Dear members of the SDN community,
I am an internist with over three decades of experience on medical school admissions committees. As I am recently retired from this particular duty I can speak freely here, and give some insight into the workings of affirmative action among those of us who make the admission decisions and wrestle with the issues many of you have been raising on SDN. I also have a background in public health with a focus on demographics and international health, and have been active in efforts to recruit underrepresented minorities (URMs) to train in the health professions. As a result I have a good deal of experience overseas and familiarity (as part of my work) with the historical milieu of the medical, educational and broader institutions of the US versus its counterparts in the developed world. Thus I hope my insights and experience here can be uniquely helpful in more conclusively addressing the issues related to URM recruitment and affirmative action in medical schools and the health professions. I compiled a FAQ starting some years ago based on questions the adcom members routinely field from our applicants and their families, and in light of the confusion about adcom policies given the recent review of affirmative action by the White House, several of my former students suggested I post the FAQ here (in two posts due to length). As I am flying out of town to start a sabbatical tomorrow, I will not be able to respond directly, but I hope this FAQ will be comprehensive enough to answer most questions that continue to arise. I’ll get right to the heart of the matter, and speak as bluntly and honestly as I can about the topic.
Q: What’s the overall rationale for affirmative action and URM recruitment in US (as well as Canadian and Australian) medical schools?
A: The short version of the rationale behind URM recruitment: Our profession must provide care for Americans across the country, and due to America’s remarkable diversity –both in its historical development and emerging demographics—we as the gatekeepers must ensure the country has physicians from its ever diversifying communities. It’s really as simple as that, and despite the emotional nature of the debate, our reasoning as admissions officers is immediate and practical. US history and ongoing demographic change thus have a concrete impact on how American institutions conduct their admissions, providing the moral and practical foundation that motivates affirmative action at US workplaces and universities, including medical schools.
To best illustrate the reasoning behind URM preference in the US, as well as Canada and Australia, consider the starkly contrasting approach used in Europe and most of Asia—and in South America due to close tracking of the European model—where med school and university admissions as a rule operate on something closer to a “pure meritocracy” basis: While there are exceptions, such as a variety of supporting programs for ethnic minorities in India and China, for the most part the admissions process itself is “blind” compared to its equivalent in North America. Medical school applicants in particular are selected based on academic criteria and examination performance alone, regardless of background and with no affirmative action, explicit or implied. Why? Because European and Asian countries are (unsurprisingly) dominated by Europeans and Asians who, more importantly, have been resident and indigenous there since the first written records. There is thus little need or rationale, whether ethical or practical, for URM recruitment, and migrants to Europe or Asia are expected to prove themselves within this meritocratic framework when applying to medical school. (Note that this includes many Americans who have moved to Europe or Asia for schooling; it’s true, as many students have recognized in our Q&A’s, that medical school is nearly free of charge in many European countries like France and Germany, but admission is quite competitive.)
The USA, Canada and Australia in sharp contrast are colonial “settler” nations that span large and diverse continents, emerging in the past 3 centuries from a mix of indigenous peoples and migrants pouring in from across the world. They were diverse nations from the start that required cooperation among a variety of peoples, and in roughly 25 years, this historical character will once again become dominant, with none having a clear majority of any ethnic group. As we in US medical education are responsible for training the professionals to serve this diversifying population, we therefore have a mandate to diversity that is worlds apart from our counterparts in Europe or Asia. Thus if you read nothing else, simply keep in mind that we, in selecting the next generation of doctors, are simply trying to ensure that our medical professional population (at least roughly) reflects the broader US population as a whole. In crafting our affirmative action and underrepresented minority recruitment policies, this consideration towers above all others.
Q: But Europe and Asia have also been seeing major immigration waves like the US and Canada, so how can their universities and medical schools justify sticking with purely meritocratic admissions?
A: An informative question we’ve often fielded that will help to illuminate another common query, just below, on exactly which groups in the US are recognized as URM’s (visible minorities in Canada) for affirmative action purposes, and why. Again it’s a product of the differing histories of the continents, combined with the much greater scale of demographic change in North America and Australia. Or in other words, a contrast between ancient continents with long-established indigenous populations, as in Europe and Asia, and settler “proposition” nations with very distinct indigenous populations, like the US, Canada and Australia, founded more on common belief systems and constitutions. This is why immigration is viewed quite differently in “established” (Europe/Asia) vs. “proposition” (US/Canada) nations, and why affirmative action programs in the US, Canada and Australia are tailored heavily to give a helping hand to indigenous populations or those long resident before Anglo settlement, and facing centuries of discrimination. These are the URM groups noted in the next question: primarily native Americans, Latinos and African-Americans in the US, indigenous and African/Caribbean peoples in Canada, aborigines and islander peoples in Australia. The delicate fabric of society in such nations depends on cooperation among their diverse peoples, both indigenous and migrant, and this requires that the professions reflect the diverse peoples that those professions serve, including the medical profession.
Q: So then how do American medical schools precisely define a URM?
A: The precise designations of which applicants are URM or not vary depending on the school, and on the demographics and historical context of the medical school and the community that it and its graduates tend to serve. However, as hinted in the answer to the previous question, a URM in general corresponds to a US Census category for which the percentage of its members in the physician population lags the proportion of that community’s population in the United States as a whole, and for which (usually) historical discrimination has been well-documented. Thus in almost any medical school, a URM will come from the African-American, Native American, and Latino (either a subgroup or Latinos as a whole) communities, with Arab-Americans and Muslim-Americans in generalmore recently acquiring at least informal URM status in some regions, as I’ll get to below.
We realize the classification system is imperfect, and that the US Census categories, particularly for groups like Filipinos and other Asian-Americans, too often lump together dissimilar groups while failing to duly consider many underrepresented minority communities. But for the vast majority of applicants it’s a satisfactory approximation of the American racial and ethnic breakdown, and for now it’s the most quantitative and valuable demographic tool we have, with further Census subdivisions probably helping to clarify in the future—see below. Also it’s worth repeating that it’s the schools that ultimately determine an applicant’s URM status, not the applicants alone, that is there’s no “URM checkbox” on the AMCAS. So as I’ll state repeatedly below, don’t dissemble, just mark the category that best and most honestly describes the community you identify with and with which you are identified.
Q: Why, more specifically, do URM’s receive a preference in admissions?
A: In spite of the apparently loaded nature of this question, the answer as summarized above is fairly basic and straightforward: as the educational institutions that train our nation’s physicians, one of our essential duties is to ensure that we train physicians who will serve the ever more diverse population of the USA. And since there is ample research demonstrating that physicians from URM communities are more likely to serve in their communities upon licensure, it is our duty to help train more URM physicians to meet this pressing need. Many confuse MD and DO school URM preferences with the broader justifications for affirmative action used by private employers, undergraduate colleges and scholarships (such as the Bill Gates Millennium Scholarship), which frequently cite sheer institutional diversity as bases for their programs. For us, the motivation is much more direct: making sure that underserved communities, especially those facing a long legacy of discrimination, have culturally competent physicians from their communities to serve them.
This also helps to explain the regional variation of affirmative action for different medical schools, and the emphasis they place on recruiting different URM communities. Schools across the country but particularly in the South, given the history of slavery and Jim Crow laws as well as their large African-American populations, will naturally place a strong emphasis on recruitment of African-American physicians. Schools in Southwestern states as well as Florida in particular will heavily recruit Latinos, especially Mexican-Americans, many of whom have had families present in the region since long before the Mexican-American War, and large and growing Latino populations. (I encountered many such cases when I was starting my adcom work in Tecas decades ago.) More recently, some medical schools especially in the Midwest tend to recruit Arab and Muslim-Americans generally in underrepresented areas where there has been a history of Islamophobia or anti-Arab discrimination, though this as yet is not much backed up by official policy. In any case, this approach is the same basic policy used in Australia and Canada, for example, to recruit professionals to serve the aboriginal and indigenous communities.
Q: So are med schools’ URM recruitment and affirmative action policies voluntary, or mandated by law?
A: Most recruiting of URM applicants in United States medical schools is done for voluntary reasons based on our training goals, as well as the communities served by our teaching hospitals and primary care facilities staffed by our graduates. To varying extents, however, URM recruitment is also mandated by American laws at the local, state and federal levels as well as by court decisions and regulatory prescriptions which the Trump Administration, despite some recent confusion, has not altered in the slightest. There are in fact tangible and sometimes devastating legal and financial penalties for schools, workplaces, loan assistance programs, scholarships and US institutions in general (including private entities) that fail to meet diversity targets, and these official mandates have become even more detailed and vigorously enforced in recent years.
Q: So how much of a boost do URM’s receive in med school admissions?
A: I promised to answer bluntly and honestly in this FAQ, so I’ll do so here: The boost can indeed be significant, though it varies substantially from school to school and is always secondary to demonstrated potential and academic performance. SDN and many other forums have linked to studies by the AAMC and other institutions on test score differences among accepted applicants from different groups, URM and otherwise, so I won’t bother with a list of links here. Moreover the students and families at our Q&A sessions are well aware of the mean MCAT and GPA differentials among accepted applicants from URM vs non-URM groups, so I see no value in dissembling or tiptoeing around the issue. Yes, it is true that URM applicants in general and particular at some institutions will enjoy a significant admissions advantage given equal science/non-science GPA and MCAT scores as non-URM applicants. And yes, both white and Asian-American applicants will often have to score much higher given their overrepresentation.
However, I again want to emphasize that this does not mean we take unqualified applicants. A boost is just that—a boost. It does not substitute for solid academic performance and demonstrated motivation to become a good physician and serve the community. URM applicants must meet these basic standards of academic aptitude and achievement as surely as non-URM’s do, and while URM applicants generally do have a better shot at admission with lower GPA and MCAT scores than the general applicant pool, this factor is not as large as many make it out to be, especially compared to other determinants in the holistic admissions process. As we in the adcom business often say, in full honesty, we could fill our classes many times over with qualified future physicians by dipping into the pool of rejected applicants. Thus giving a boost to URM applicants is simply a matter of nudging that somewhat subjective selection process in a certain direction to choose a certain subgroup among a pool of already qualified applicants.
Q: But isn’t this grossly unfair to non-URM’s? Especially white and Asian applicants?
A: As stated above, we on the admissions committees are conducting our decisions with a much bigger picture in mind, one that simply isn’t going to be apparent to pre-meds or medical students (seeking residency) who are, quite rightly, focused on the immediate needs of their training. On the other hand, there are broader societal needs that we as administrators must serve—needs of a diverse society which are not met by simply choosing names based on GPA and test scores alone. While the US system may not be perfectly meritocratic in comparison to for ex. Continental European or Asian medical schools as specified above, it’s incorrect to claim that American MD and DO schools “drop their standards” for URM applicants. Every accepted candidate, whether URM or not, has to meet a high bar to get an offer of admission, and medicine in the US and Canada still uses a much more meritocratic approach than most professions. Asserting “fairness” here can thus be rather misleading because the concept fails to take in mind the broader history, diversity and especially societal context that US, Canadian and Australian physicians are entering into.
If the lack of a “pure meritocracy” is so bothersome to you, then you can always apply to medical schools in Europe or Asia (or South America) that tend to use a more fundamentally performance-oriented approach, and if you can speak the language, it may even be of benefit since such schools are often free of charge or require minimal fees. But pure meritocracy there means what it means—you have to prove yourself and you won’t get many breaks, and you may wind up finding out that it’s far better to simply stay and practice there instead of coming back home. Overall, the relative boost, or lack of it), for URM or non-URM applicants isn’t as decisive a factor as it’s often claimed to be, so if you want to study in the US (or Canada or Australia), you’re better off just focusing on improving your MCAT score and application rather than splitting hairs about what threshold you’ll need in a holistic admissions process that is, inevitably, rather unpredictable.
Now the big question that’s always rearing its head in our Q&A’s and on SDN:
Q: How do I identify myself on the AMCAS, and how do I determine if I’m a URM or not especially if I’m in a “gray area” category (ex.: mixed-race, Filipino, North African)?
A: Identify yourself based on the US racial/ethnic community that you most honestly and easily identify with, *and would be happy to talk about if the question comes up in an interview*. This is the essential criterion for you, or stated another way, “Don’t overcomplicate it”. Anyone who’s served more than once on an adcom is well aware of the tricks and stretches some applicants will use to gain URM status and the boost in admissions chances from that. As I said, the main justification for URM preference is the fundamental need to bring medical care to underserved communities particularly those for which there is a documented history of displacement or discrimination. So from our standpoint, when someone checks off a self-identification box corresponding to a URM category, we expect that this applicant will be a member of and identify with (and be identified with) this community. Whatever you put down, be sure you’re assured enough so that you could go into an interview and talk comfortably about that identification. We don’t grill students about it of course, but you should feel secure enough in that identity that you can speak about your affiliation with that community in a social medical context.
Note this has nothing to do with disadvantaged or socioeconomic status in general, which we consider separately as part of holistic admissions. An applicant who comes from a wealthy Senegalese, Somali, Nigerian or Malian African immigrant family will still be recruited as an African-American URM, in part since he or she is more likely to help underserved US African-American communities. A poor or middle class applicant from an immigrant Chinese family or a destitute white coal-mining community in Pennsylvania is not a URM, though of course we are often impressed by applicants who overcome tough economic circumstances and prove themselves to be resourceful. This figures into our subjective evaluations , though we don’t give less well-off applicants “a pass” if their GPA, MCAT scores or other indicators are subpar.
Also, the vast majority of Latino applicants, whatever their specific heritage, are considered URM at some or most MD or DO schools they apply to, even if the specific recruitment of different national-origin groups varies from school to school. This is partly because many schools as well as scholarships) simply recruit Latino applicants as a whole, without subdividing based on national-origin background. Naturally, Mexican-Americans and those whose families are of Salvadoran, Guatemalan, Dominican and Puerto Rican origin tend to be heavily recruited as URM applicants at all or nearly all schools due to the sheer size and underrepresentation of their communities, as well as specific historical factors (such as the Mexican-American War and annexation of Puerto Rico) resulting in a special status for people with these national-origin backgrounds. However, a Cuban-American, Colombian, Venezuelan, Spanish, Peruvian or Ecuadoran-origin Latino physician is also more likely to serve underserved Latino communities in general and to understand their cultural nuances and concerns. Thus even the latter group of Latino applicants will still be granted URM status and be recruited by at least a subset of the schools to which they apply.
Q: What if I come from a mixed-race background? Am I a URM?
A: Once again: it depends on the community that you identify with. Barack Obama and Halle Berry are both mixed-race, as is former governor Bill Richardson of New Mexico, yet Obama and Berry both clearly identify (and are identified) with the US African-American community, while Richardson clearly identifies (and is identified) with the US Latino community. They would all be identified as URM. On the flipside, yes we do run into those cases of white applicants with 1/16th Navajo or Cherokee blood and no tribal affiliation trying to identify as native Americans, and yes it is as irritating to us as it sounds.
As always, keep it simple. If you have no tribal affiliation and no connection to these native American indigenous communities, then don’t identify yourself with them, you’ll only damage your application with such a clear act of dishonesty which will come out in an interview or before. Would full-blooded members of the tribe accept you as one of their own? Do you appreciate the culture, history, language, stories and traditions of the tribe as your own? Would you be comfortable moving to gain formal recognition as a tribal member? If not, then do not identify yourself as a member of a native American tribe. We heavily frown on prevarication in this area and you can torpedo your application by trying to stretch things. Similarly, if you’ve always identified as white but gone onto a genealogy site and discovered that you had an African slave ancestor 8 generations back—congratulations on your interesting discovery. But do not mark yourself as “African-American” in your self-identification, as you clearly do not identify with (and are not identified by others with) this community.
On the other hand, If you are only 1/4th Puerto Rican or Colombian but still volunteer in local Hispanic communities, identify with the people, speak decent Spanish, appreciate the cultural nuances and have a genuine interest in working with these underserved communities once you’re board-certified—then by all means, identify yourself as Latino, and you will be recruited as a URM because we will see that you are reasonably more likely to provide services to the underserved community you identify with. On the other hand if you’re 1/8th Venezuelan, cringe at the thought of entering a Hispano “barrio”, know little Spanish beyond “no problema”, little appreciation for the culture and in general have little earnest interest in serving Latino communities (be honest with yourself on this), then no, you are not a URM and should not identify as Latino. As I said, we know the tricks and we can smell dishonesty or evasiveness in an interview. We understand that med school admissions are stressful and competitive—we had to go through all this ourselves at some point—but your self-identification is one of those places where you need to be scrupulously honest.
Q: What if I’m in one of those “gray-area” racial/ethnic categories, like Filipino?
A: I’ll acknowledge that these can be tricky cases which can pose some confusion for applicants from these backgrounds, yet here too, the formula is all about the community you honestly identify with. In general Filipinos are considered Asian/Pacific Islander, yet because of the complicated and diverse history of the Spanish presence, and the considerable heterogeneity of the different ethnic groups in the Philippines as well as immigration patterns in the USA, some Filipino families and communities do legitimately identify as Hispanic/Latino while some don’t. What community or communities do you honestly identify with? For the record, yes we are aware that most Filipinos have Spanish last names, come from a Catholic background and can understand at least basic Spanish without studying it (due to the many Spanish words borrowed into Tagalog and other Filipino languages). This in itself does not mean a particular applicant is Latino. Remember the question going through our minds and why we recruit URM applicants in the first place: “Does this person honestly identify with the underserved URM community and is he or she more likely to serve it after getting an MD?” If yes, and if you can talk about this in an interview, then by all means identify yourself as Latino, if no, then don’t try to stretch things.
Q: Have Filipino-American applicants been recruited as Latino URM’s in your experience?
A: Yes, absolutely, when their specific personal histories justify an identification as Latino and suggest a likelihood of serving in Latino communities. I actually did encounter several instances of this during my own adcom tenure, and a couple contrasting examples can perhaps help to illustrate. One young Filipina woman I myself interviewed identified as Latina. She had grown up in a mixed community but she and her neighbors identified with the broader Latino community. She had taken part in Latino cultural events and volunteered with the community from a young age, spoke passable Spanish as well as Tagalog, and she clearly aimed to work in underserved Latino communities after graduation. This came out in her interviews, where she was secure in her identity and affiliation, and we did not question her on it. Her application was solid though not stellar, but she was also considered a URM, was eventually admitted, and did indeed go on to perform primary care in an underserved Latino community. Which is exactly what we’re aiming to achieve.
On the other hand another Filipina applicant interviewed by one of my adcom colleagues claimed to be Latina, but came off as evasive in her interviews. She had had little contact with the Latino communities in her vicinity, was not active in community health, spoke little Spanish, and had little understanding of the unique social health culture of the Latino communities or of their public health in general. It was clear from the interviews that she did not really identify with the Latino community and had little interest in helping their health needs, and was soundly rejected despite very strong credentials otherwise. Moral of the story is to mark the broader community with which you honestly identify and are identified with. If you honestly identify with the Latino community and culture and are accepted as such, then by all means mark yourself down as Latino, but if you really have to strain to make the connection, you are probably not a URM.
We on the adcoms do understand how frustrating this can be for Asian applicants such as Filipinos, Vietnamese and Cambodians who are often lumped in with highly overrepresented Asian-American applicants in general, making their admission more of an uphill climb even if their own communities are facing more trying circumstances and are underrepresented. If it’s any solace, keep in mind that this is hardly an isolated problem—Irish-American, Italian, Jewish, Dutch, German, Scottish and Greek Americans are all lumped together as “white” despite significant differences in representation among their own communities. As I said, it’s an imperfect system, but it’s what we have based on what the US Census data and broader US institutional framework have provided us. Also keep in mind that a handful of US medical schools *do* recruit Filipinos specifically as URM’s especially if their teachings hospitals are serving a clearly underrepresented Filipino-American population.
Q: What about North African, Arab-American or other Middle Eastern origin applicants? Are they considered URM?
A: This is one of those tricky gray areas where the US Census really hasn’t caught up to modern demographic realities. The Census officials are hard at work at creating a category for Americans of North African, Arab and other Middle Eastern and Muslim (MENA) descent for the 2020 Census, but I realize this isn’t much comfort for those applying in the next 1-2 years. Still, there is at least unofficial recognition by many adcoms of the need to recruit more Arab-American and generally Muslim-American physicians particularly in regions of the Midwest with significant Muslim populations (parts of Minnesota and Michigan, for example). This fact, along with documented histories of Islamophobia and anti-Arab discrimination in parts of the US, will quite likely extend formal URM recruitment to applicants of MENA background within a few years. If you are of MENA background, then don’t hesitate to identify yourself as such, and if you have experienced discrimination, by all means feel free to discuss it in interviews.
I am an internist with over three decades of experience on medical school admissions committees. As I am recently retired from this particular duty I can speak freely here, and give some insight into the workings of affirmative action among those of us who make the admission decisions and wrestle with the issues many of you have been raising on SDN. I also have a background in public health with a focus on demographics and international health, and have been active in efforts to recruit underrepresented minorities (URMs) to train in the health professions. As a result I have a good deal of experience overseas and familiarity (as part of my work) with the historical milieu of the medical, educational and broader institutions of the US versus its counterparts in the developed world. Thus I hope my insights and experience here can be uniquely helpful in more conclusively addressing the issues related to URM recruitment and affirmative action in medical schools and the health professions. I compiled a FAQ starting some years ago based on questions the adcom members routinely field from our applicants and their families, and in light of the confusion about adcom policies given the recent review of affirmative action by the White House, several of my former students suggested I post the FAQ here (in two posts due to length). As I am flying out of town to start a sabbatical tomorrow, I will not be able to respond directly, but I hope this FAQ will be comprehensive enough to answer most questions that continue to arise. I’ll get right to the heart of the matter, and speak as bluntly and honestly as I can about the topic.
Q: What’s the overall rationale for affirmative action and URM recruitment in US (as well as Canadian and Australian) medical schools?
A: The short version of the rationale behind URM recruitment: Our profession must provide care for Americans across the country, and due to America’s remarkable diversity –both in its historical development and emerging demographics—we as the gatekeepers must ensure the country has physicians from its ever diversifying communities. It’s really as simple as that, and despite the emotional nature of the debate, our reasoning as admissions officers is immediate and practical. US history and ongoing demographic change thus have a concrete impact on how American institutions conduct their admissions, providing the moral and practical foundation that motivates affirmative action at US workplaces and universities, including medical schools.
To best illustrate the reasoning behind URM preference in the US, as well as Canada and Australia, consider the starkly contrasting approach used in Europe and most of Asia—and in South America due to close tracking of the European model—where med school and university admissions as a rule operate on something closer to a “pure meritocracy” basis: While there are exceptions, such as a variety of supporting programs for ethnic minorities in India and China, for the most part the admissions process itself is “blind” compared to its equivalent in North America. Medical school applicants in particular are selected based on academic criteria and examination performance alone, regardless of background and with no affirmative action, explicit or implied. Why? Because European and Asian countries are (unsurprisingly) dominated by Europeans and Asians who, more importantly, have been resident and indigenous there since the first written records. There is thus little need or rationale, whether ethical or practical, for URM recruitment, and migrants to Europe or Asia are expected to prove themselves within this meritocratic framework when applying to medical school. (Note that this includes many Americans who have moved to Europe or Asia for schooling; it’s true, as many students have recognized in our Q&A’s, that medical school is nearly free of charge in many European countries like France and Germany, but admission is quite competitive.)
The USA, Canada and Australia in sharp contrast are colonial “settler” nations that span large and diverse continents, emerging in the past 3 centuries from a mix of indigenous peoples and migrants pouring in from across the world. They were diverse nations from the start that required cooperation among a variety of peoples, and in roughly 25 years, this historical character will once again become dominant, with none having a clear majority of any ethnic group. As we in US medical education are responsible for training the professionals to serve this diversifying population, we therefore have a mandate to diversity that is worlds apart from our counterparts in Europe or Asia. Thus if you read nothing else, simply keep in mind that we, in selecting the next generation of doctors, are simply trying to ensure that our medical professional population (at least roughly) reflects the broader US population as a whole. In crafting our affirmative action and underrepresented minority recruitment policies, this consideration towers above all others.
Q: But Europe and Asia have also been seeing major immigration waves like the US and Canada, so how can their universities and medical schools justify sticking with purely meritocratic admissions?
A: An informative question we’ve often fielded that will help to illuminate another common query, just below, on exactly which groups in the US are recognized as URM’s (visible minorities in Canada) for affirmative action purposes, and why. Again it’s a product of the differing histories of the continents, combined with the much greater scale of demographic change in North America and Australia. Or in other words, a contrast between ancient continents with long-established indigenous populations, as in Europe and Asia, and settler “proposition” nations with very distinct indigenous populations, like the US, Canada and Australia, founded more on common belief systems and constitutions. This is why immigration is viewed quite differently in “established” (Europe/Asia) vs. “proposition” (US/Canada) nations, and why affirmative action programs in the US, Canada and Australia are tailored heavily to give a helping hand to indigenous populations or those long resident before Anglo settlement, and facing centuries of discrimination. These are the URM groups noted in the next question: primarily native Americans, Latinos and African-Americans in the US, indigenous and African/Caribbean peoples in Canada, aborigines and islander peoples in Australia. The delicate fabric of society in such nations depends on cooperation among their diverse peoples, both indigenous and migrant, and this requires that the professions reflect the diverse peoples that those professions serve, including the medical profession.
Q: So then how do American medical schools precisely define a URM?
A: The precise designations of which applicants are URM or not vary depending on the school, and on the demographics and historical context of the medical school and the community that it and its graduates tend to serve. However, as hinted in the answer to the previous question, a URM in general corresponds to a US Census category for which the percentage of its members in the physician population lags the proportion of that community’s population in the United States as a whole, and for which (usually) historical discrimination has been well-documented. Thus in almost any medical school, a URM will come from the African-American, Native American, and Latino (either a subgroup or Latinos as a whole) communities, with Arab-Americans and Muslim-Americans in generalmore recently acquiring at least informal URM status in some regions, as I’ll get to below.
We realize the classification system is imperfect, and that the US Census categories, particularly for groups like Filipinos and other Asian-Americans, too often lump together dissimilar groups while failing to duly consider many underrepresented minority communities. But for the vast majority of applicants it’s a satisfactory approximation of the American racial and ethnic breakdown, and for now it’s the most quantitative and valuable demographic tool we have, with further Census subdivisions probably helping to clarify in the future—see below. Also it’s worth repeating that it’s the schools that ultimately determine an applicant’s URM status, not the applicants alone, that is there’s no “URM checkbox” on the AMCAS. So as I’ll state repeatedly below, don’t dissemble, just mark the category that best and most honestly describes the community you identify with and with which you are identified.
Q: Why, more specifically, do URM’s receive a preference in admissions?
A: In spite of the apparently loaded nature of this question, the answer as summarized above is fairly basic and straightforward: as the educational institutions that train our nation’s physicians, one of our essential duties is to ensure that we train physicians who will serve the ever more diverse population of the USA. And since there is ample research demonstrating that physicians from URM communities are more likely to serve in their communities upon licensure, it is our duty to help train more URM physicians to meet this pressing need. Many confuse MD and DO school URM preferences with the broader justifications for affirmative action used by private employers, undergraduate colleges and scholarships (such as the Bill Gates Millennium Scholarship), which frequently cite sheer institutional diversity as bases for their programs. For us, the motivation is much more direct: making sure that underserved communities, especially those facing a long legacy of discrimination, have culturally competent physicians from their communities to serve them.
This also helps to explain the regional variation of affirmative action for different medical schools, and the emphasis they place on recruiting different URM communities. Schools across the country but particularly in the South, given the history of slavery and Jim Crow laws as well as their large African-American populations, will naturally place a strong emphasis on recruitment of African-American physicians. Schools in Southwestern states as well as Florida in particular will heavily recruit Latinos, especially Mexican-Americans, many of whom have had families present in the region since long before the Mexican-American War, and large and growing Latino populations. (I encountered many such cases when I was starting my adcom work in Tecas decades ago.) More recently, some medical schools especially in the Midwest tend to recruit Arab and Muslim-Americans generally in underrepresented areas where there has been a history of Islamophobia or anti-Arab discrimination, though this as yet is not much backed up by official policy. In any case, this approach is the same basic policy used in Australia and Canada, for example, to recruit professionals to serve the aboriginal and indigenous communities.
Q: So are med schools’ URM recruitment and affirmative action policies voluntary, or mandated by law?
A: Most recruiting of URM applicants in United States medical schools is done for voluntary reasons based on our training goals, as well as the communities served by our teaching hospitals and primary care facilities staffed by our graduates. To varying extents, however, URM recruitment is also mandated by American laws at the local, state and federal levels as well as by court decisions and regulatory prescriptions which the Trump Administration, despite some recent confusion, has not altered in the slightest. There are in fact tangible and sometimes devastating legal and financial penalties for schools, workplaces, loan assistance programs, scholarships and US institutions in general (including private entities) that fail to meet diversity targets, and these official mandates have become even more detailed and vigorously enforced in recent years.
Q: So how much of a boost do URM’s receive in med school admissions?
A: I promised to answer bluntly and honestly in this FAQ, so I’ll do so here: The boost can indeed be significant, though it varies substantially from school to school and is always secondary to demonstrated potential and academic performance. SDN and many other forums have linked to studies by the AAMC and other institutions on test score differences among accepted applicants from different groups, URM and otherwise, so I won’t bother with a list of links here. Moreover the students and families at our Q&A sessions are well aware of the mean MCAT and GPA differentials among accepted applicants from URM vs non-URM groups, so I see no value in dissembling or tiptoeing around the issue. Yes, it is true that URM applicants in general and particular at some institutions will enjoy a significant admissions advantage given equal science/non-science GPA and MCAT scores as non-URM applicants. And yes, both white and Asian-American applicants will often have to score much higher given their overrepresentation.
However, I again want to emphasize that this does not mean we take unqualified applicants. A boost is just that—a boost. It does not substitute for solid academic performance and demonstrated motivation to become a good physician and serve the community. URM applicants must meet these basic standards of academic aptitude and achievement as surely as non-URM’s do, and while URM applicants generally do have a better shot at admission with lower GPA and MCAT scores than the general applicant pool, this factor is not as large as many make it out to be, especially compared to other determinants in the holistic admissions process. As we in the adcom business often say, in full honesty, we could fill our classes many times over with qualified future physicians by dipping into the pool of rejected applicants. Thus giving a boost to URM applicants is simply a matter of nudging that somewhat subjective selection process in a certain direction to choose a certain subgroup among a pool of already qualified applicants.
Q: But isn’t this grossly unfair to non-URM’s? Especially white and Asian applicants?
A: As stated above, we on the admissions committees are conducting our decisions with a much bigger picture in mind, one that simply isn’t going to be apparent to pre-meds or medical students (seeking residency) who are, quite rightly, focused on the immediate needs of their training. On the other hand, there are broader societal needs that we as administrators must serve—needs of a diverse society which are not met by simply choosing names based on GPA and test scores alone. While the US system may not be perfectly meritocratic in comparison to for ex. Continental European or Asian medical schools as specified above, it’s incorrect to claim that American MD and DO schools “drop their standards” for URM applicants. Every accepted candidate, whether URM or not, has to meet a high bar to get an offer of admission, and medicine in the US and Canada still uses a much more meritocratic approach than most professions. Asserting “fairness” here can thus be rather misleading because the concept fails to take in mind the broader history, diversity and especially societal context that US, Canadian and Australian physicians are entering into.
If the lack of a “pure meritocracy” is so bothersome to you, then you can always apply to medical schools in Europe or Asia (or South America) that tend to use a more fundamentally performance-oriented approach, and if you can speak the language, it may even be of benefit since such schools are often free of charge or require minimal fees. But pure meritocracy there means what it means—you have to prove yourself and you won’t get many breaks, and you may wind up finding out that it’s far better to simply stay and practice there instead of coming back home. Overall, the relative boost, or lack of it), for URM or non-URM applicants isn’t as decisive a factor as it’s often claimed to be, so if you want to study in the US (or Canada or Australia), you’re better off just focusing on improving your MCAT score and application rather than splitting hairs about what threshold you’ll need in a holistic admissions process that is, inevitably, rather unpredictable.
Now the big question that’s always rearing its head in our Q&A’s and on SDN:
Q: How do I identify myself on the AMCAS, and how do I determine if I’m a URM or not especially if I’m in a “gray area” category (ex.: mixed-race, Filipino, North African)?
A: Identify yourself based on the US racial/ethnic community that you most honestly and easily identify with, *and would be happy to talk about if the question comes up in an interview*. This is the essential criterion for you, or stated another way, “Don’t overcomplicate it”. Anyone who’s served more than once on an adcom is well aware of the tricks and stretches some applicants will use to gain URM status and the boost in admissions chances from that. As I said, the main justification for URM preference is the fundamental need to bring medical care to underserved communities particularly those for which there is a documented history of displacement or discrimination. So from our standpoint, when someone checks off a self-identification box corresponding to a URM category, we expect that this applicant will be a member of and identify with (and be identified with) this community. Whatever you put down, be sure you’re assured enough so that you could go into an interview and talk comfortably about that identification. We don’t grill students about it of course, but you should feel secure enough in that identity that you can speak about your affiliation with that community in a social medical context.
Note this has nothing to do with disadvantaged or socioeconomic status in general, which we consider separately as part of holistic admissions. An applicant who comes from a wealthy Senegalese, Somali, Nigerian or Malian African immigrant family will still be recruited as an African-American URM, in part since he or she is more likely to help underserved US African-American communities. A poor or middle class applicant from an immigrant Chinese family or a destitute white coal-mining community in Pennsylvania is not a URM, though of course we are often impressed by applicants who overcome tough economic circumstances and prove themselves to be resourceful. This figures into our subjective evaluations , though we don’t give less well-off applicants “a pass” if their GPA, MCAT scores or other indicators are subpar.
Also, the vast majority of Latino applicants, whatever their specific heritage, are considered URM at some or most MD or DO schools they apply to, even if the specific recruitment of different national-origin groups varies from school to school. This is partly because many schools as well as scholarships) simply recruit Latino applicants as a whole, without subdividing based on national-origin background. Naturally, Mexican-Americans and those whose families are of Salvadoran, Guatemalan, Dominican and Puerto Rican origin tend to be heavily recruited as URM applicants at all or nearly all schools due to the sheer size and underrepresentation of their communities, as well as specific historical factors (such as the Mexican-American War and annexation of Puerto Rico) resulting in a special status for people with these national-origin backgrounds. However, a Cuban-American, Colombian, Venezuelan, Spanish, Peruvian or Ecuadoran-origin Latino physician is also more likely to serve underserved Latino communities in general and to understand their cultural nuances and concerns. Thus even the latter group of Latino applicants will still be granted URM status and be recruited by at least a subset of the schools to which they apply.
Q: What if I come from a mixed-race background? Am I a URM?
A: Once again: it depends on the community that you identify with. Barack Obama and Halle Berry are both mixed-race, as is former governor Bill Richardson of New Mexico, yet Obama and Berry both clearly identify (and are identified) with the US African-American community, while Richardson clearly identifies (and is identified) with the US Latino community. They would all be identified as URM. On the flipside, yes we do run into those cases of white applicants with 1/16th Navajo or Cherokee blood and no tribal affiliation trying to identify as native Americans, and yes it is as irritating to us as it sounds.
As always, keep it simple. If you have no tribal affiliation and no connection to these native American indigenous communities, then don’t identify yourself with them, you’ll only damage your application with such a clear act of dishonesty which will come out in an interview or before. Would full-blooded members of the tribe accept you as one of their own? Do you appreciate the culture, history, language, stories and traditions of the tribe as your own? Would you be comfortable moving to gain formal recognition as a tribal member? If not, then do not identify yourself as a member of a native American tribe. We heavily frown on prevarication in this area and you can torpedo your application by trying to stretch things. Similarly, if you’ve always identified as white but gone onto a genealogy site and discovered that you had an African slave ancestor 8 generations back—congratulations on your interesting discovery. But do not mark yourself as “African-American” in your self-identification, as you clearly do not identify with (and are not identified by others with) this community.
On the other hand, If you are only 1/4th Puerto Rican or Colombian but still volunteer in local Hispanic communities, identify with the people, speak decent Spanish, appreciate the cultural nuances and have a genuine interest in working with these underserved communities once you’re board-certified—then by all means, identify yourself as Latino, and you will be recruited as a URM because we will see that you are reasonably more likely to provide services to the underserved community you identify with. On the other hand if you’re 1/8th Venezuelan, cringe at the thought of entering a Hispano “barrio”, know little Spanish beyond “no problema”, little appreciation for the culture and in general have little earnest interest in serving Latino communities (be honest with yourself on this), then no, you are not a URM and should not identify as Latino. As I said, we know the tricks and we can smell dishonesty or evasiveness in an interview. We understand that med school admissions are stressful and competitive—we had to go through all this ourselves at some point—but your self-identification is one of those places where you need to be scrupulously honest.
Q: What if I’m in one of those “gray-area” racial/ethnic categories, like Filipino?
A: I’ll acknowledge that these can be tricky cases which can pose some confusion for applicants from these backgrounds, yet here too, the formula is all about the community you honestly identify with. In general Filipinos are considered Asian/Pacific Islander, yet because of the complicated and diverse history of the Spanish presence, and the considerable heterogeneity of the different ethnic groups in the Philippines as well as immigration patterns in the USA, some Filipino families and communities do legitimately identify as Hispanic/Latino while some don’t. What community or communities do you honestly identify with? For the record, yes we are aware that most Filipinos have Spanish last names, come from a Catholic background and can understand at least basic Spanish without studying it (due to the many Spanish words borrowed into Tagalog and other Filipino languages). This in itself does not mean a particular applicant is Latino. Remember the question going through our minds and why we recruit URM applicants in the first place: “Does this person honestly identify with the underserved URM community and is he or she more likely to serve it after getting an MD?” If yes, and if you can talk about this in an interview, then by all means identify yourself as Latino, if no, then don’t try to stretch things.
Q: Have Filipino-American applicants been recruited as Latino URM’s in your experience?
A: Yes, absolutely, when their specific personal histories justify an identification as Latino and suggest a likelihood of serving in Latino communities. I actually did encounter several instances of this during my own adcom tenure, and a couple contrasting examples can perhaps help to illustrate. One young Filipina woman I myself interviewed identified as Latina. She had grown up in a mixed community but she and her neighbors identified with the broader Latino community. She had taken part in Latino cultural events and volunteered with the community from a young age, spoke passable Spanish as well as Tagalog, and she clearly aimed to work in underserved Latino communities after graduation. This came out in her interviews, where she was secure in her identity and affiliation, and we did not question her on it. Her application was solid though not stellar, but she was also considered a URM, was eventually admitted, and did indeed go on to perform primary care in an underserved Latino community. Which is exactly what we’re aiming to achieve.
On the other hand another Filipina applicant interviewed by one of my adcom colleagues claimed to be Latina, but came off as evasive in her interviews. She had had little contact with the Latino communities in her vicinity, was not active in community health, spoke little Spanish, and had little understanding of the unique social health culture of the Latino communities or of their public health in general. It was clear from the interviews that she did not really identify with the Latino community and had little interest in helping their health needs, and was soundly rejected despite very strong credentials otherwise. Moral of the story is to mark the broader community with which you honestly identify and are identified with. If you honestly identify with the Latino community and culture and are accepted as such, then by all means mark yourself down as Latino, but if you really have to strain to make the connection, you are probably not a URM.
We on the adcoms do understand how frustrating this can be for Asian applicants such as Filipinos, Vietnamese and Cambodians who are often lumped in with highly overrepresented Asian-American applicants in general, making their admission more of an uphill climb even if their own communities are facing more trying circumstances and are underrepresented. If it’s any solace, keep in mind that this is hardly an isolated problem—Irish-American, Italian, Jewish, Dutch, German, Scottish and Greek Americans are all lumped together as “white” despite significant differences in representation among their own communities. As I said, it’s an imperfect system, but it’s what we have based on what the US Census data and broader US institutional framework have provided us. Also keep in mind that a handful of US medical schools *do* recruit Filipinos specifically as URM’s especially if their teachings hospitals are serving a clearly underrepresented Filipino-American population.
Q: What about North African, Arab-American or other Middle Eastern origin applicants? Are they considered URM?
A: This is one of those tricky gray areas where the US Census really hasn’t caught up to modern demographic realities. The Census officials are hard at work at creating a category for Americans of North African, Arab and other Middle Eastern and Muslim (MENA) descent for the 2020 Census, but I realize this isn’t much comfort for those applying in the next 1-2 years. Still, there is at least unofficial recognition by many adcoms of the need to recruit more Arab-American and generally Muslim-American physicians particularly in regions of the Midwest with significant Muslim populations (parts of Minnesota and Michigan, for example). This fact, along with documented histories of Islamophobia and anti-Arab discrimination in parts of the US, will quite likely extend formal URM recruitment to applicants of MENA background within a few years. If you are of MENA background, then don’t hesitate to identify yourself as such, and if you have experienced discrimination, by all means feel free to discuss it in interviews.