#ACGME2024 Session Summary: Graduate Medical Education following the SCOTUS Affirmative Action Decision

March 26, 2024

The 2023 US Supreme Court decision regarding the constitutionality of affirmative action in higher education was a pivotal event. How should graduate medical education (GME) programs respond? In one of the 2024 ACGME Annual Educational Conference’s four Featured Plenaries, GME Following the SCOTUS Affirmative Action Decision, panelists shed light on ways this verdict impacts recruitment, admissions, and selection strategies. The session also provided an overview of associated legal issues, potential closings of diversity, equity, and inclusion (DEI) programs as dictated by executives or legislatures, and state-specific strategies used in states where race had previously been eliminated as a factor from admissions decisions.

ACGME Chief DEI Officer, Bill McDade, MD, PhD, opened the session reflecting on where DEI is now, and why it matters. The importance of patient-physician racial concordance dates back to Abraham Flexner’s 1910 report, in which a few historically Black medical schools were allowed to remain open. Dr. McDade shared recent evidence that increasing patient-physician racial/ethnic concordance reduces health care disparities. Data show that outcomes improve in instances where the patient and physician share the same race or ethnicity. Dr. McDade also highlighted the importance of medical education as a critical time to support physician learners’ motivation to care for marginalized and minoritized populations. This is fundamentally important as our nation’s population becomes more diverse and the health care disparity gap grows.

Based on this evidence and its Mission, Dr. McDade said, the ACGME is committed to the goals of having a diverse, equitable, and inclusive health care workforce. In 2019, the ACGME launched its Department of DEI to study the situation and provide resources to programs and institutions.

Eight months ago, the Supreme Court’s decision on affirmative action had higher education scrambling to understand the new law. GME scrambled as well, trying to grasp its impact on recruitment of residents and fellows and hiring of faculty members. Heather Alarcon, JD, senior director, Legal Services at the Association of American Medical Colleges (AAMC), summarized the new law and addressed what changed and what didn’t. The Supreme Court decided that there was a problem in the subjective nature of affirmative action, she said, and specifically with the “racial checkbox” applicants use to self-identify and that universities use as a proxy for identifying the kinds of students they seek. Students may no longer be evaluated on the basis of their race, but rather on their experiences as individuals. She clarified that the Supreme Court is not prohibiting the consideration of the impact of someone’s race on their lived experiences, skills, and attributes if the applicant chooses to disclose this information in their application, such as in their personal statement. The applicant has the right to disclose, she stressed, but the university does not have the right to assume.

Ms. Alarcon then provided a framework for thinking about admission and hiring under this new law. She noted the distinction between hiring and admissions: race has not been allowed as a factor in hiring, so nothing will change in terms of use of race for GME programs. First, she said, focus on the school’s mission and goals for the student population. Create an admission rubric that centers authentically on those goals and seek to recruit accordingly. Be very clear about your admission goals and make sure they align with the mission.

Her recommendation was to focus on the letter of the law and look to find ways to achieve your mission. “Evaluate your processes about how to achieve those goals but know that you can still have [them].”

Ms. Alarcon also noted proactive steps schools can take. For schools wondering how to consider racial status in making admission decisions, she recommended building relationships, creating targeted recruitment and pathway programs, partnering with historically Black colleges and universities, as well as community colleges, or offering scholarships to learners motivated to care for the population an institution seeks to reach. These are ways of aligning institutional mission with recruitment practices.

Patrick N. Olomu, MD, FRCA, professor of anesthesiology and pain management, currently at the University of Texas Southwestern Medical Center, spoke about the impact of Texas Senate Bill 17, what he dubbed “the anti-DEI law,” which was proposed soon after the Supreme Court’s decision. He shared both his story and that of another physician, Quinn Capers, MD, who was recruited to diversify the workforce at his institution. Citing the double blow of Texas Senate Bill 17 and the Supreme Court decision in June 2023, Dr. Olomu described how DEI offices and programs in higher education have been dismantled. Many prohibitions were placed on faculty members, forcing them to abandon projects. He noted that the ripple effects of both laws are still affecting wider circles. Drs. Olomu and Capers are two of many faculty members leaving Texas for new positions in states with fewer restrictions. Dr. Olomu reflected on the experience in California in 1996 with Proposition 209, a bill banning affirmative action in public universities. Diversity has decreased in the intervening years, he warned, again adding the context that the nation’s population is actually becoming more diverse.

Gloria Richard-Davis, MD, MBA, NCMP, FACOR, executive director of the Division of DEI and professor of reproductive endocrinology at the University of Arkansas Medical Sciences (UAMS) shared the impact of the Supreme Court decision in her state. Borrowing a framework from the US Department of Health and Human Services, she said she sees the issue as one of “health equity” and highlighted the need for programs, measurement, policy, and infrastructure to support that. Paraphrasing Jordan Cohen, MD, past president of the AAMC, she said, “We won’t be able to solve our health care disparity problems without a diverse medical workforce.” Dr. Richard-Davis said her institution is trying to achieve “population equity” between faculty members and learners (including medical students, residents, and fellows), meaning the demographics of the learner population should be reflected in the faculty body. Right now, she said, they are not even close. Those pushing back on DEI efforts, she said, claim that “equity lowers standards.” She described how, rather than dismantle its DEI programs though, the institution has pivoted strategies, illustrating one of the strategies Ms. Alarcon outlined earlier in the session. When UAMS dissolved the Division of DEI, Dr. Richard-Davis’ office pivoted, and was renamed “Academic Pathways and Workforce Partnerships.”

J. Renee Navarro, MD, PharmD, vice chancellor for Diversity and Outreach and professor of anesthesia and perioperative care at the University of California, San Francisco (UCSF), rounded out the panel with an overview of where DEI has gone in her state since 1996’s Proposition 209. The impact of Proposition 209 applied not just to college admissions, but also to hiring. Institutions overreacted and implemented more limitations than were outlined in the law. Over the years, she said, there was a realization that the university was not fulfilling its mission as a public institution to serve the public, so UCSF redirected efforts more creatively by making “pathway investments,” partnering with communities (even down to the K-12 level), and building relationships. She described the institution’s expanded outreach with a race- and gender-neutral approach.

The Supreme Court’s recent affirmative action decision will continue to impact schools and institutions across the county as students and faculty members make choices about where to learn and work, how to design programs, and how to fulfill institutional and program missions and goals. The panelists in this Featured Plenary underscored the importance of truly learning and understanding the details of the law, and of leaning into creative solutions and strategies for building a physician workforce that can provide high quality care for all patients.

As Ms. Alarcon said, “If one of your goals is to increase racial diversity, you can still have those goals.”