Every year, tens of thousands of premeds apply to U.S. medical schools. Each one of them has spent years studying, researching, and volunteering to get to this point, and yet, more than half of them don’t receive a single acceptance.
As these students prepare for the next application season, they start looking for reasons why they didn’t get in. Was their GPA too low? Was their MCAT not high enough? Did they have too few volunteer hours? Or was affirmative action to blame?
Affirmative action is a hotly debated topic in the United States with strong opinions on both sides of the argument. In fact, the debate spans far beyond medical school admissions and extends to all forms of higher education – from high schoolers applying to college to master’s students applying to Ph.D. programs.
Let’s cover what affirmative action is, the main arguments both for and against it, and what it all means for you as a premed trying to get into medical school.
1 | What is Affirmative Action?
Affirmative action, as it relates to medical school admissions, is a set of policies and practices designed to decrease systemic discrimination and increase diversity among medical students. Although we often use the term to refer to race, it can also be used to refer to any underrepresented group.
There are two types of affirmative action: indirect and direct.
Indirect affirmative action includes policies that may on the surface seem neutral; however, they are aimed at benefiting underrepresented groups. An example of indirect affirmative action might be giving preference to students who speak Spanish. Although it doesn’t directly give priority to Hispanic students, it is likely to benefit Hispanic students more so than students from other ethnic backgrounds.
More commonly, medical schools employ direct affirmative action – sometimes referred to as preferential treatment or positive discrimination. These types of policies grant an advantage to members of designated groups in final decisions for medical school acceptance.
An example would be a medical school that allocates a certain number of seats each year to underrepresented students. In this scenario, an applicant from an underrepresented group may be granted a medical school seat even if there is an applicant from an overrepresented group with a stronger application. In short, the race of the applicant helps determine which student receives that spot.
In the United States, White and Asian students are overrepresented in medical schools and Hispanic and African American students are underrepresented. Because Asians are a minority in the general population, you can think of them as an “overrepresented minority” in terms of medical school admissions.
During the 2021-2022 medical school application cycle, 42% of U.S. allopathic medical matriculants were White, 23% were Asian, 9% were Black and 7% were Hispanic.
Affirmative action in medical school admissions aims to increase racial diversity among medical students by helping underrepresented Black and Hispanic students get into medical school.
To understand the debate regarding affirmative action, let’s explore both sides of the argument.
2 | Arguments for Affirmative Action
The primary argument in favor of affirmative action is that it helps “level the playing field” for Black and Hispanic applicants.
Historically, these students have had to overcome cycles of social, economic, and educational disadvantage. According to the U.S. census, Black and Hispanic individuals are between one and a half to two times more likely to experience poverty than White or Asian individuals.
As such, many live in poorer neighborhoods and attend schools with less funding and fewer resources. Affirmative action is meant to help these students gain entrance into medical school despite these disadvantages.
Proponents of affirmative action also argue that the negative impact on White and Asian applicants is relatively small compared to the positive impact on Black and Hispanic applicants. Underrepresented minorities make up only a small portion of the total number of applicants and receive far fewer medical school positions than their overrepresented peers.
For every 100 medical school spots, roughly 65 of them go to White or Asian applicants and only 16 of them go to Black or Hispanic applicants. In this example, if you were to take just 5 seats away from Black or Hispanic applicants and give them to White or Asian applicants, the number of seats for underrepresented students would decrease by 31% whereas the number of seats for overrepresented students would only increase by 7%.
When schools have stopped considering race in admissions in the past, there have been significant declines in enrollment of Black and Hispanic students leading to decreased diversity among students. This is problematic as research has shown that student body diversity is beneficial for all students – not just underrepresented ones. Diverse student bodies have been associated with increases in academic performance, retention, community engagement, cooperation, and openness to different ideas and perspectives.
Research has also shown that diversity among physicians is beneficial for patient care. When patients have doctors that are of the same race, they are more likely to go for treatment and more likely to be satisfied with the care they receive. They are also less likely to use the emergency department and tend to have lower total healthcare expenditures compared to those with race-discordant physicians.
Underrepresented physicians are also more likely to work in underserved communities and take care of patients with poor access to healthcare – namely minorities and uninsured patients.
By increasing diversity among physicians, we are also setting an example for future generations. When children see doctors that look like them, it shows them that they can become doctors too.
Now, let’s look at the other side of the argument.
3 | Arguments Against Affirmative Action
The most common argument against affirmative action is that it goes against meritocracy. Instead of having the most qualified premeds get into medical school, affirmative action policies allow students with lower metrics to “steal spots” from more competitive applicants.
Whenever you provide an advantage to one group, you simultaneously apply a disadvantage to all of the other groups. Although affirmative action helps Black and Hispanic applicants, it comes at the cost of hurting Asian students, who are also minorities subject to racism and other issues in the U.S.
During the most recent 2021-2022 medical school application cycle, White matriculants had an average GPA of 3.78 and MCAT of 512.7 and Asian matriculants had an average GPA of 3.79 and MCAT of 514.5. The average Asian matriculant had an MCAT nearly 2 points higher than the average Caucasian. In comparison, Black matriculants had an average GPA of 3.55 and MCAT of 505.9 and Hispanic matriculants averaged a 3.64 GPA and 506.6 MCAT. In several previous years, the disparities in GPA and MCAT scores have been even more pronounced.
When we look at the data, it is evident that Asian applicants are being hurt the most by affirmative action policies. Compared to the average Black matriculant, the average Asian matriculant achieves a GPA that is nearly 0.25 points higher and an MCAT score that is nearly 8 points higher. For perspective, a 506 on the MCAT is a 65th percentile score and a 515 is a 90th percentile score. Ask anyone who has taken the MCAT, and they’ll tell you how big of a difference this is.
Another argument is that if the goal of affirmative action is to “level the playing field” for disadvantaged students, then we should use a different metric to define which students are “disadvantaged.”
Race-based affirmative action policies tend to help applicants from middle- and upper-class backgrounds more so than those from lower-class backgrounds. Should the under-qualified son of a black doctor get into medical school over the qualified daughter of a Chinese immigrant?
Many who oppose race-based affirmative action believe that socioeconomic-based affirmative action would be a much more appropriate basis for preferential admission. They argue that it is more important to help the poor White or Asian student have upward mobility than it is to help the wealthy Black or Hispanic student whose parents are both surgeons.
The next argument is that diversity extends beyond race. Just because two students come from different racial backgrounds doesn’t mean that one has a unique perspective over the other. Conversely, just because two students come from the same racial background doesn’t mean they have the same perspective.
Racial affirmative action assumes that students of different racial backgrounds think differently and students from the same racial background think the same. There are many aspects of human experience that shape the way we think beyond race. This is not reflected in race-based affirmative action policies.
Lastly, those who oppose affirmative action argue that it perpetuates racial discrimination. Although the average GPA and MCAT are lower on average for Black and Hispanic matriculants, this is not true for all of them. Many of these students have competitive metrics and stellar applications and would get into medical school regardless of their race.
In these scenarios, affirmative action policies can undermine the accomplishments of underrepresented students. They may experience discrimination based on the assumption that they didn’t “genuinely deserve” admission and instead just happened to fit into some racial diversity matrix.
Whatever the argument though, the reality is that affirmative action does play a significant role in medical school admissions.
Whether you come from an overrepresented background or an underrepresented background, it impacts everyone. That being said, there are many other components of your medical school application that are within your control and have a far greater impact on your chances of acceptance.
If you’re from an overrepresented group, don’t feel defeated. The worst thing you can do is adopt a victim mentality and believe that you won’t get into medical school because of your racial background. When that happens, it tarnishes your perspective and influences your actions, and it becomes a self-fulfilling prophecy.
At the end of the day, getting into medical school is hard – regardless of race. What is often overlooked in these debates is the importance of the hard-to-quantify metrics like volunteer work, research, recommendations, essays, and other soft components. Instead of focusing on the things you can’t control, focus on those that you can.
Despite coming from an overrepresented and not-financially-privileged background myself, I worked hard throughout college and became the best applicant I could be against all odds, including major health issues. As a result, I was able to achieve multiple top 10 medical school acceptances and receive sizable merit-based scholarships. Sure it’s harder, but statistics apply to populations, not to individuals, and you don’t have to accept defeat.
No matter your background, strive to apply to medical school only once. Set a goal for yourself to get accepted into your top choice program and do whatever you can to achieve it. Work on getting the strongest MCAT and GPA possible, craft a strong narrative that puts you in the best light, and be so compelling that medical schools fight over you. By doing this, you can even get top medical schools offering full-ride scholarships to incentivize you to go to their school.
If you’d like to learn how to do this yourself, be sure to check out our medical school admissions consulting services. Our Insiders are physicians from top programs, many of whom earned merit-based scholarships themselves, and can help mentor you in crafting a stellar application as well. Or if you need help bolstering your GPA and MCAT, we also offer tutoring services and an MCAT course that’ll deliver the results you need. It’s what we’re passionate about as we help empower a generation of happier, healthier, and more effective future doctors.