Acceptance rates to US medical schools slipped among students who aren’t White or Asian following the Supreme Court's 2023 decision ending race-based admissions policies, especially in states without pre-existing bans on affirmative action, according to a new study published in JAMA Network Open. 

While acceptance rates grew from 2019 to 2023 among Whites (40.37% vs 47.47%, P < .001) and Asians (38.26% vs 45.19%, P < .001), they fell among racial groups that are considered underrepresented in medicine (36.06% vs 33.08%, P < .001, all respectively), Yale School of Medicine Professor Sarwat Chaudhry, MD, and colleagues reported. 

The retrospective, cross-sectional analysis echoes a report by the Association of American Medical Colleges (AAMC) showing that the numbers of Black and Latino individuals entering medical school in the 2024-2025 academic year dropped by 11.6% and 10.8%, respectively, compared to 2023-2024. 

The researchers used the AAMC data to examine 291,764 applicants to 151 MD programs between 2019 and 2024, focusing on racial/ethnic groups considered to be underrepresented in medicine: Blacks (11.74% of the total), Hispanics (12.24%), and American Indians, Alaska Natives, Native Hawaiians, and Pacific Islanders (1.57%). Whites made up 53.0% of the sample, and Asians made up 28.8%. (Applicants could identify with more than one group.)

The mean decline among underrepresented groups translates to 503 fewer acceptances in 2024, “raising concerns about the future racial and ethnic diversity of the health care workforce,” the authors write. They also argue that the decline has “significant implications for the future of health care access, especially for patients with the greatest need.”

However, the report also notes that applications by students in underrepresented groups fell by 782 in 2024 compared to the mean from 2019-2023 (11,958 vs 11,176, respectively). 

Affirmative Action Overturned

In June 2023, the Supreme Court struck down the use of race-conscious admissions in higher education, reversing more than four decades of affirmative-action policies. Chief Justice John Roberts wrote that universities have “wrongly concluded that the touchstone of an individual's identity is not challenges bested, skills built, or lessons learned, but the color of their skin. Our constitutional history does not tolerate that choice.”

However, Roberts wrote that universities could still consider the role of race in the lives of applicants.

Among acceptances, the representation of underrepresented groups remained about the same vs the mean from 2019-2023 in states with existing affirmative action bans (25.44% in 2019-2023 vs 25.33% in 2024) while shrinking in those without bans (27.04% in 2019-2023 vs 20.89% in 2024, P = .001).

An analysis of 2024 acceptances found that schools had the highest school-level percentage acceptance rates for underrepresented groups in private schools (24.52%) vs in public schools (20.10%). Over time, proposed or existing state legislation against diversity, equity, and inclusion programs was not associated with statistically significant differences in acceptance rates.

The study notes limitations such as its focus on a single year after the court ruling and the possibility that other factors are affecting the numbers. 

Norma Poll-Hunter, PhD, senior director of workforce diversity at the AAMC, told Medscape Medical News that the findings align with historic patterns. 

“We have been here before when we had state-level initiatives that passed in Washington state and California in the mid-nineties, ending affirmative action and admissions,” Poll-Hunter said. “As a result, we did see declines at that time, not only for medical school, but for other schools, including law school and other graduate programs.”

The current landscape differs because of both the Supreme Court ruling and state-level efforts to target diversity programs, she said. 

For now, she said, medical schools are embracing other approaches to boost diversity, such as pipeline programs and partnerships with undergraduate institutions. In admissions, it’s also important to understand that factors such as communication skills are important to physician success and not just test scores, she said.

In an accompanying commentary, internist Atul Grover, MD, PhD, of George Washington University School of Medicine and Health Sciences, Washington DC, argued that having a diverse medical student body remains crucial. “Decades of analysis have found that female and underrepresented in medicine physicians are more likely to serve underserved communities, and applicants from rural areas are more likely to serve rural populations,” he wrote.

But another physician applauded the move away from diversity policies and questioned the study.

The analysis “fails to address applicant qualifications,” said nephrologist Stanley Goldfarb, MD, chairman of Do No Harm, an organization that claims 30,000 members and is “focused on keeping identity politics out of medical education, research, and clinical practice.”

In an interview with Medscape Medical News, Goldfarb cited his organization's new analysis of 23 public medical schools, which found that “accepted Asian and White applicants had, on average, higher MCAT scores than accepted black applicants” at all but one school.

A 2015 study led by a Uniformed Services University team didn’t find any link between MCAT scores and clinical-based assessment of performance in medical school, even though “admissions committees use this test to predict future accomplishment.”

Goldfarb disputed diversity's benefit in medical education. “Diversity, in itself, carries no inherent moral value — it is neither intrinsically good nor bad,” he said. “What matters most in medical education is excellence, as it ensures future physicians possess the skills and knowledge to provide exceptional patient care.”

He also questioned whether there are viable alternatives to race-based policies to increase admissions for underrepresented groups. No one has identified a strategy to encourage higher acceptance rates for underrepresented applicants without discrimination, he said.

The study is funded by the American Medical Association and National Institutes of Health. Two authors report support from the NIH. Other authors report relationships with the AMA and University of California, Davis Health. 

Poll-Hunter and Goldfarb have no disclosures.