For Equality, a New and Ambitious Affirmative Action

The Supreme Court in June disallowed affirmative action in education that had provided relief from discrimination based on racial identity. Affirmative action was to have compensated for past oppression and, in our era, was offering equality to some descendants of the victims.

Young people heading for medical school interacted with affirmative action. The policy eased the way for some of those identified by their skin color to become medical students.  Black youths with economic resources gained, while most of the others did not.

The story here begins with an article from 2000 written by health-policy researchers Magnus and Mick. Affirmative action, they suggested, should “include social class as a supplement to race,” and medical schools “should weigh the possibility of class-based affirmative action.” Sociologists, they noted, have detected “a characteristically American discomfort with the subject of social class… [and] American researchers do not even gather relevant statistics.”

The authors claimed that affirmative action particularly benefited those “economically privileged individuals who belong to ethnic minority groups.” And, “downplaying social class in admissions decisions” assured that most medical students, Black and white, would be of “the middle and upper classes.”

No research was available, they indicated, showing that “access to medical education [was] diminished for lower-SES (socioeconomic status) students.”

We soon published a study of the social-class affiliation of white and Black medical students. The Association of American Medical Colleges (AAMC) supplied data based on the responses to questionnaires of successful applicants to all U.S. medical schools between 1990 and 2000.  There were 96,480 white students and 10,181 Black students.

We found that “parents of medical students command significant financial resources, more by far than are available to U.S. families in general.” Median family income for all families in those years was $41,606; for the parents of all black families, $29,114; for the parents of all medical students, $70,000.  Median family income for the parents of white students was $75,000; for the parents of Black students. $49, 000. So, “most Black students [and white students] admitted to medical schools have parents who enjoy at least moderate economic prosperity.”

Data on the parents’ educational levels likewise suggested that relatively few medical students, white or Black, grew up in economically deprived circumstances. For example, in the general population 26.6% of white men and 21% of white women were college graduates.  Only 13% of Black men and 13.6% of Black women had completed college. By contrast, over 25% of the Black fathers and mothers of entering medical students had earned at least a master’s degree; 50% of those fathers had finished college. More than 50% of the fathers of white medical students had completed graduate-level programs.

Most of the parents, Black and white, worked in occupations promising comfortable life styles, and more. We concluded that, “Most beginning medical students—African American and white alike … had parents who are high earners and well educated and whose work was professional, executive, or intellectual in nature.”

Affirmative action, initiated in 1965, led to change. Blacks represented 2% of all U.S. medical students in 1960. Among entering medical students, 6.1%  were Black In 2011, and 10% in 2022.  Even so, the current  5% of all U.S. physicians who are Black, up from 2% in 1960, do not match the 14% or so proportion of Black people in the U.S. population today.

Affirmative action had failed twice. It opened up medical education to a fraction of Black youths only. And the goal of producing enough Black physicians to upgrade quality of care for Black people was defeated, this on the theory that with more of them, access to care would improve and physician-patient relationships would be sympathetic.

Affirmative action worked as it was supposed to.  Black applicants for admission to medical schools were being accepted over the years at rates varying from 34% to 40%, rates similar to, or slightly below, those of white applicants. It was too late.

Discrimination precedes application processes and involves more than racial identity. As regards medical school admissions, affirmative action ultimately served economically-secure Black youths while doing nothing for others who had already been excluded.

In 2020, 29.2% of Black children and 9.1% of white children grew up in poverty. Those children’s lives, and the lives of other Black and white children, were precarious, thanks to economic oppression. Families were enduring low-wage jobs, shifting employment, crowded housing, and stresses relating to racism. Schooling was often poor. In circumstances like these, most Black young people wouldn’t be thinking about careers as doctors.

Now would be the time for a kind of affirmative action to end all discrimination and no longer exclude. The individualized approach to widespread economic hardship, as advanced by New York Times writer David French, is so puny as to be rejected at once in favor of a reality-based proposal.

The Supreme Court, he explains, “left in place a number of alternative admissions measures that can both increase diversity and address real injustice.” He agrees with Justice Clarence Thomas:  the states could give “admissions preference to identified victims of discrimination,” as long as racial discrimination is not involved. If “an applicant has less financial means … then surely a university may take that into account.”

A recent report praises the University of California at Davis Medical School, “because of its ability to bring in diverse students using what the schools says are “race-neutral” socioeconomic models.” Now “a vast majority of the U.C. Davis class — 84 percent — comes from disadvantaged backgrounds, and 42 percent are the first in their family to go to college.”

That medical school apparently recognized its obligation as a public institution to train economically-deprived youth to become physicians and to select students that would match a region’s ethnic diversity. That model may not resonate soon.

The American Association of Medical Colleges recently showed that for 30 years ending in 2017, around 75% of entering medical students benefitted from household income in the top 40% of U.S. households. Each year for 11 years ending in 2017, the parents of between 24% and 30% of the students accounted for incomes in the top 5% of households.  The parents of only 5% of the students took in income at the 20% lowest level.

Most U.S. medical students attend private medical schools and the larger, well-established public ones. The AAMC indicates that “overrepresentation of the highest income levels and the underrepresentation of the lowest income levels is more pronounced” in medical schools than in U.S. colleges and universities.

That may be so, but one wonders, given the picture of undergraduate life painted by commentator David Brooks on June 29: “We’ve wound up with a system where rich kids dominate elite schools,” he claims: “these elite places become these little islands where rich people pass down their advantages to their kids.”

New thinking is required. Instead of individualized rise-to-the-top fantasies, there would be affirmative action of a new type, one versatile enough for use in promoting equality both as physicians are prepared, and as young people build lives. It would be a tool for collective effort and movement toward the social change needed for survival.

W.T. Whitney Jr. is a retired pediatrician and political journalist living in Maine.