DEI in surgical subspecialties

[EmperorK]

I think we both agree that class mobility is beneficial for society and that everyone should have equal opportunities and resources. Your analogy is an example of SES-based affirmative action, and your argument is that since culture, which is associated with race, is a form of SES, race-based preferences are appropriate.

I understand your argument, but I disagree with your assumption that race is a proxy for SES. For example, would an ORM from a working-class family have a higher SES than a URM from a family of physicians? It's too reductive.

I also disagree that, even if we accept your premise that certain racial groups are more culturally adapted to succeed, this means we should discriminate against them. It is very different to come from a high-income province with access to prep courses than to come from a household which values education and achievement, and that shaping one's aspirations and career path.


And I will point out, intentionally or not, this statement is a form of implicit bias/racism--implying that Asian Americans (which is a broad term to begin with) are generally deficient in soft skills. While it would be off-topic to delve into the reasons behind this stereotype, it is telling that the two users liked who liked your post are supposed advocates for diversity equity and inclusion.

Hmmmm where do we start? So first, I didn't add the caveat of equal opportunities and resources because that's not what class mobility is about. Class mobility gives one class more resources to compensate for its inherent disadvantages, it is Medicaid of resource distribution. You do it because it gives you more bang for your buck.

The second point you're making is also problematic. Race is certainly a predictor for SES in the United States (so a proxy, no?). The example you give is possible but just unlikely at a population level. In other words, I'm saying there are much more lower SES URM than both High SES URM and low/mid SES ORM, which is why the resources are not distributed equally. Like Medicaid.

The third point is really something I want you to listen to. You're saying that valuing education and achievements leads to a better shaping of one's aspirations and career path. The reality is backward. I'm saying, and the literature agrees with me, that a higher SES leads to valuing one's education more (because you know you'll get a better job that pays more, which doesn't happen if you're poor) and therefore leads to a better shaping of one's aspiration and career path. Ironically, I come from a high SES URM, and boy did my mom not let me play with friends and I had to study all the time. Why? She knew it would lead to a better future. Kinda like a stereotypical Asian-American/Indian parent, wouldn't you say?

Finally, on your last point. I was stating that you were anxious and lacked self-esteem (which you didn't address). If you are such a great candidate an URM will not beat, you to a spot that you were not competing for anyways (if DEI was present). Therefore, your competitors are other members of the ORM, so your worry is moot. Additionally, I was stating that in my experience when coaching Asian Americans (because you are Asian American) for soft skills (I coach other people of course), they come across as you do in this whole post. I'm addressing my experience with this subset of people, who are not all falling within my experience, but what matters is that you do fall within that experience in this post. The issue is that you don't feel you might be competitive for the subspecialty you want, and it manifests as this odd logical argument against DEI and ORMs. This is what I meant that you like you use logic to hide behind what either u don't know you're feeling, or you don't want to accept your feeling. That is why you cherry-pick the points you address, while I address your whole post.

I will say I'm not trying to be personal here, there are just my observations and experiences of dealing with these kinds of concerns from people like you.

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[Friheten]

Hmmmm where do we start? So first, I didn't add the caveat of equal opportunities and resources because that's not what class mobility is about. Class mobility gives one class more resources to compensate for its inherent disadvantages, it is Medicaid of resource distribution. You do it because it gives you more bang for your buck.

The second point you're making is also problematic. Race is certainly a predictor for SES in the United States (so a proxy, no?). The example you give is possible but just unlikely at a population level. In other words, I'm saying there are much more lower SES URM than both High SES URM and low/mid SES ORM, which is why the resources are not distributed equally. Like Medicaid.

The third point is really something I want you to listen to. You're saying that valuing education and achievements leads to a better shaping of one's aspirations and career path. The reality is backward. I'm saying, and the literature agrees with me, that a higher SES leads to valuing one's education more (because you know you'll get a better job that pays more, which doesn't happen if you're poor) and therefore leads to a better shaping of one's aspiration and career path. Ironically, I come from a high SES URM, and boy did my mom not let me play with friends and I had to study all the time. Why? She knew it would lead to a better future. Kinda like a stereotypical Asian-American/Indian parent, wouldn't you say?

I think we agree on the first point and are arguing semantics. By equal opportunities and resources I mean that everyone should have the same "starting point" so that meritocracy is achievable. If someone begins at a disadvantage, they should receive proportional help (though it is complicated to make this happen in real life.)

Your own example of a high SES URM proves that the current implementation of DEI is flawed and likely favors high SES URMs over low SES candidates. So, why not switch to using SES instead of an imperfect proxy for it?

Both points can be true. Cultural values can lead to shaping one's aspirations just as SES can. If anything your example supports my argument that, regardless of race, when parents place an emphasis on academics their children are more likely to be traditionally successful. Even in the case of your mother, who is an URM but you compare to an ORM parent, this held true for you. Would your Mom have valued education less if she had been low SES? Probably, but again both can be true.

Finally, on your last point. I was stating that you were anxious and lacked self-esteem (which you didn't address). If you are such a great candidate an URM will not beat, you to a spot that you were not competing for anyways (if DEI was present). Therefore, your competitors are other members of the ORM, so your worry is moot. Additionally, I was stating that in my experience when coaching Asian Americans (because you are Asian American) for soft skills (I coach other people of course), they come across as you do in this whole post. I'm addressing my experience with this subset of people, who are not all falling within my experience, but what matters is that you do fall within that experience in this post. The issue is that you don't feel you might be competitive for the subspecialty you want, and it manifests as this odd logical argument against DEI and ORMs. This is what I meant that you like you use logic to hide behind what either u don't know you're feeling, or you don't want to accept your feeling. That is why you cherry-pick the points you address, while I address your whole post.

I will say I'm not trying to be personal here, there are just my observations and experiences of dealing with these kinds of concerns from people like you.

I never stated my ethnicity due to not wanting to make this about me. The fact that you assumed I'm Asian and viewed me in a negative light (such as being anxious and lacking self-esteem) is telling.

 

[Kierkegaard's Bud]

I'm sorry if I made you feel less deserving/accomplished or if I implied that; that was not my goal. I'm feeling conflicted about the current state of DEI in academia, so I spoke up for my beliefs. I tried to make this discussion impersonal and not about me, but I recognize that people naturally take these discussions personally. I hope we can try to discuss things without personal attacks which was always my intention.

I can genuinely understand where you are coming from, but DEI in academia isn't what will close the door for you.

 

[Friheten]

I can genuinely understand where you are coming from, but DEI in academia isn't what will close the door for you.

I appreciate you understanding my perspective and responding empathetically. Again I am not worried about the competitiveness of my own application/specialty, even if it sparked the thread (since I found out about a quota system while talking to my specialty mentor).

But it seems contradictory to recognize that DEI is an emphasis in academia while also asserting that certain groups, who are excluded from DEI initiatives, will not be put at a disadvantage. From a statistical standpoint, I understand that it is unlikely an ORM would be compared to an equivalent URM applicant based on factors other than race; however, in this case, the less-favored ORM candidate would certainly have that door "closed" to them.

 

[EmperorK]

I think we agree on the first point and are arguing semantics. By equal opportunities and resources I mean that everyone should have the same "starting point" so that meritocracy is achievable. If someone begins at a disadvantage, they should receive proportional help (though it is complicated to make this happen in real life.)

Your own example of a high SES URM proves that the current implementation of DEI is flawed and likely favors high SES URMs over low SES candidates. So, why not switch to using SES instead of an imperfect proxy for it?

Both points can be true. Cultural values can lead to shaping one's aspirations just as SES can. If anything your example supports my argument that, regardless of race, when parents place an emphasis on academics their children are more likely to be traditionally successful. Even in the case of your mother, who is an URM but you note as similar to an ORM parent, this held true for you. Would your Mom have valued education less if she had been low SES? Probably, but again both can be true.


I never stated my ethnicity due to not wanting to make this about me. The fact that you assumed I'm Asian and viewed me in a negative light (such as being anxious and lacking self-esteem) is telling.

But we're not agreeing on the first point. Because I'm trying to tell you meritocracy is not achievable if you started with a large advantage..... that's why the different cutoffs in the China example, remember?

I presume you mean low SES URM? or I'm not sure what you're referring to otherwise. But to address the other point, this is where the logic is flawed from your side. If Race is a proxy for SES, then by using SES I would just end up selecting predominantly URMs, correct? All I would do is increase my population, but it would still be predominantly URM, that is the very reason Race is a predictor of SES....... To go even beyond that, the system was created to help URMs to get into medicine/residency, and because Race is a proxy for SES.....well you get what I mean? It is doing its job, it doesn't have to be fair, because the situation isn't fair either. I would presume asking about people's race is easier than determining someone's SES.

Yes, both points can be true. Yet they aren't, this is why I mentioned the literature part........ This isn't a theory-crafting class, this has been thoroughly researched in western countries. No, my example shows that my mother, who was successful, knew what she needed to do with me to be successful. She shows the example of breaking the circle and she also showed me how to do it, so the system works you know? She's moving up a class even though she's URM. And again, please note that Race is a predictor of SES......... (I know you're going to produce an exception, but please understand policies are made on the population, not the individual.) Can you please tell me why you think SES is going to be fairer?

 

[Kierkegaard's Bud]

I appreciate you understanding my perspective and responding empathetically. Again I am not worried about the competitiveness of my own application/specialty, even if it sparked the thread (since I found out about a quota system while talking to my specialty mentor).

But it seems contradictory to recognize that DEI is an emphasis in academia while also asserting that certain groups, who are excluded from DEI initiatives, will not be put at a disadvantage. From a statistical standpoint, I understand that it is unlikely an ORM would be compared to an equivalent URM applicant based on factors other than race; however, in this case, the less-favored ORM candidate would certainly have that door "closed" to them.

This is beyond short-sighted; you will match at a top program if your application is great. Since you mentioned statistics, there aren't enough URMs to fill those spots, not even close (this is the focal point that I think is missed).

If you have serious conflicts about DEI this early, I'd say to shy away from academia.

 

[operaman]

It seems like this isn't going anywhere. You are not understanding my points, contradicting yourself in your response, and making blatantly prejudiced comments about Asian Americans. I wish you the best!

You two seem to have fundamental disagreements on the nature or fairness and the value of equity itself. Fairly common points of contention on these issues and ones not easily overcome.

I think the more interesting question is where in the process do we apply the cudgel of DEI initiatives. For now that seems to be primarily at the undergraduate level with another strong bump at the med school admissions level. At both points we see massive attrition of URM students, but quite a few get through and flourish who would otherwise not have been given a chance. Sadly we see high attrition of URM residents as well when looking at acgme data broadly, so smaller programs like the subs are particularly wary.

At some point we do have to abandon ideas of potential and fairness and fairly evaluate the candidates in front of us with respect to what they can do right now. Residency seems more focused on this because it’s such a short time and you really need the very best trainees you can get. Hence why you hear all the programs trumpet their DEI priorities while their matched demographics don’t budge.

It’s an interesting time to be sure. I suspect we will see some major changes with the upcoming SC ruling, and there does seem to be some pendulum swinging back on DEI now as the 2020 fad is starting to fade.

 

[Friheten]

You two seem to have fundamental disagreements on the nature or fairness and the value of equity itself. Fairly common points of contention on these issues and ones not easily overcome.

I think the more interesting question is where in the process do we apply the cudgel of DEI initiatives. For now that seems to be primarily at the undergraduate level with another strong bump at the med school admissions level. At both points we see massive attrition of URM students, but quite a few get through and flourish who would otherwise not have been given a chance. Sadly we see high attrition of URM residents as well when looking at acgme data broadly, so smaller programs like the subs are particularly wary.

At some point we do have to abandon ideas of potential and fairness and fairly evaluate the candidates in front of us with respect to what they can do right now. Residency seems more focused on this because it’s such a short time and you really need the very best trainees you can get. Hence why you hear all the programs trumpet their DEI priorities while their matched demographics don’t budge.

It’s an interesting time to be sure. I suspect we will see some major changes with the upcoming SC ruling, and there does seem to be some pendulum swinging back on DEI now as the 2020 fad is starting to fade.

Thank you for your analysis operaman. I believe you are correct that most debates about DEI/affirmative action ultimately come down to what you highlighted, and that the pendulum appears to be swinging back socially. Your point about when applicants should be evaluated "fairly", i.e. taking into account only their current abilities / accomplishments, resonates with me. At what point have we done enough to elevate applicants who have been disadvantaged? Medicine is distinct from other fields because of its numerous tiers of education and advancement (college, medical school, residency, fellowship, and the academic ladder some choose to climb) at which to apply corrective measures. Of course there is nuance, as many DEI advocates would argue that URMs are still not adequately represented in higher-level leadership roles--though this also holds true for ORMs. It is such a delicate topic to discuss as people feel quite passionate/personal about this issue, myself included of course as I am human.

Ultimately, I believe that most reasonable people can agree with the goal of DEI initiatives - to provide opportunities to those who have been limited by societal and experiential factors until deeper issues such as inequity, discrimination, and access to opportunities are addressed. We can also agree that intellectual diversity and differing discourse are good for society. Where people may disagree, however, is in the implementation of DEI initiatives and when these stopgap measures should be ended/revised and what constitutes diversity. Unfortunately, this discussion rarely takes place because it tends to become overly charged before reaching that point.

 

[GoSpursGo]

@EmperorK and @Friheten I think it's time for you guys to put each other on ignore. It's clear you're not going to agree, and it isn't helpful to anyone for you to continue sniping at each other in public. I'm going to delete and edit a few of your posts.

Everyone else let's please try to keep this thread civil. I suspect this thread will wind up getting closed eventually as they almost always do when we talk about these kinds of sensitive topics, but we'll try to keep the thread going a little longer.

 

[Niwrad]

So having grown up in California, one of few states that explicitly bans affirmative action, as an Asian American that also qualified for placement three times into more a rigorous elementary, middle and high school via testing, and also qualified for reduced lunch, I’d like to give my 2c.

It was relatively easy to get to the top of the class. In fact, often avoided recognition since it had become burdensome with constant requests for help in studies. I don’t like to say this, but had the classic Asian parent stereotype, not unlike Steven He’s character who wished his child was a neurosurgeon at age 9. This made everything else seem like a cake walk.

With this had the pick of all top public universities in CA. For unrelated reasons ended up on the east coast and discovered it was much more difficult to get by using the basis of accomplishments and sustained high intensity effort. Obviously could be due to several confounding variables not the least of which is the higher degree of difficulty of graduate education.

My opinion now having first hand experience with selection committees from both sides:


Previously was leaning towards affirmative action, as some schools in CA have even a super majority of Asians (>70%) and was a told that are indeed minority Asian subgroups that would be considered URM. These specific subgroups generally correlated with the lowest socioeconomic status and made this subgroup distinct from the most common subgroup. The most URM Asian American subgroup from that time was Hmong followed by other ethnic minorities from Laos, Vietnam and neighboring southeastern Asian countries. Probably due to having been involved in the Vietnam war prior to immigrating to the US.

However, now leaning away from affirmative action after some serious self reflection.

One thing is that DEI is more important at earlier stages of life. When you’ve already had several life experiences to demonstrate yourself, it’ll make you stand out. Whereas as a child or a teenager there isn’t as much distinctiveness. I think I wouldn’t have minded attending a slightly less rigorous primary school education if it meant someone else would have benefited more from it.

Now I’m wondering if it really matters what someone’s particular ethnicity is rather than their day to day experiences. Using ethnicity is a shortcut/correlated with day to day experiences. It is, IMHO, fundamentally the day to day effort that really determines any particular person’s future and competitiveness. I think if put into a relative meat grinder from day 1 to be the hardest working person then anyone can reach the heights of their profession. That said, it can create someone who can come off as very jaded and may come off as a surprise to those not familiar with the grueling lifestyle.

This policy of affirmative action and looking up its history is quite strange, as CA is considered liberal yet bans it while groups that also support banning affirmative action at the SC level are considered conservative. It seems like people are tripping over themselves and making the whole thing very confusing. Saying they want affirmative action but also saying the don’t discriminate on the basis of ethnicity is kind of like trying to have your cake and eat it too.

 

[Friheten]

Thank you for your analysis operaman. I believe you are correct that most debates about DEI/affirmative action ultimately come down to what you highlighted, and that the pendulum appears to be swinging back socially. Your point about when applicants should be evaluated "fairly", i.e. taking into account only their current abilities / accomplishments, resonates with me. At what point have we done enough to elevate applicants who have been disadvantaged? Medicine is distinct from other fields because of its numerous tiers of education and advancement (college, medical school, residency, fellowship, and the academic ladder some choose to climb) at which to apply corrective measures. Of course there is nuance, as many DEI advocates would argue that URMs are still not adequately represented in higher-level leadership roles--though this also holds true for ORMs. It is such a delicate topic to discuss as people feel quite passionate/personal about this issue, myself included of course as I am human.

Ultimately, I believe that most reasonable people can agree with the goal of DEI initiatives - to provide opportunities to those who have been limited by societal and experiential factors until deeper issues such as inequity, discrimination, and access to opportunities are addressed. We can also agree that intellectual diversity and differing discourse are good for society. Where people may disagree, however, is in the implementation of DEI initiatives and when these stopgap measures should be ended/revised and what constitutes diversity. Unfortunately, this discussion rarely takes place because it tends to become overly charged before reaching that point.

I wanted to resurface this post given the recent SCOTUS decision. It's interesting how the court brought up similar arguments in their opinion regarding the lack of a logical endpoint for race-based admissions as well as how our current definition of "diversity" as implemented in admissions promotes negative stereotyping, particularly against Asian American applicants.

Reading over the opinion, there are lots of legal analyses that may not be directly relevant to our discussion, but I tried to pick out relevant points as summarized below:

• The Supreme Court opinion states that race-based admissions programs in universities must comply with strict scrutiny and adhere to specific criteria. The respondents' admissions systems, although implemented in good faith, fail to meet these criteria and therefore violate the Equal Protection Clause of the Fourteenth Amendment.
• The opinion highlights two main reasons for invalidating the admissions programs.
  • First, the educational benefits that the universities claim to pursue are not sufficiently coherent for the purpose of strict scrutiny. It is unclear how these goals can be measured, and there is no specific point at which these goals can be deemed achieved. For example, the opinion notes how "[t]he attainment of a critical mass is, of course, a vague concept that may vary depending on the perspective of the speaker" and that universities' response is essentially "trust us".
  • Second, the admissions programs lack a meaningful connection between the means employed and the goals pursued. The use of racial categories in admissions decisions is imprecise and arbitrary, and it undermines the universities' goals of diversity and underrepresentation. For example, overly broad/undefined categories i.e. "Asian" or "Hispanic", categorization of Middle Eastern applicants.
• Furthermore, the admissions programs violate the commands of the Equal Protection Clause by using race as a negative factor and operating on stereotypes. The consideration of race in admissions has led to a 11.1% decrease in the number of Asian-Americans admitted, which constitutes using race against applicants. Moreover, the programs tolerate stereotyping by assuming inherent benefits in race and treating individuals differently based on their skin color.
• The court re-emphasizes how admissions programs lack a logical end point. The respondents' suggestion that the programs will end when there is meaningful representation and diversity is insufficient and lacks a measurable criterion for determining when that point is reached. Promoting racial balancing (which in my view appears to be the underlying implication of many arguments supporting affirmative action for patient-physician concordance) is not only unconstitutional but also potentially detrimental to society."It would be a sad day indeed, were America to become a quota-ridden society, with each identifiable minority assigned proportional representation in every desirable walk of life".
• Overall, the Supreme Court opinion concludes that the respondents' admissions systems fail to comply with strict scrutiny, use race in a negative and stereotypical manner, and lack a meaningful connection between the means and the goals pursued.

 

[Mr.Smile12]

Just noting how the history of the Supreme Court contributed to defining race.

"Overrepresented Minorities": A Brief History - SDN

The Student Doctor Network provides free tools, resources, and advising services to help students become health professionals.

www.studentdoctor.net

 

[MateoGM416]

"It would be a sad day indeed, were America to become a quota-ridden society, with each identifiable minority assigned proportional representation in every desirable walk of life".

I'm not going to engage you in discussion again considering DEI had no impact on your success as a physician or whatever it is that you wanted to be, but this part is hilarious to me. This statement is literally exactly what we want, patient outcomes for underrepresented minorities are better when they interact with physicians and care team members of their own race, that's a statistically proven, undeniable fact that's been proven multiple times over the past century.

The way Gorsuch/Thomas/whoever paints this argument as an 'A-ha' is both farcically humorous and crushing to see how out-of-touch the 6 (six) humans are that make judgements affecting so many millions of people.

 

[WhereMyLiberalsAt]

exactly what we want, patient outcomes for underrepresented minorities are better when they interact with physicians and care team members of their own race, that's a statistically proven, undeniable fact that's been proven multiple times over the past century.

Over the past century? Century?!? Forty of those years Jim Crow was on the books… It undermines your entire argument. Including four generations with the 4th looking nothing like the 1st. However, their racial preferences for their doctor are the same?!

Ummm, no… Your stance is not an undeniable fact. A great deal of the published work has weak methodology. I remember a horribly weak paper in recent years plastered all over news outlets that basically read “White doctors in Florida kill black babies”…. Right, how does this not erode patients trust in doctors? Additionally, can you imagine a professor sounding their concerns over the weak methodology that is found in the body of work!?! Maoist level struggle session…

We’re going to have to agree to disagree on this one… My belief is to work towards a post-racial society, and I won’t subscribe to any ideology that runs counter to that primary goal.

 

[Friheten]

I'm not going to engage you in discussion again considering DEI had no impact on your success as a physician or whatever it is that you wanted to be, but this part is hilarious to me. This statement is literally exactly what we want, patient outcomes for underrepresented minorities are better when they interact with physicians and care team members of their own race, that's a statistically proven, undeniable fact that's been proven multiple times over the past century.

The way Gorsuch/Thomas/whoever paints this argument as an 'A-ha' is both farcically humorous and crushing to see how out-of-touch the 6 (six) humans are that make judgements affecting so many millions of people.

Respectfully, you seem to fundamentally misunderstand the purpose of affirmative action. Here is an excerpt from the original text:

"It would be a sad day indeed, were America to become a quota-ridden society, with each identifiable minority assigned proportional representation in every desirable walk of life. But that is not the rationale for programs of preferential treatment; the acid test of their justification will be their efficacy in eliminating the need for any racial or ethnic preferences at all."

The point being the justification for affirmative action should be based on its effectiveness in eliminating the need for racial or ethnic preferences altogether, rather than achieving proportional representation through racial quotas. Now you can argue that you think each identifiable minority group should be assigned a specific number or proportion of positions or opportunities in various aspects of life, but that is not why affirmative action was originally implemented and certainly not a majority position like you are implying.

 

[operaman]

I wanted to resurface this post given the recent SCOTUS decision. It's interesting how the court brought up similar arguments in their opinion regarding the lack of a logical endpoint for race-based admissions as well as how our current definition of "diversity" as implemented in admissions promotes negative stereotyping, particularly against Asian American applicants.

Reading over the opinion, there are lots of legal analyses that may not be directly relevant to our discussion, but I tried to pick out relevant points as summarized below:

• The Supreme Court opinion states that race-based admissions programs in universities must comply with strict scrutiny and adhere to specific criteria. The respondents' admissions systems, although implemented in good faith, fail to meet these criteria and therefore violate the Equal Protection Clause of the Fourteenth Amendment.
• The opinion highlights two main reasons for invalidating the admissions programs.
  • First, the educational benefits that the universities claim to pursue are not sufficiently coherent for the purpose of strict scrutiny. It is unclear how these goals can be measured, and there is no specific point at which these goals can be deemed achieved. For example, the opinion notes how "[t]he attainment of a critical mass is, of course, a vague concept that may vary depending on the perspective of the speaker" and that universities' response is essentially "trust us".
  • Second, the admissions programs lack a meaningful connection between the means employed and the goals pursued. The use of racial categories in admissions decisions is imprecise and arbitrary, and it undermines the universities' goals of diversity and underrepresentation. For example, overly broad/undefined categories i.e. "Asian" or "Hispanic", categorization of Middle Eastern applicants.
• Furthermore, the admissions programs violate the commands of the Equal Protection Clause by using race as a negative factor and operating on stereotypes. The consideration of race in admissions has led to a 11.1% decrease in the number of Asian-Americans admitted, which constitutes using race against applicants. Moreover, the programs tolerate stereotyping by assuming inherent benefits in race and treating individuals differently based on their skin color.
• The court re-emphasizes how admissions programs lack a logical end point. The respondents' suggestion that the programs will end when there is meaningful representation and diversity is insufficient and lacks a measurable criterion for determining when that point is reached. Promoting racial balancing (which in my view appears to be the underlying implication of many arguments supporting affirmative action for patient-physician concordance) is not only unconstitutional but also potentially detrimental to society."It would be a sad day indeed, were America to become a quota-ridden society, with each identifiable minority assigned proportional representation in every desirable walk of life".
• Overall, the Supreme Court opinion concludes that the respondents' admissions systems fail to comply with strict scrutiny, use race in a negative and stereotypical manner, and lack a meaningful connection between the means and the goals pursued.

Perhaps one of the most compelling SCOTUS decisions and most moving I’ve read since Obergefell.

Sadly, the racial designations in AA were basically defined as “groups of people that kind of look alike to white people.” To lazily lump the diverse billions from the eastern hemisphere into one monolithic “Asian” category is almost as comical as it is cringy. To then actively discriminate against so many of them who are just as disadvantaged as any other group is simply cruel, and I applaud the court for recognizing that it’s also unlawful.

I hope schools take this as an opportunity to retool and focus on looking at actual disadvantages and hardships and discrimination faced by applicants instead of just lazily using race as a surrogate. It certainly makes sense to do so in surgical residency applications where grit and ability to overcome difficult situations is strongly desired and correlated with success, and I think this is mainly how DEI/AA has played out at the surgical sub residency level for some time. Someone’s skin color doesn’t necessarily mean they’ve faced hardships and developed the grit and determination that you need in a surgical trainee.

 

[MateoGM416]

We’re going to have to agree to disagree on this one… My belief is to work towards a post-racial society, and I won’t subscribe to any ideology that runs counter to that primary goal.

I really don't care whether you agree with me or not, as the stakes are much higher for me than they are for you and they definitely don't hinge on whatever singular paper you're talking about, but you live a sheltered life if you think a 'post-racial' society is actually possible in the United States, of all places.

Someone’s skin color doesn’t necessarily mean they’ve faced hardships and developed the grit and determination that you need in a surgical trainee.

To then actively discriminate against so many of them who are just as disadvantaged as any other group is simply cruel, and I applaud the court for recognizing that it’s also unlawful.

I hope schools take this as an opportunity to retool and focus on looking at actual disadvantages and hardships and discrimination faced by applicants instead of just lazily using race as a surrogate.

Someone’s skin color doesn’t necessarily mean they’ve faced hardships and developed the grit and determination that you need in a surgical trainee.

Educated, intelligent people saying things these is exactly why we need more underrepresented minorities in medicine. But again the crux of these arguments is the fundamental disagreement of how much of a disadvantage being born black/latino/native in this country puts you at compared to Asian Americans and whites. The Boomer/Gen X whites will never agree with us on that issue, so in my opinion it's a moot point to argue it.

I do wonder though how the ridiculous way white politicians who legislated affirmative action categorized the Asian diaspora the way they did somehow became our problem. Two different things being wrong at the same time doesn't make one of those things less of an issue.

 

[Friheten]

I really don't care whether you agree with me or not, as the stakes are much higher for me than they are for you and they definitely don't hinge on whatever singular paper you're talking about, but you live a sheltered life if you think a 'post-racial' society is actually possible in the United States, of all places.





Educated, intelligent people saying things these is exactly why we need more underrepresented minorities in medicine. But again the crux of these arguments is the fundamental disagreement of how much of a disadvantage being born black/latino/native in this country puts you at compared to Asian Americans and whites. The Boomer/Gen X whites will never agree with us on that issue, so in my opinion it's a moot point to argue it.

I do wonder though how the ridiculous way white politicians who legislated affirmative action categorized the Asian diaspora the way they did somehow became our problem. Two different things being wrong at the same time doesn't make one of those things less of an issue.

You're basically saying Asian American issues are not your problem because you're not Asian, and that dialogue is pointless with no agreement. I strongly disagree with this mentality. What if we applied the same mindset to issues affecting Black/Latino/Native Americans? You are suggesting every minority group should focus on their own problems, and that your problems and disadvantages are more significant than others'. I'm not part of the Boomer or Gen X generations, but I and many peers feel alienated by this rhetoric, which is divisive and harmful to DEI efforts.

Let me quote a relevant portion from the SCOTUS opinion, which I honestly think you should read and reflect upon:

"Most troubling of all is what the dissent must make these omissions to defend: a judiciary that picks winners and losers based on the color of their skin. While the dissent would certainly not permit university programs that discriminated against black and Latino applicants, it is perfectly willing to let the programs here continue. In its view, this Court is supposed to tell state actors when they have picked the right races to benefit. Separate but equal is “inherently unequal,” said Brown. 347 U. S., at 495 (emphasis added). It depends, says the dissent."

 

[WhereMyLiberalsAt]

I really don't care whether you agree with me or not, as the stakes are much higher for me than they are for you and they definitely don't hinge on whatever singular paper you're talking about, but you live a sheltered life if you think a 'post-racial' society is actually possible in the United States, of all places.

This is the crux of everything… Intolerance. You’re literally incapable of tolerating an opposing view? To assume someone who has an opposing solution to a problem must have less skin in the game than you is naive.

Let me be clearer when I say body of work… Postmodern philosophy and critical theory as a whole is intellectually frail. When found masquerading as medical science it generally is in an attempt to cudgel its way into legitimacy. (Interesting fact: Justice Jackson’s decent opinion included the trash study I mentioned previously.)

There is a reason I’m tolerant of your idea… It’s not because I believe my idea is inherently better (I actually do believe mine is superior), however, it’s because I believe in liberal fundamentals.

A post-racial society is possible, it’s just hitting this speed bump what seems to be some sort of Cultural Maoism/Marxism.

The Boomer/Gen X whites will never agree with us on that issue, so in my opinion it's a moot point to argue it.

Discounting older generations… Discounting wisdom… Are you really that confident that you have complete understanding of the problem and solution? This is a dogmatism and fanaticism manifesting itself.

"unity, criticism, unity". To elaborate, it means starting from the desire for unity, resolving contradictions through criticism or struggle and arriving at a new unity on a new basis. In our experience this is the correct method of resolving contradictions among the people.
On the Correct Handling of Contradictions Among the People (February 27, 1957), 1st pocket ed., p. 12.

It wasn’t an accident the Red Guard was full of youth and “old things” were a target for the dogma.

 

[Kierkegaard's Bud]

This is the crux of everything… Intolerance. You’re literally incapable of tolerating an opposing view? To assume someone who has an opposing solution to a problem must have less skin in the game than you is naive.

Let me be clearer when I say body of work… Postmodern philosophy and critical theory as a whole is intellectually frail. When found masquerading as medical science it generally is in an attempt to cudgel its way into legitimacy. (Interesting fact: Justice Jackson’s decent opinion included the trash study I mentioned previously.)

There is a reason I’m tolerant of your idea… It’s not because I believe my idea is inherently better (I actually do believe mine is superior), however, it’s because I believe in liberal fundamentals.

A post-racial society is possible, it’s just hitting this speed bump what seems to be some sort of Cultural Maoism/Marxism.


Discounting older generations… Discounting wisdom… Are you really that confident that you have complete understanding of the problem and solution? This is a dogmatism and fanaticism manifesting itself.

"unity, criticism, unity". To elaborate, it means starting from the desire for unity, resolving contradictions through criticism or struggle and arriving at a new unity on a new basis. In our experience this is the correct method of resolving contradictions among the people.
On the Correct Handling of Contradictions Among the People (February 27, 1957), 1st pocket ed., p. 12.

It wasn’t an accident the Red Guard was full of youth and “old things” were a target for the dogma.

It’s quite myopic to think 100-200 year issues will be solved because of your blinkered optimism. Is a post-racial society possible, maybe for my grandchildren.

Calling CRT intellectually frail while it’s road blocked in many states and new minds can’t contribute to its growth is like a government official gutting a social program and saying it doesn’t work after all.

 

[Lawpy]

The biggest injustice is the continued persistence of legacy admissions

Legacy admissions propagate both structural racism and massive socioeconomic disparities and have done so for decades to centuries

End legacy admissions permanently and it’s a huge step forward for DEI

 

[WhereMyLiberalsAt]

new minds can’t contribute to its growth

CRT is nothing new… It uses the same dialectics Hegel and Marx uses. Hence the insane amount of frail worthless “sub-genres” postmodernism has spewed out.

It’s quite myopic to think 100-200 year issues will be solved because of your blinkered optimism. Is a post-racial society possible, maybe for my grandchildren.

You’re making multiple assumptions. I don’t believe my optimism solves the issue… Liberalism solves the issue. You’re assuming I believe this is a quick fix or something I’ll see in my life time. The idea that my grandchildren have the possibility to live in a post-racial society is significant. Even after this regressive delay in progress, countless other speed bumps are ahead (ie corporatism.)

 

[MateoGM416]

CRT is nothing new… It uses the same dialectics Hegel and Marx uses. Hence the insane amount of frail worthless “sub-genres” postmodernism has spewed out.

I honestly can't tell if you're trolling at this point

 

[WhereMyLiberalsAt]

I honestly can't tell if you're trolling at this point

Um yikes.... This is pretty straight forward stuff. A quote comes to mind "never cure what you don't understand".... There is a reason critical theory utilizes struggle sessions, institutional capture, and ad hominem. The ideas/theories are frail and can't withstand thorough examination.

Merlin | A History of Western Philosophy Chart

This awesome chart from superscholar.org provides an abbreviated, easy to follow, and informative overview of the flow of thought in Western Philosophy.

merlinccc.org

https://www.tandfonline.com/doi/full/10.1080/00131857.2021.1876669

Critical Philosophy of Race (Stanford Encyclopedia of Philosophy)

Sokal affair - Wikipedia

en.wikipedia.org

Grievance studies affair - Wikipedia

en.wikipedia.org

 

[Kierkegaard's Bud]

Um yikes.... This is pretty straight forward stuff. A quote comes to mind "never cure what you don't understand".... There is a reason critical theory utilizes struggle sessions, institutional capture, and ad hominem. The ideas/theories are frail and can't withstand thorough examination.

View attachment 373891

Merlin | A History of Western Philosophy Chart

This awesome chart from superscholar.org provides an abbreviated, easy to follow, and informative overview of the flow of thought in Western Philosophy.

merlinccc.org

https://www.tandfonline.com/doi/full/10.1080/00131857.2021.1876669

Critical Philosophy of Race (Stanford Encyclopedia of Philosophy)

Sokal affair - Wikipedia

en.wikipedia.org

Grievance studies affair - Wikipedia

en.wikipedia.org

Couple of things to unpack:

Struggle sessions are more of a Marxist notion. CRT isn’t even a branch of analytical philosophy so those two concepts don’t go together.

Be a little humble, this is from your own citation, it would behoove you to read before you post. “To suggest that CPR has a singular methodology would be a mistake: discourse analysis, psychoanalysis, and phenomenology have conducted a famous war against one another, and do not share a methodology.”

 

[WhereMyLiberalsAt]

Struggle sessions are more of a Marxist notion

More Maoist, but sure... Pick your poison.

ON THE CORRECT HANDLING OF CONTRADICTIONS AMONG THE PEOPLE

it would behoove you to read before you post. “To suggest that CPR has a singular methodology would be a mistake: discourse analysis, psychoanalysis, and phenomenology have conducted a famous war against one another, and do not share a methodology.”

smh... keep reading... "In general, Critical Philosophers of Race focus on how race operates in societies, the effects of race at both the structural and phenomenological levels, and the ways in which some forms of resistance to racial systems can be recuperated into sustaining the status quo."

Honestly, you're horrendous with your assumptions. They're just straw man arguments. I never said they were singular, nor did I say anything about which specific methodologies they employ.

CRT isn’t even a branch of analytical philosophy

Didn't say it was... In fact... I'm pretty sure that map (or journal article) I posted didn't say that either. Not sure what you're trying to get at... I mentioned Hegel, Marx, and Mao... Hegel is contrasted against analytical philosophy.

But honestly, either way... That isn't even the "essence" of my argument. The dialectic is used to form an evolution... be it material dialectic or some other "insert critical theory" dialectic.

 

[operaman]

I really don't care whether you agree with me or not, as the stakes are much higher for me than they are for you and they definitely don't hinge on whatever singular paper you're talking about, but you live a sheltered life if you think a 'post-racial' society is actually possible in the United States, of all places.





Educated, intelligent people saying things these is exactly why we need more underrepresented minorities in medicine. But again the crux of these arguments is the fundamental disagreement of how much of a disadvantage being born black/latino/native in this country puts you at compared to Asian Americans and whites. The Boomer/Gen X whites will never agree with us on that issue, so in my opinion it's a moot point to argue it.

I do wonder though how the ridiculous way white politicians who legislated affirmative action categorized the Asian diaspora the way they did somehow became our problem. Two different things being wrong at the same time doesn't make one of those things less of an issue.

Perhaps the advantage of being a Boommer/GenX white is that not being subject to the disparites faced by minorities allows them to see the nuances and how all the pieces fit together.

I don't think anyone would argue that being born black/latino/native in the US has disadvantages, but when compared to certain whites and asians on an individual level it gets more comlicated. Hmong or Burmese applicants may have faced very similar disparities as black/latino applicants, but they get lumped in with wealthy Korean and Japanese applicants simply because they look similar to white people. Now you have a system openly discriminating against people solely on race.

The old AA system also fails on helping many of those who are black/latino because skin color is a poor surrogate for hardships. If we want to stick with the surgical subs idea, take a look at any top tier residency class. Let’s take the Harvard Ortho program. Yes, very white and Asian predominantly, but of the 5 black residents with pictures up, 4 of them appear to be 1st or 2nd generation African immigrants. So while they have the right skin color to assuage the white guilt, they’re often coming from a far different set of circumstances than those suffering the generational trauma of slavery and Jim Crow.

AA is simply too lazy and fails to look beyond skin color to examine real disadvantages and give a leg up to those who really need it. Hopefully as schools pivot from race to discrimination and hardship measures, it may still have a similar result in terms of overall demographics, but perhaps more people who really need the help can get a boost.

 

[Kierkegaard's Bud]

More Maoist, but sure... Pick your poison.

ON THE CORRECT HANDLING OF CONTRADICTIONS AMONG THE PEOPLE

smh... keep reading... "In general, Critical Philosophers of Race focus on how race operates in societies, the effects of race at both the structural and phenomenological levels, and the ways in which some forms of resistance to racial systems can be recuperated into sustaining the status quo."

Honestly, you're horrendous with your assumptions. They're just straw man arguments. I never said they were singular, nor did I say anything about which specific methodologies they employ.


Didn't say it was... In fact... I'm pretty sure that map (or journal article) I posted didn't say that either. Not sure what you're trying to get at... I mentioned Hegel, Marx, and Mao... Hegel is contrasted against analytical philosophy.

But honestly, either way... That isn't even the "essence" of my argument. The dialectic is used to form an evolution... be it material dialectic or some other "insert critical theory" dialectic.

Have a good one. Learn to communicate decently, I heard it's free.

 

[GadRads]

My racially homogenous home country has a similar diversity system in higher education and jobs. Certain ethnic groups and states who tend to score lower on the university entry exams have an "easier" time compared to the more scholastic and higher-achieving regions of the country. The higher-performing ethnic groups still dominate institutions of higher learning. For example, a high-performing state or ethnic group may have an average score of 85% with a B+ average, while the lower performing ethnic groups may score 75%/C+ on average. No ethnic group has previously enslaved another or perpetuated racism, although there is ethnocentrism which can be equally directed against any ethnic group. The compelling interest is ensuring each state or ethnic group has the opportunity to succeed. I personally view affirmative action in the US similarly.

I also think most DEI programs are smokescreens. They look good on a paper, but those in power don't really care about it, especially at the residency level.

 

[aldol16]

In response to OP, that is a view that is shared by many people in this country and many within medicine as well. My own feeling is that these DEI programs tend to emphasize superficial factors rather than personal ones when dealing with the issue and they do it so that they can market it. They do it for the sake of doing it rather than getting at the underlying rationale.

 

[EngineerPreMD]

In response to OP, that is a view that is shared by many people in this country and many within medicine as well. My own feeling is that these DEI programs tend to emphasize superficial factors rather than personal ones when dealing with the issue and they do it so that they can market it. They do it for the sake of doing it rather than getting at the underlying rationale.

Well under current DEI initiatives schools get no credit for accepting a white man from rural Kentucky who is likely to go back to his community to practice. It just shows you have to set up the system with the right incentives. Some schools are approaching this with "disadvantage scores," but as long as the supposed goals are framed as "fairness" initiatives, I don't see this issue ever getting solved through admissions policy. The goals need to be based in pure practicality and openly acknowledge bias, which is why this ruling is a huge step back for anyone who wants the physician workforce to represent the US from a socioeconomic perspective.

The argument is that socioeconomic factors make admission criteria unfair for low SES individuals, and we're rediscovering lost intellect/talent by not overlooking those who had disadvantages. That's true for some people. However, it's 2023 and intellectual segregation is at an all time high. People gravitate towards and start a family with people of similar intellect and work ethic. Doctors marry similarly intelligent professionals, and then they have kids who are highly qualified to be doctors, and it's not just because they had a stable home and help with schoolwork (though it undeniably contributes). So if the goal is for the physician workforce to represent the US population in SES while fairly identifying talent, it will never happen. A meritocracy naturally and rapidly creates an intellectual and socioeconomic divide, even if it's imperfect.

Schools need to outright say that representation from rural communities and from black/hispanic communities is more important than intellectual prowess for creating an effective physician workforce. That's the reality. On average, the kid from Kentucky is probably not as smart or talented as the kid from NYC with MCAT scores 10 points higher and a better GPA from a more competitive school, and they probably wouldn't be even if they went to private school, but they are a better addition to the physician workforce. Same with a Spanish-speaking hispanic kid or a black kid who can better communicate with and gain the trust of many patients.

 

[ChordaEpiphany]

I don't think anyone would argue that being born black/latino/native in the US has disadvantages, but when compared to certain whites and asians on an individual level it gets more comlicated. Hmong or Burmese applicants may have faced very similar disparities as black/latino applicants, but they get lumped in with wealthy Korean and Japanese applicants simply because they look similar to white people. Now you have a system openly discriminating against people solely on race.

The old AA system also fails on helping many of those who are black/latino because skin color is a poor surrogate for hardships. If we want to stick with the surgical subs idea, take a look at any top tier residency class. Let’s take the Harvard Ortho program. Yes, very white and Asian predominantly, but of the 5 black residents with pictures up, 4 of them appear to be 1st or 2nd generation African immigrants. So while they have the right skin color to assuage the white guilt, they’re often coming from a far different set of circumstances than those suffering the generational trauma of slavery and Jim Crow.

AA is simply too lazy and fails to look beyond skin color to examine real disadvantages and give a leg up to those who really need it. Hopefully as schools pivot from race to discrimination and hardship measures, it may still have a similar result in terms of overall demographics, but perhaps more people who really need the help can get a boost.

Definitely agree that AA does not capture the nuances, and I'm really glad someone brought up immigrant vs. generational trauma of slavery/Jim Crow. We absolutely group people according to who looks similar to white people. However, immigrants are often (though not always) a much more privileged class than generationally oppressed minorities. Immigrants often had an education, exceptional talent, and some sort of means in their home country, which is how they came to the US to begin with. So even if they don't speak English and can't afford a middle-class life, they still pass down intelligence, work ethic, and cultural ideals that were fostered for generations in an environment where they were not wealthy but also not systematically oppressed. Black people in the US are overcoming generations of culture that taught them that they cannot succeed regardless of hard work or talent, and this goes underappreciated in a system that only appreciates skin tone.

 

[operaman]

Well under current DEI initiatives schools get no credit for accepting a white man from rural Kentucky who is likely to go back to his community to practice. It just shows you have to set up the system with the right incentives. Some schools are approaching this with "disadvantage scores," but as long as the supposed goals are framed as "fairness" initiatives, I don't see this issue ever getting solved through admissions policy. The goals need to be based in pure practicality and openly acknowledge bias, which is why this ruling is a huge step back for anyone who wants the physician workforce to represent the US from a socioeconomic perspective.

The argument is that socioeconomic factors make admission criteria unfair for low SES individuals, and we're rediscovering lost intellect/talent by not overlooking those who had disadvantages. That's true for some people. However, it's 2023 and intellectual segregation is at an all time high. People gravitate towards and start a family with people of similar intellect and work ethic. Doctors marry similarly intelligent professionals, and then they have kids who are highly qualified to be doctors, and it's not just because they had a stable home and help with schoolwork (though it undeniably contributes). So if the goal is for the physician workforce to represent the US population in SES while fairly identifying talent, it will never happen. A meritocracy naturally and rapidly creates an intellectual and socioeconomic divide, even if it's imperfect.

Schools need to outright say that representation from rural communities and from black/hispanic communities is more important than intellectual prowess for creating an effective physician workforce. That's the reality. On average, the kid from Kentucky is probably not as smart or talented as the kid from NYC with MCAT scores 10 points higher and a better GPA from a more competitive school, and they probably wouldn't be even if they went to private school, but they are a better addition to the physician workforce. Same with a Spanish-speaking hispanic kid or a black kid who can better communicate with and gain the trust of many patients.

This is definitely a point where we and many others likely disagree. And it was also an interesting point that got discussed in the SCOTUS case, and was summarily rejected.

Personally, I don’t think diversity is more important than actual intellectual prowess, but defining the term diversity itself is a moving target and something good people can disagree on as well. But I just don’t see any compelling argument that there’s a benefit to be gained by making the physician workforce look like the population at the expense of intellectual ability. There was one terrible paper out of Florida awhile back that tried to claim black people got better care from black doctors, but the study was so comically flawed that even an MS1 after one EBM class could see why it was invalid.

We see the end result of this diversity ethos in higher attrition rates for disadvantaged students both at the med school and residency level, especially in surgical fields. You can only give so much leeway for disadvantage before you’re letting in people who lack the baseline ability to make it through. It’s a tough needle to thread and something schools have struggled with for decades.

I think the med Ed system has been addressing some of this issue by opening schools in many more rural areas, so that poor kid from Kentucky, assuming he’s actually got the chops to do it, can probably gain admission to a school in his home state or nearby and get his medical degree that way. That’s long been a mission of state schools and they heavily weigh in state residency in their decision making process. Their goal is less about some abstract concept if diversity and more about training doctors who are more likely to practice locally, a goal that makes practical sense.

 

[operaman]

Definitely agree that AA does not capture the nuances, and I'm really glad someone brought up immigrant vs. generational trauma of slavery/Jim Crow. We absolutely group people according to who looks similar to white people. However, immigrants are often (though not always) a much more privileged class than generationally oppressed minorities. Immigrants often had an education, exceptional talent, and some sort of means in their home country, which is how they came to the US to begin with. So even if they don't speak English and can't afford a middle-class life, they still pass down intelligence, work ethic, and cultural ideals that were fostered for generations in an environment where they were not wealthy but also not systematically oppressed. Black people in the US are overcoming generations of culture that taught them that they cannot succeed regardless of hard work or talent, and this goes underappreciated in a system that only appreciates skin tone.

Yeah it’s something that doesn’t get talked about much. It’s the classic six sigma “what gets measured gets done” adage. It’s why I think the SCOTUS ruling has the potential to do a lot of good. The fact is that a 2nd generation Nigerian American immigrant has a LOT more advantage than the son and daughters of former slaves and sharecroppers. They come over with intact multi-generational families, strong religious convictions, often some financial resources, and a set of cultural values that lends itself very well to success in the United States. Their rates of college and professional degrees exceed many other racial groups entirely.

It’s going to take a lot more work, but I think the end result could be much better. I don’t think anyone has a problem with giving disadvantaged applicants a boost to account for their life circumstances, but to do so just because of their skin color is lazy and woefully insufficient. Those on the left decrying the SCOTUS ruling forget that liberal California got rid of AA in college admissions years ago, yet nobody would accuse Cali schools of not caring about diversity.

 

[lolthroaway]

This is definitely a point where we and many others likely disagree. And it was also an interesting point that got discussed in the SCOTUS case, and was summarily rejected.

Personally, I don’t think diversity is more important than actual intellectual prowess, but defining the term diversity itself is a moving target and something good people can disagree on as well. But I just don’t see any compelling argument that there’s a benefit to be gained by making the physician workforce look like the population at the expense of intellectual ability. There was one terrible paper out of Florida awhile back that tried to claim black people got better care from black doctors, but the study was so comically flawed that even an MS1 after one EBM class could see why it was invalid.

We see the end result of this diversity ethos in higher attrition rates for disadvantaged students both at the med school and residency level, especially in surgical fields. You can only give so much leeway for disadvantage before you’re letting in people who lack the baseline ability to make it through. It’s a tough needle to thread and something schools have struggled with for decades.

I think the med Ed system has been addressing some of this issue by opening schools in many more rural areas, so that poor kid from Kentucky, assuming he’s actually got the chops to do it, can probably gain admission to a school in his home state or nearby and get his medical degree that way. That’s long been a mission of state schools and they heavily weigh in state residency in their decision making process. Their goal is less about some abstract concept if diversity and more about training doctors who are more likely to practice locally, a goal that makes practical sense.

You keep going on about attrition rates, but do you have data? Last I checked attrition rates in general surgery were higher for all minority groups, and even then it was 2-3% higher than whites. Is that really meaningful? And can you say it's due to them being disadvantaged, not as prepared, not as intelligent, etc? Considering rates of discrimination are higher for minority physicians, combined with the stress of residency (especially in surgery), I don't find it surprising attrition rates are a bit higher.

 

[operaman]

You keep going on about attrition rates, but do you have data? Last I checked attrition rates in general surgery were higher for all minority groups, and even then it was 2-3% higher than whites. Is that really meaningful? And can you say it's due to them being disadvantaged, not as prepared, not as intelligent, etc? Considering rates of discrimination are higher for minority physicians, combined with the stress of residency (especially in surgery), I don't find it surprising attrition rates are a bit higher.

I think the key is the relative rates - 2-3% more is not that much, unless the baseline is also around that much. Then You’re looking at a significant increase. There have been a number of papers looking at Gen surg, subspecialty, and even medical school attrition. The results are all consistent and show that URM and other disadvantaged students wash out at a higher rate.

Causality is another issue and to my knowledge nobody has published any good studies on this. A good multivariate analysis using things like mcat and usmle to control for baseline ability/knowledge level would be interesting. To my knowledge that hasn’t been published, and I can’t imagine many PIs willing to risk publishing it if the results ran counter to the prevailing narrative. Without a good multivariate analysis, it’s a big leap to claim discrimination as the primary cause for the attrition.

 

[GorillaPanic]

they have set demographic quotas for selecting residents.

I'm unsure how they can set "quotas" when residents are selected via the match... not really how the match system works.

 

[lolthroaway]

I think the key is the relative rates - 2-3% more is not that much, unless the baseline is also around that much. Then You’re looking at a significant increase. There have been a number of papers looking at Gen surg, subspecialty, and even medical school attrition. The results are all consistent and show that URM and other disadvantaged students wash out at a higher rate.

Causality is another issue and to my knowledge nobody has published any good studies on this. A good multivariate analysis using things like mcat and usmle to control for baseline ability/knowledge level would be interesting. To my knowledge that hasn’t been published, and I can’t imagine many PIs willing to risk publishing it if the results ran counter to the prevailing narrative. Without a good multivariate analysis, it’s a big leap to claim discrimination as the primary cause for the attrition.

I'll stick to the residency portion since that's the main topic of the thread, and the medical school portion deserves more analysis.

So unless I was looking at something different or not I'm not remembering correctly, white attrition rates were around 2%, Asian around 3%, and black around 4%. In a large sample size that's only a couple more black residents compared to whites. I don't have any hard data on the reason(s) behind that, but considering Asians (who have comparable scores to whites) also have slightly higher attrition, I find it more likely it's due to something like discriminatory experiences rather than deficiencies in ability as you're implying.

 

[GadRads]

I think the key is the relative rates - 2-3% more is not that much, unless the baseline is also around that much. Then You’re looking at a significant increase. There have been a number of papers looking at Gen surg, subspecialty, and even medical school attrition. The results are all consistent and show that URM and other disadvantaged students wash out at a higher rate.

Causality is another issue and to my knowledge nobody has published any good studies on this. A good multivariate analysis using things like mcat and usmle to control for baseline ability/knowledge level would be interesting. To my knowledge that hasn’t been published, and I can’t imagine many PIs willing to risk publishing it if the results ran counter to the prevailing narrative. Without a good multivariate analysis, it’s a big leap to claim discrimination as the primary cause for the attrition.

I am strongly convinced that discrimination is one important cause of the higher attrition rate, even if it is not the only factor. Discrimination does not have to be overt like being harassed with racial insults to result in an unfortunate outcome. It can be subtle and difficult to "prove", and that subtle execution can be just as effective.

URMs (and even non-URMs such as Asians) still experience varying degrees of prejudice and negative effects of implicit bias during medical training which can impact attending ratings of trainee performance. See PUBMED ID: 31032666): ("non-URM minority students were more likely than White students (Adjusted Odds Ratio = 0.53), confidence interval [0.36, 0.76], p = .001, to receive a lower category MSPE summary word in analyses adjusting for student demographics (age, gender, maternal education), year, and United States Medical Licensing Examination Step 1 scores. Similarly, in four of six required clerkships, grading disparities (p < .05) were found to favor White students over either URM or non-URM minority students. In all analyses, after accounting for all available confounding variables, grading disparities favored White students.") So even when adjusting for scores, URMs still receive lower evaluations compared to white students. A similar pattern was recently shown for IM residents in their PGY1 and PGY2 years. It is not a stretch to see how such evaluations can ultimately result in a perception of poorer performance, lower ratings, trainee stress, withdrawals, transfers, and even dismissals.

Conversations with high-performing URM attendings indicate that this implicit bias/discrimination is not uncommon. One of my close colleagues (1st gen black immigrant) who finished top 10 in his/her class at a big state school, AOA, 260s boards, high in-training exam scores, etc and is now an attending in a very competitive surgical subspecialty, experienced several episodes of encountering implicit bias, and in some cases outright racism and xenophobia, with one case requiring the involvement of higher authorities at his/her institution. Consistent with what he/she noticed, the OR techs approached my colleague to say that there were some attendings (usually white) who routinely gave more leeway to white residents (compared to URMs) before taking over a surgical case. It is easy to see how this leads to less independence for a trainee and the negative effect this can have on trainee confidence. My colleague approached this problem by being extra-prepared for every case and taking advantage of the good graces of other surgeons who were more willing to teach and allow him/her operate with a longer leash. Now these are all anecdotes, but almost every URM has encountered at least one sour event of implicit bias/prejuduce clearly influenced by race/ethnicity. This also matches my experience as a URM with very strong performance. If this can happen to high-performing URMs, I would expect a higher frequency for average or marginal URMs. It is not a stretch to see how this can contribute to higher rates of attrition.

 

[lolthroaway]

I am strongly convinced that discrimination is one important cause of the higher attrition rate, even if it is not the only factor. Discrimination does not have to be overt like being harassed with racial insults to result in an unfortunate outcome. It can be subtle and difficult to "prove", and that subtle execution can be just as effective.

URMs (and even non-URMs such as Asians) still experience varying degrees of prejudice and negative effects of implicit bias during medical training which can impact attending ratings of trainee performance. See PUBMED ID: 31032666): ("non-URM minority students were more likely than White students (Adjusted Odds Ratio = 0.53), confidence interval [0.36, 0.76], p = .001, to receive a lower category MSPE summary word in analyses adjusting for student demographics (age, gender, maternal education), year, and United States Medical Licensing Examination Step 1 scores. Similarly, in four of six required clerkships, grading disparities (p < .05) were found to favor White students over either URM or non-URM minority students. In all analyses, after accounting for all available confounding variables, grading disparities favored White students.") So even when adjusting for scores, URMs still receive lower evaluations compared to white students. A similar pattern was recently shown for IM residents in their PGY1 and PGY2 years. It is not a stretch to see how such evaluations can ultimately result in a perception of poorer performance, lower ratings, trainee stress, withdrawals, transfers, and even dismissals.

Conversations with high-performing URM attendings indicate that this implicit bias/discrimination is not uncommon. One of my close colleagues (1st gen black immigrant) who finished top 10 in his/her class at a big state school, AOA, 260s boards, high in-training exam scores, etc and is now an attending in a very competitive surgical subspecialty, experienced several episodes of encountering implicit bias, and in some cases outright racism and xenophobia, with one case requiring the involvement of higher authorities at his/her institution. Consistent with what he/she noticed, the OR techs approached my colleague to say that there were some attendings (usually white) who routinely gave more leeway to white residents (compared to URMs) before taking over a surgical case. It is easy to see how this leads to less independence for a trainee and the negative effect this can have on trainee confidence. My colleague approached this problem by being extra-prepared for every case and taking advantage of the good graces of other surgeons who were more willing to teach and allow him/her operate with a longer leash. Now these are all anecdotes, but almost every URM has encountered at least one sour event of implicit bias/prejuduce clearly influenced by race/ethnicity. This also matches my experience as a URM with very strong performance. If this can happen to high-performing URMs, I would expect a higher frequency for average or marginal URMs. It is not a stretch to see how this can contribute to higher rates of attrition.

Same.

 

[GadRads]

I'll stick to the residency portion since that's the main topic of the thread, and the medical school portion deserves more analysis.

So unless I was looking at something different or not I'm not remembering correctly, white attrition rates were around 2%, Asian around 3%, and black around 4%. In a large sample size that's only a couple more black residents compared to whites. I don't have any hard data on the reason(s) behind that, but considering Asians (who have comparable scores to whites) also have slightly higher attrition, I find it more likely it's due to something like discriminatory experiences rather than deficiencies in ability as you're implying.

Unless one has experienced prejudice or been at the negative end of implicit/ethnic bias, some of these matters can be hard to understand for most in the dominant culture. It becomes purely an academic issue, and belief is suspended unless definite proof is laid bare, despite the mountain of data suggesting that the hypothesis is more than likely true. As an immigrant, I questioned racial bias, until I experienced it despite working my tail off. I was not a weak medical student, resident or fellow. Thankfully, I don't believe racism has been a significant part of my medical experience, but I could imagine it being way worse if I were an average student or trainee, or if the few isolated experiences I suffered met the right amount of circumstantial baggage and fuel to create a large flame. Being the target of even one attending who has influence can make a trainee's experience very challenging. It is these experiences (and that of others), that have given me pause when I read about or come across these issues.

It is well known that appearing as similar as you can to the dominant culture, helps with your ratings and perception. Another example: a black female resident received a lower grade on professionalism because her hair was too curly. The attending essentially implied straighter hair was 'more professional'. She got good evaluations otherwise from this attending. The attending was probably not outright racist, but it is easy to see the disparate racial impact of "enforcing" the assumption that the linearity of one's hair is somewhat proportional to professional status.

 

[lolthroaway]

Unless one has experienced prejudice or been at the negative end of implicit/ethnic bias, some of these matters can be hard to understand for most in the dominant culture. It becomes purely an academic issue, and belief is suspended unless definite proof is laid bare, despite the mountain of data suggesting that the hypothesis is more than likely true. As an immigrant, I questioned racial bias, until I experienced it despite working my tail off. I was not a weak medical student, resident or fellow. Thankfully, I don't believe racism has been a significant part of my medical experience, but I could imagine it being way worse if I were an average student or trainee, or if the few isolated experiences I suffered met the right amount of circumstantial baggage and fuel to create a large flame. Being the target of even one attending who has influence can make a trainee's experience very challenging. It is these experiences (and that of others), that have given me pause when I read about or come across these issues.

It is well known that appearing as similar as you can to the dominant culture, helps with your ratings and perception. Another example: a black female resident received a lower grade on professionalism because her hair was too curly. The attending essentially implied straighter hair was 'more professional'. She got good evaluations otherwise from this attending. The attending was probably not outright racist, but it is easy to see the disparate racial impact of "enforcing" the assumption that the linearity of one's hair is somewhat proportional to professional status.

Yeah...this is sort of an aside, but I have friends at several different medical schools in this era of increasing social justice courses/seminars. A common theme is that my white, usually conservative, friends will often moan about the constant blaming of white men for the problems in medicine. And they can only angrily sit through these microaggressions because they fear any pushback will impact their evaluations...or worse. However, they'll definitely form safe spaces to complain about it, which is completely understandable. I just find it ironic that they're so triggered after dealing with things like this for 1-4 years in medicine (depending on curriculum), when minorities and women deal with it their whole lives. And they'll usually be the first to be dismissive when they hear any other group complain about discrimination.

 

[WhereMyLiberalsAt]

era of increasing social justice courses/seminars

Medical student in favor of forced seminars? Ok, Mr. lolthroaway school administrator… Tell me, are these “medical student friends” in the room with you right now?

 

[lolthroaway]

View attachment 374138

Medical student in favor of forced seminars? Ok, Mr. lolthroaway school administrator… Tell me, are these “medical student friends” in the room with you right now?

Major leap there bud. Where did I imply anyone is in favor of them? I just said we're in an era where they're increasingly becoming common in medical school curricula.

 

[WhereMyLiberalsAt]

Major leap there bud. Where did I imply anyone is in favor of them? I just said we're in an era where they're increasingly becoming common in medical school curricula.

So it’s just not white male conservatives that dislike this curricula? So their angst towards the entire affair, if given the benefit of the doubt, could be chalked up to their disdain that they are forced in doing something other than study? If us med students couldn’t bitch amongst each other, I don’t know what we’d talk about. Just the way you wrote it made it sound like they should be enthusiastic about the ordeal. Still think you’re a Fed Mr. Throwaway Account, but I digress.

 

[lolthroaway]

So it’s just not white male conservatives that dislike this curricula? So their angst towards the entire affair, if given the benefit of the doubt, could be chalked up to their disdain that they are forced in doing something other than study? If us med students couldn’t bitch amongst each other, I don’t know what we’d talk about. Just the way you wrote it made it sound like they should be enthusiastic about the ordeal. Still think you’re a Fed Mr. Throwaway Account, but I digress.

No, in my experience it's only pandering SJW that actually like being forced to go, but it's not like I have a poll of the general feelings of med students everywhere.

Again in my experience, most people (including myself) hate the fact that we're forced to go when we could be studying. However, my white conservative friends specifically complain about their demographic being made scapegoats by leftist teachers. If you read my blurb I said I understand the frustration; I agree with some of their points. I just find it ironic that they make fun of liberals for forming safe spaces when they're doing the same thing. And that they're so triggered after enduring microaggressions for just 1-4 years, but will still readily dismiss claims of discrimination from minorities and women.

 

[Mr.Smile12]

Well under current DEI initiatives schools get no credit for accepting a white man from rural Kentucky who is likely to go back to his community to practice

I'm not sure where this is explicitly stated, so if you have examples, great! Most programs I am aware of highly desire any individual who grew up in a rural environment who wants to go back home to practice, especially if it is in their mission.

 

[Mr.Smile12]

The argument is that socioeconomic factors make admission criteria unfair for low SES individuals, and we're rediscovering lost intellect/talent by not overlooking those who had disadvantages. That's true for some people. However, it's 2023 and intellectual segregation is at an all time high. People gravitate towards and start a family with people of similar intellect and work ethic. Doctors marry similarly intelligent professionals, and then they have kids who are highly qualified to be doctors, and it's not just because they had a stable home and help with schoolwork (though it undeniably contributes). So if the goal is for the physician workforce to represent the US population in SES while fairly identifying talent, it will never happen. A meritocracy naturally and rapidly creates an intellectual and socioeconomic divide, even if it's imperfect.

Schools need to outright say that representation from rural communities and from black/hispanic communities is more important than intellectual prowess for creating an effective physician workforce. That's the reality. On average, the kid from Kentucky is probably not as smart or talented as the kid from NYC with MCAT scores 10 points higher and a better GPA from a more competitive school, and they probably wouldn't be even if they went to private school, but they are a better addition to the physician workforce. Same with a Spanish-speaking hispanic kid or a black kid who can better communicate with and gain the trust of many patients.

I should point out arguing the monolithic "Schools." Many statements about the need for more rural practitioners and those serving in highly urban or marginalized areas are consistently made by all of the higher ed medical professional associations (med, dent, PA, pharm, vet, nursing, etc.). I don't think you will hear many of them saying that it is more important than a scientifically literate/excellent workforce capable of doing these jobs properly; it's a false choice to say you must compromise "excellence" to get "diversity", especially if the sole definition of "excellence" is a "meritocracy" solely based on academic metrics. What do you think "holistic review" is all about? We've been touting this at least 10 years. Osteopathic schools have been doing this for over 20 years!

Is the result that is desirable to have a rural student from Kentucky get into a brand-name school far away from the networking and resources that rural future provider may need to establish roots more quickly? The win is getting that person into school with the right support within the school and within the network where he/she needs to connect with.

This is why these secondary essays and interviews are so important. That is why I tell people 'mission fit' is paramount. That's why the many WAMC threads that only provide metrics and hours are insufficient to determine how successful one is to get an interview or an offer.

What you are saying "should happen" is happening. I don't think that's the argument or the issue. Many of us do acknowledge the different rivers that lead to the applicant pool.

 

[Mr.Smile12]

So it’s just not white male conservatives that dislike this curricula? So their angst towards the entire affair, if given the benefit of the doubt, could be chalked up to their disdain that they are forced in doing something other than study? If us med students couldn’t bitch amongst each other, I don’t know what we’d talk about. Just the way you wrote it made it sound like they should be enthusiastic about the ordeal. Still think you’re a Fed Mr. Throwaway Account, but I digress.

There's a reason why many schools will ask in secondaries and interviews: "describe a time where you felt in the minority" even to majority-race/ethnic candidates. There are parts of the curriculum that are going to make people very uncomfortable. That's life, and we have to learn about it. (Not saying you should look forward to it with enthusiasm and joy.) We presume everyone will find ways to discuss their feelings in a safe and mature way like a professional.

 

[Kierkegaard's Bud]

So it’s just not white male conservatives that dislike this curricula? So their angst towards the entire affair, if given the benefit of the doubt, could be chalked up to their disdain that they are forced in doing something other than study? If us med students couldn’t bitch amongst each other, I don’t know what we’d talk about. Just the way you wrote it made it sound like they should be enthusiastic about the ordeal. Still think you’re a Fed Mr. Throwaway Account, but I digress.

Get a life.