Affirmative Action Ban Looms as Biomedicine Strives to Diversify

The fate of a Supreme Court case on the use of race in university admissions could upend decades of efforts to diversify and reverse a shrinking biomedical research workforce, researchers and academic medicine leaders said in interviews.

The nation’s biomedical research workforce faces shortages among physician-scientists along with underrepresentation challenges. NIH has been trying for years to come up with grants and programs to encourage investigators early in their career.

And now, with indications from the conservative majority on the court that they could end affirmative action policies during arguments challenging these programs at the University of North Carolina and Harvard College, many have expressed concerns about the downstream impacts.

“It could immediately reduce the enrollment of racial and ethnic minorities in medical schools and universities,” Heather H. Pierce, AAMC’s senior director for science policy and regulatory counsel, said about the potential Supreme Court decision.

“Those same pathways to becoming physicians are those that people are following to become physician-scientists, biomedical researchers, and PhDs. While we have more data on the impact on physicians, there’s no question that it has a potentially similarly devastating impact on the biomedical research workforce.”

Students for Fair Admissions, which brought forward the Harvard and UNC cases, argued that the use of race in their undergraduate admissions policies illegally raises the bar while lowering the bar for others.

“It is a moral failure that our most competitive universities place high schoolers on racial registers and tell the world that their skin color affects what they think and know and what they like and don’t like,” Edward Blum, the founder and president of Students for Fair Admissions, said after the oral arguments.

“Elite universities like Harvard and UNC are diminishing, rather than growing, the power and profundity of American individualism,” he said.

Racial Diversity

Race-blind admissions lead to declines in the enrollment of students of color across these fields of study, said Liliana M. Garces, a University of Texas law professor who’s run a number of studies examining the impact of race conscious admissions at public institutions.

“If we were to have a ruling to limit institutions’ ability to consider race as a factor in admissions decisions, it would undermine and lead to declines in enrollment in a way that would also exacerbate existing racial inequities,” because these are the fields that provide the pipeline for future scientists and leaders in society, Garces said.

“We would see the consequences for example, in health care, when we look at the importance that racial diversity brings to the education of doctors.”

Studies show that racial and ethnic diversity in the education and the training of doctors lead to better medicine, Garces said. “Research shows that doctors of color go on to serve in underserved communities. That racially diverse medical education improves both the quality and the frequency of care that patients receive.”

Garces examined the impact of affirmative action bans in California, Florida, Texas, and Washington on graduate schools in a 2013 paper and found the greatest reductions in the science-related fields of engineering, the natural sciences, and the social sciences.

Long Way to Go

Improving diversity has become a top focus across health care and academic medicine. The National Institutes of Health started an initiative a few years ago called UNITE that aims to end structural racism in biomedical research, with an arm that’s devoted to the biomedical research workforce.

The AAMC released a framework that addresses similar goals and also led an amicus brief signed by 45 health professional and organizational groups that argued that racial and ethnic diversity in the health professions in classrooms, labs, and clinical settings is important for improving the overall health of the nation.

The NIH also plans to offer some new grants to address diversity, equity and inclusion, such as one that allows research institutions to conduct system-wide evaluations and address shortcomings they flag.

The NIH’s approach to address the pipeline shortage links the need to attract a workforce that’s diverse as well. There’s compelling evidence this will help NIH accomplish its mission and will ensure that all applicants are treated fairly in the peer review system, the agency said in outlining its workforce diversity plan more than a decade ago.

“When you have diverse researchers, you get a different viewpoint, you get a different set of eyes, a different perspective on research,” Keisha S. Ray, a bioethicist and assistant professor in the McGovern Center for Humanities and Ethics at UTHealth Houston, said. They’re also more likely to encourage other diverse researchers to pursue science and more likely to go into diverse communities and have community engagement and involvement.

“It benefits everyone to have diverse researchers, not just diverse students or trainees,” she said.

The NIH created its workforce diversity office more than a decade ago to address shortcomings. While the agency has seen improvements in the diversity of the biomedical workforce, it still has a long way to go, Marie A. Bernard, NIH’s chief officer for scientific workforce diversity, said.

In 2021, just 2.6% of applicants for grants to NIH were Black, and only 4.8% were Hispanic, Bernard said.

“We have a lot of good data that shows that when you have diverse perspectives, you have better outcomes. And the sorts of problems we’re trying to solve in biomedical research are huge,” Bernard said. “Anything we can do to continue to enhance that diversity is going to be extremely valuable for the health of this country.”

Med School Enrollment

A ban on affirmative action could counteract efforts to turn around a workforce shortage and make it more representative of the US population, some research indicates.

Before states implemented affirmative action bans, underrepresented medical students comprised about 14.8% of the student population in US public medical schools, according to a study published in May in the Annals of Internal Medicine. Five years later it dropped 37% in states such as Arizona, Nebraska, and California that had implemented bans from 1997 to 2013.

“It’s a huge drop,” said Dan P. Ly, a physician and assistant professor of medicine at the University of California, Los Angeles, who was the lead author of the Annals study. “Even many, many years after the ban—and trying alternative ways of having a diverse medical school certain body—these are losses of medical school students that persist.”

While Ly’s study focuses on medical schools, he said there’s a pipeline issue as well. “If you ban affirmative action, you’re banning it at the undergraduate level, so there are probably also fewer students from underrepresented groups even applying to medical school.”

When affirmative action ended in California, minority enrollment dropped more than 50% in its most selective colleges. The University of Michigan still hasn’t fully regained its share of Black students, despite millions of dollars spent over 15 years.

“The pathways to biomedical research come through our universities, undergraduate programs, graduate programs,” Pierce said. “Anything that impacts, all of these opportunities is going to be felt, not just immediately, but also for years down the road.”

The Supreme Court will rule based on its perspectives and the law, Ly said. “But the consequences are going to be pretty drastic for groups who are underrepresented and graduates going into medicine,” Ly said. “It’s sad to foresee this.”