Healthcare groups fear SCOTUS affirmative action ruling will harm diversity, health equity efforts

The U.S. Supreme Court ruled Thursday that colleges and universities can no longer take race into consideration as a specific basis in admissions—a landmark decision that will have profound impacts on higher education institutions including medical and nursing schools.

The court ruled 6-2 in Students for Fair Admissions v. President and Fellows of Harvard College and 6-3 in Students for Fair Admissions v. University of North Carolina. Justice Ketanji Brown Jackson recused herself from the case involving Harvard, The Washington Post reported.

The decisions overturn more than four decades of court precedent.

Chief Justice John Roberts, who wrote the opinion for the conservative majority, said Harvard and University of North Carolina admissions programs violated the Equal Protection Clause because they failed to offer “measurable” objectives to justify the use of race. 

The rulings also will have far-reaching consequences for the healthcare industry and its collective efforts to address diversity in the workforce and health inequities among underrepresented groups. Many organizations, including the American Medical Association (AMA), filed an amicus brief in support of Harvard and the University of North Carolina. The AMA's amicus brief was cited by the dissenting justices in the ruling.

“Today’s decision by the U.S. Supreme Court undermines decades of progress centered on the educational value of diversity, and will reverse gains made in the battle against health inequities. This ruling restricts medical schools from considering race and ethnicity among the multiple factors in admissions policies and will translate into a less diverse physician workforce," said Jesse Ehrenfeld, M.D., president of the AMA, in a statement.

"Diversity is vital to health care, and this court ruling deals a serious blow to our goal of increasing medical career opportunities for historically marginalized and minoritized people," Ehrenfeld said.

Currently, only 5.7% of physicians in the U.S. identify as Black or African American, according to the latest data from the Association of American Medical Colleges. The data show that 6.9% of physicians identify as Hispanic and 64% are White.

Physicians even took to Twitter to decry the SCOTUS decision.

"For many of us, becoming health professionals is more than about individual success. We are more likely to practice in our communities. Our patients are more likely to feel seen, heard, and appreciated by us. Our presence in our communities is associated with better health," tweeted physician Uché Blackstock, M.D. "This decision will hasten the deaths of Black people in this country and we already die prematurely."

Amanda Williams, M.D., tweeted that cultural concordance is associate with improved maternal and neonatal health outcomes, highlighting that racial diversity in the healthcare workforce is imperative for patient safety.

Here is a roundup of statements and comments from healthcare industry groups reacting to the Supreme Court rulings on affirmative action (Students for Fair Admissions, Inc. v. President and Fellows of Harvard College and SFFA v. University of North Carolina).

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American Medical Association

“While our country grows more diverse, historically marginalized communities have been left behind on nearly every health indicator. A physician workforce that reflects the diversity of the nation is key to eliminating racial inequities. There is convincing evidence that racially diverse care teams produce measurably positive health outcomes for patients in historically marginalized populations. The goal is not racially segregated care, but rather a health care workforce in which racial and ethnic representation is a more common aspect of care teams.
 
“Recently established AMA policy reinforces our stance that medical schools must continue to make progress toward enrolling talented and highly qualified medical students in racial and ethnic groups that have been traditionally underrepresented in medicine. Eliminating health inequity requires more commitment to, investment in and support for Black, Latinx and Native American and Indigenous communities, and LGBTQ+ people. Yet, today’s ruling undermines policy that was producing positive results and improving the health of our patients, as well as making all physicians better practitioners. This ruling is bad for health care, bad for medicine, and undermines the health of our nation.” — Jesse Ehrenfeld, M.D., president 

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U.S. Department of Health and Human Services

"The Supreme Court ruling today weakens efforts to make higher education more accessible to members of historically underrepresented groups. People of color have been excluded from attending medical school and joining medical organizations for generations. While progress has been made, there is still a significant deficit in the number of Black and Latino doctors and medical students." 
 
"We need more health workers, especially those who look like and share the experiences of the people they serve. This builds trust between provider and patient, and helps to improve the overall quality of care. This ruling will make it even more difficult for the nation’s colleges and universities to help create future health experts and workers that reflect the diversity of our great nation. The health and wellbeing of Americans will suffer as a result." — HHS Secretary Xavier Becerra 

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Association of American Medical Colleges

“We are deeply disappointed with the U.S. Supreme Court’s decision to dismantle its longstanding precedent in the 2003 case, Grutter v. Bollinger, which had recognized student body diversity as a compelling interest permitting the limited consideration of race in admissions. Today’s decision demonstrates a lack of understanding of the critical benefits of racial and ethnic diversity in educational settings and a failure to recognize the urgent need to address health inequities in our country."

"The AAMC, informed by decades of research, recognizes the undeniable benefits of diversity for improving the health of people everywhere. We remain committed to enhancing health professional education and practice by emphasizing critical thinking, innovation, effective communication with all patients, and increased access to patient care for an increasingly diverse population."

"In addition, the AAMC believes that a diverse and inclusive biomedical research workforce with individuals from historically excluded and underrepresented groups in biomedical research is critical to gathering the range of perspectives needed to identify and solve the complex scientific problems of today and tomorrow."

"The AAMC and its member institutions are committed to providing the most effective medical education and patient care, as well as advancing scientific discovery to improve lives in our communities. We will work together to adapt following today’s court decision without compromising these goals. The health of everyone depends on it." — David Skorton, M.D., president and CEO; Frank Trinity, JD, chief legal officer

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American Association of Colleges of Nursing

"The 6-3 decision has reversed decades of progress to ensure equal access to education for all. Removal of racial considerations oppresses people of color and puts the onus on colleges to develop race-neutral programs that advance diversity.

"The American Association of Colleges of Nursing (AACN) joins with the larger higher education community in denouncing this decision, which threatens the creation of more diverse and inclusive learning environments."

"AACN reaffirms our commitment to serving as a champion for diversity, equity, and inclusion, while recognizing the importance of a diverse nursing workforce to reducing health disparities, addressing social determinants of health, and improving patient outcomes. We stand with our schools of nursing and will work diligently to identify strategies, to ensure our student populations reflect the broad diversity of our society." — Deborah Trautman, Ph.D., president and CEO

(The AACN said it is planning a webinar on how to structure a holistic admissions process and other student recruitment strategies that will not violate the new restrictions.)

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American College of Obstetricians and Gynecologists

"Today’s Supreme Court decision is a direct blow to people of color across the United States, who are already at risk of poor health outcomes. We know that racial diversity in health care literally saves lives: research and experience have shown time and time again that disparities in health outcomes decrease when patients are treated by health care professionals who have learned and worked alongside colleagues of different racial and ethnic backgrounds. The best way to ensure diversity in the medical workforce is through holistic considerations of medical school candidates that take into account race, ethnicity, and the lived experiences that each candidate could bring to their career as a physician because of their background. Comprehensive consideration of each medical student candidate as an individual can only benefit the communities for which they will ultimately provide care.

"More diversity in health care means better-educated physicians; higher quality of care; and healthier people, families, and communities everywhere. Less diversity in health care can mean physicians who may be less equipped to connect with and treat the diverse patient populations they serve and patients with worse health outcomes, both of which cause entire communities to suffer." — Molly Meegan, JD, general counsel and chief legal officer

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American College of Physicians

"The American College of Physicians (ACP) was disappointed to see the Supreme Court decision issued today that rules against the use of affirmative action as a part of a college or university’s comprehensive admissions process. ACP believes that a diverse, equitable, and inclusive physician workforce is crucial to promoting equity and understanding. Diversity in the health care workforce not only benefits underserved patients but improves care for all patients. Evidence has shown diverse populations in educational and medical training settings improves learning outcomes by increasing active thinking and intellectual engagement skills and increases understanding of and empathy for diverse cultures. A diverse physician workforce should include individuals of all races, including Indigenous, Black, Latinx, Asian American, Native Hawaiian, Pacific Islander, and other persons affected by discrimination to better reflect the population for whom we care. Considering race as one of the many determining factors used when considering an individual’s admission to an education program can be an important way to combat the harm that systemic racism and discrimination has in the United States.

"Affirmative action is one means of helping to promote that diversity. Medical schools and other institutions of higher education should consider a person’s race and ethnicity, alongside other factors that are often considered like socioeconomic status and geographic location, as part of evaluating applicants to counter both past and current discrimination. ACP will continue to advocate for policies that can help to increase diversity and promote equity." — Omar Atiq, M.D., president

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University of North Carolina at Chapel Hill

"While not the outcome we hoped for, we respect the Supreme Court’s decision and will follow its guidance.

"Carolina is committed to bringing together talented students with different perspectives and life experiences and to making an affordable, high-quality education accessible to the people of North Carolina and beyond. We are passionately public, and that will always be true. Our strategic plan’s first initiative is to “Build our Community Together.” We will build that community with you and work to provide a campus environment where all of our students know they belong and can thrive.

"I know that this decision may raise questions about our future and how we fulfill our mission and live out our values. But Carolina is built for this, and we have been preparing for any outcome. Our leadership team will need time to thoroughly review the details of this outcome and its potential impact before determining specifically how we will comply with this decision. In the coming weeks, we will communicate our plans with the campus community." — Kevin M. Guskiewicz, chancellor

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Harvard University

"The Supreme Court held that Harvard College’s admissions system does not comply with the principles of the equal protection clause embodied in Title VI of the Civil Rights Act. The Court also ruled that colleges and universities may consider in admissions decisions 'an applicant’s discussion of how race affected his or her life, be it through discrimination, inspiration, or otherwise.' We will certainly comply with the Court’s decision.

"We write today to reaffirm the fundamental principle that deep and transformative teaching, learning, and research depend upon a community comprising people of many backgrounds, perspectives, and lived experiences. That principle is as true and important today as it was yesterday. So too are the abiding values that have enabled us—and every great educational institution—to pursue the high calling of educating creative thinkers and bold leaders, of deepening human knowledge, and of promoting progress, justice, and human flourishing.

"We affirm that:

• Because the teaching, learning, research, and creativity that bring progress and change require debate and disagreement, diversity and difference are essential to academic excellence.
• To prepare leaders for a complex world, Harvard must admit and educate a student body whose members reflect, and have lived, multiple facets of human experience. No part of what makes us who we are could ever be irrelevant.
• Harvard must always be a place of opportunity, a place whose doors remain open to those to whom they had long been closed, a place where many will have the chance to live dreams their parents or grandparents could not have dreamed.

"For almost a decade, Harvard has vigorously defended an admissions system that, as two federal courts ruled, fully complied with longstanding precedent. In the weeks and months ahead, drawing on the talent and expertise of our Harvard community, we will determine how to preserve, consistent with the Court’s new precedent, our essential values.

"The heart of our extraordinary institution is its people. Harvard will continue to be a vibrant community whose members come from all walks of life, all over the world. To our students, faculty, staff, researchers, and alumni—past, present, and future—who call Harvard your home, please know that you are, and always will be, Harvard. Your remarkable contributions to our community and the world drive Harvard’s distinction. Nothing today has changed that." — Lawrence S. Bacow, president, Harvard University, along with other Harvard leadership including George Q. Daley, dean, Harvard Medical School; and Michelle A. Williams, dean, Harvard T.H. Chan School of Public Health