Without Affirmative Action, Equity in Medicine Requires Intention

The Supreme Court’s decision to effectively end race-conscious college admission policies rekindled debates on racial discrimination and its deep-rooted presence in societal structures. While the ruling directly impacts educational institutions, its ripple effect will undoubtedly be felt across various sectors, including in medical training, which will thus impact the entire field of medicine. The decision now challenges us to be even more intentional in addressing inequities and ensuring equitable access to opportunities for minoritized individuals, especially in psychiatry.

The cessation of race-conscious admissions, a practice in place for over four decades, is seen by many as a regressive step. Without sufficient diversity in medical schools, we risk losing students and future faculty members who recognize the effect that cultural background has on patients, as well as the impact of discrimination and biases on their patients. According to a 2020 study in JAMA Network Open, patients were more likely to positively rate their physicians if they were of the same racial/ethnic background as the patient. Diversity in academic medicine allows our institutions to be reflective of the communities we serve and enhance patients’ trust. Arguably, nowhere in medicine is cultural understanding more important than in psychiatry.

Psychiatry, intrinsically connected to social dynamics, flourishes through a nuanced comprehension of diverse cultural backgrounds. Diversity in this field goes beyond mere numbers; it’s the tapestry of varied perspectives that enhances the discipline, guaranteeing that patients from different backgrounds receive care that recognizes and values their cultural subtleties. Omitting race as an admission criterion might unintentionally homogenize the psychiatric workforce unless we take steps to prevent such a scenario.

Challenges often pave the way for innovation, and many institutions are exploring alternative strategies to foster diversity. A promising approach is considering an individual’s lived experiences, which can encapsulate challenges they’ve faced due to racial or ethnic biases and systemic barriers. On August 14, 2023, the U.S. departments of Education and Justice jointly released resources to help colleges and universities understand the Supreme Court’s decision. The released resources include a “Dear Colleague Letter” and a question-and-answer document that clarify the implications of the Supreme Court’s decision.

“[S]chools can consider the ways that a student’s background, including experiences linked to their race, have shaped their lives and the unique contributions they can make to campus,” the letter states.

Addressing biases and rectifying inequities caused by structural barriers is not just a necessity but a moral obligation. Without affirmative action policies to rely on, it’s time for educational institutions, workplaces, and medical training programs to be intentional in their efforts. Strategies need to be devised and implemented, not just to replace previous systems, but to forge a new path forward that truly champions equity and representation for all. The path toward a more inclusive and equitable society may present challenges, but it’s a journey we must embrace with firm determination. ■

German Velez, M.D., is a child and adolescent psychiatry fellow at Weill Cornell Medicine and the Columbia College of Physicians and Surgeons Department of Psychiatry and APA’s resident-fellow member trustee.

Balkozar Adam, M.D., is a child and adolescent psychiatrist at Burrell Behavioral Health and professor emeritus at the University of Missouri.