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Affirmative Action Repeal and Racial and Ethnic Diversity in US Medical School Admissions
Natalie Florescu1,2, Andrea Lin1, Samantha Temucin3
1Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.
Importance:
In June 2023, the US Supreme Court's decision in Students for Fair Admissions v. Harvard University effectively overturned affirmative action, raising concerns about the future of diversity in medical education. A diverse physician workforce is crucial for advancing health care equity and improving patient outcomes.
Objective:
To evaluate the association between the Supreme Court's ruling and the racial and ethnic composition of students matriculating into Doctor of Medicine (MD) and Doctor of Osteopathic Medicine (DO) programs.
Design, Setting, And Participants:
Cross-sectional analysis of comprehensive publicly available data on medical school applications and matriculation by race and ethnicity from 2020 to 2024. Data were obtained from the Association of American Medical Colleges (AAMC) and the American Association of Colleges of Osteopathic Medicine (AACOM) to compare across MD and DO programs. Five application cycles were analyzed, with 4 representing preruling trends.
Main Outcome And Measure:
Change in the racial and ethnic composition of matriculating medical students following the Students for Fair Admissions v. Harvard University decision.
Results:
From 2020 to 2025, there were a mean (SD) of 55 037 (4315) applicants and 22 750 (349) matriculants to MD institutions and 214 163 (17 243) applicants and 9019 (274) matriculants to DO institutions. Significant disparities in application and matriculation patterns were observed across both program types, with persistent underrepresentation among American Indian or Alaska Native, Black, Hispanic, Native Hawaiian, and multiracial applicants. Between the 2023 to 2024 and 2024 to 2025 academic years, MD matriculation declined by 11.6% for Black students (χ21 = 40.59; P < .001) and 10.8% for Hispanic students (χ21 = 45.87; P < .001), respectively. DO programs showed broader underrepresentation. Compared with White and Asian applicants, all other racial groups were significantly underrepresented in both applications and matriculation.
Conclusions And Relevance:
These declines threaten progress toward health care equity. Medical schools must explore alternative admissions strategies, such as holistic review processes that account for structural barriers. Without such efforts, reduced diversity in medical education may worsen existing health disparities.
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