one factor that you're legally not allowed to consider when you're looking at all of the things that are necessary to build a class that can learn together and take great care of patients in the future, seems like an arbitrary exclusion."

Earlier this year, the Association of American Medical Colleges and 14 other healthcare education groups filed an amicus brief with SCOTUS arguing in favor of affirmative action for medical schools.

"As an overwhelming body of scientific research compiled over decades confirms, diversity literally saves lives by ensuring that the Nation's increasingly diverse population will be served by healthcare professionals competent to meet its needs," the brief said.

According to Lee Jones, dean of medical education at the Georgetown University School of Medicine, the Supreme Court's decision will hurt efforts to mitigate massive racial and health disparities throughout the United States.

"There is an incredibly well documented body of literature that shows that the best, and indeed perhaps the only way, to give outstanding care to our marginalized communities is to have physicians that look like them, and come from their backgrounds and understand exactly what is going on with them," he said.

One group that is significantly underrepresented in the medical profession are Indigenous people, said Siobhan Wescott, professor of American Indian health at the University of Nebraska Medical Center.

"American Indian and Alaska Native physicians are less than 1% of the physician workforce, manyfold lower than our 3% of the total U.S. population," Wescott said. "If Native physicians are less than one percentage point of the physician workforce with affirmative action in place, imagine how much more marginalized we might become without affirmative action."

In recent years, many healthcare providers have taken steps to deliver more culturally competent care to patients. Ultimately, Advisory Board's Alex Polyak believes this ruling may cause healthcare organizations to pause or reconsider race-based initiatives.

However, he noted that if healthcare providers want to improve overall outcomes for their entire patient population, color-blind, one-size-fits-all approaches will actively impede that goal. After all, as Justice Jackson puts it, " deeming race irrelevant in law does not make it so in life."

In addition, Advisory Board's Darby Sullivan noted that this ruling could be a hit to the overall healthcare workforce pipeline and solidify the industry's staffing challenges for years to come. (McFarling, STAT, 6/29; Firth, MedPage Today, 11/2/22)

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