Ensuring health workforce diversity in the post-affirmative action era

The Supreme Court decision regarding affirmative action will affect admissions programs for all institutions of higher education, including those that educate health professionals. This represents a serious blow to efforts to ensure the diversity of the health workforce, which is essential to delivering the highest quality health care to our nation.  

A diverse medical workforce brings more diverse views to the table, which improves problem-solving, innovation and assessment skills relative to non-diverse teams. The rulings damage efforts to reduce health disparities, as there is strong evidence that a diverse student body and a diverse health workforce have a positive impact on the quantity and quality of care especially for currently underserved populations.

Research by the George Washington University shows that Black, Latino and Native American populations are dramatically underrepresented in the health workforce, and the latest news could make that situation worse.

Make no mistake — a less diverse health care workforce is a bad outcome for everyone. The Supreme Court’s decision is likely to have an adverse effect on the nation’s health unless we act quickly.

We can and must forge a path forward. We know there are other policies and programs that can support a more diverse health workforce but it requires that we maintain our commitment to diversity of the health workforce.

While we have lost one of the most effective constitutional justifications used to create a diverse student body that leads to a diverse health workforce, there is strong empirical evidence that other strategies can help achieve the goal of ensuring student and workforce diversity in the health professions. 

Diversity extends beyond consideration of race in admissions decisions. Admittance into higher education is only one step along a long continuum from K-12 to a career in health. In 2021, a team at GW conducted a study of the multiple barriers to a diverse health workforce and identified numerous strategies to address these barriers.  

Consideration in admissions of such factors as income, wealth, rank in high school class and being first generation to go to college not only increases racial and ethnic diversity but also increases educational access for other high-need students such as rural and non-traditional students. Holistic admissions review that considers a wide range of race-neutral factors leads to a more diverse workforce.

Ending legacy admissions is another step that would open up a large number of slots in higher education, making room for broader diversity. A recent study revealed that applicants that had received preferred treatment at Harvard as legacy applicants, athletes, children of faculty/staff and other preferred applicants represented 29 percent of admissions, and an overwhelming majority of these students were white. Eliminating these preferences would boost the ability of non-white students, who are less likely to have legacy or donor parents, to enroll in these institutions.

Building a diverse workforce must start well before individuals apply to higher education programs. Pathway programs have many benefits, including preparing and assisting students interested in all careers requiring higher education. Mentorship can also be very effective — whether through formal programs or informal support of students. Building bridges between health professional education programs and community colleges, Historically Black Colleges and Universities and other minority-serving institutions has also proved to be effective. Scholarship support can make a difference for many students.

The experience in the nine states that have previously banned consideration of race in admissions provides important lessons, including in California where Proposition 209 in 1996 banned consideration of race in admissions at public universities.

A recent University of California, San Francisco study documented the recovery of Black and Latino medical student enrollments. They reported that the number of Latino students in California medical schools fell immediately after Proposition 209 from 113 in 1990 to a low of 92 in 1997 before climbing to 200 in 2019. Similarly, Black medical student enrollments initially plummeted after Proposition 209 from 63 in 1990 to 47 in 1997 but rose to 121 by 2019. This success in California is due to significant strategic investments in training programs for students committed to caring for underserved groups, advising and mentoring programs for college students from disadvantaged backgrounds and post-baccalaureate programs for students that graduated from underresourced schools.

The health of our population depends on our continued forward progress toward a diverse health care workforce notwithstanding the fact that we must follow the new Supreme Court decisions. The higher education and health communities must redouble their efforts to ensure a strong and diverse U.S. health workforce, one that stands just as ready to treat the common cold or the next infectious disease. The health of our nation depends upon it.

Dayna Bowen Matthew is the dean and Harold H. Greene Professor of Law at the George Washington University Law School. Edward Salsberg is the co-director of the Health Workforce Diversity Initiative at the George Washington University. The opinions expressed in this piece reflect those of the authors and do not represent the views of the George Washington University.