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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.
 
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Q: I still don’t understand why the child of a wealthy immigrant family from, say, Guinea, Guatemala or Morocco should get a boost and URM preference over a poor kid from Appalachia, the child of parents who had to hustle as cooks in a Chinese or Indian restaurant, or a descendant of boat people from Vietnam. How can you justify this?
A: Again I promised to be blunt and honest with this FAQ, and since variations on this question come up all the time in our Q&A’s with applicants and families, I’ll address it in frank terms here. As spelled out before, we on admissions committees are making our decisions with a broad and often challenging societal big picture in mind, and our ultimate mandate is to recruit a more diverse pool of physicians to meet the needs of an ever more diverse American population. The immediate future for America, as well as for Canada and Australia, is that the demographics will have changed radically within the next two decades from a majority European-derived population to a majority non-European population, indeed this is already true of the school-age population that will soon be signing up for pre-med courses and taking the MCAT. Given the many years involved in medical training and gaining of career expertise, we are obligated to anticipate this change and prepare for it well in advance, as reflected in our minority recruitment efforts.

Just looking at the USA as of 2016, far more white /Caucasian Americans die every year than are born, while the opposite is true for Latinos, African-Americans and those of Middle Eastern/North African descent. For those of you with a public health bent, you may have encountered the famous studies by Nobel Laureate Angus Deaton and Anne Case, published in the last 2 years, demonstrating a sharp and worsening spike in mortality for American whites although, curiously, not for their counterparts in Europe, perhaps due to better health care access. Links for those interested:
Mortality and morbidity in the 21st century
http://www.pnas.org/content/112/49/15078/F1.expansion.html
While this is undoubtedly tragic, the demographic effects are undeniable. At the same time, immigration from Africa, the Caribbean and the Middle East and North Africa is surging, with African immigrants now the fastest-growing immigrant group to America with high naturalization rates, while Latino immigration, already high, also continues to surge. One need not be a demographer or MPH to see the demographic crystal ball here, the sobering reality is that America will sooner than later be a country comprised in the main by people of color who will need physicians to understand and closely interact with their communities.

It’s worth re-stating, as has been demonstrated repeatedly, URM physicians are far more likely to return and serve in their communities, study after study has confirmed this. And since Latino, African-American and other URM communities will soon comprise the majority of America’s population, it would be nothing less than a public health catastrophe for URM’s to be as underrepresented in the physician and nursing population as they currently are. This is why we in the admissions committees do, indeed, often recruit URM students from a wealthy family of African, Latino or Middle Eastern immigrant background: the physicians they will become are far more likely to provide care to, and be able to connect culturally with the communities of color that are rapidly becoming the US majority population. We do, of course, respect and reward working class or middle class applicants of any background who overcome financial hardship to succeed, but as explained before, URM recruitment is a separate matter altogether, and the country’s fast-changing demographics are the ultimate driver for our affirmative action efforts.

Q: What about the recent announcement by the Trump Administration, in July of 2017, that higher educational programs engaging in affirmative action will be investigated by the Justice Department? Won’t this shut down your URM recruitment programs at MD and DO schools?
A: No, not even to the slightest degree. Remember that medical and osteopathic schools are administered almost completely at the state level in the US, and there’s a consensus among both private and public medical schools that affirmative action and URM recruitment are absolutely necessary and if anything must be intensified a few notches with the USA’s rapid diversification. (In case anyone is wondering, anti-affirmative action initiatives in many states have no effect on our policies since they do not forbid URM recruitment, especially when done to ensure a representative physician population.) The Trump Administration’s statements are simply meaningless in a legal and administrative sense since the federal government has so little impact on medical school admissions that are handled almost exclusively at the state level. The only lever the Trump Administration has is cuts in federal and grant funding, but as far as legal avenues, these are all but impossible to affect or alter by the federal government on a school by school basis. Even with Trump’s recent Supreme Court appointment, the Court overall remains quite committed to supporting affirmative action, as many of the justices often regarded as conservative have weighed in favor of it.

The Trump Administration could make deep cuts in federal budget funding for research overall, and the Trump Budget will likely do just that, but this will be a hit felt by med schools and research institutions across the country, not selectively on the basis of our affirmative action and URM recruitment policies. In fact when it comes to legal repercussions, medical schools are in much greater danger if they fail to meet diversity targets under laws that have been in place for a decade or more, some training programs have even been shut down for failing to meet those targets. Thus for reasons of voluntary goals and compliance, medical schools will absolutely continue their affirmative action policies and intensify them over the next few years.

Q: One last question, you pointed out that med school admissions are in general more purely meritocratic in Europe and Asia, based on test scores and academics, due to the very different histories in those continents. But what about South America? It’s composed of settler countries just like the US, Canada and Australia, so why do South American schools generally use the same kind of meritocratic admissions as Europe and Asia, instead of holistic admissions with affirmative action like the US?
A: While the policies do vary throughout South America, with Brazil for many reasons going its own way, it’s true that South American medical schools tend to follow the European “straight meritocracy” model despite being settler nations themselves. The reasons are complicated and beyond what I can express in a short FAQ, but the essence is just the quirks of historical development which have led South America to more closely track the medical education standards established in France, Italy, Portugal, Germany and Spain, the most influential for South American culture in general. For other reasons, within Europe itself, Britain is the one country that’s broken, albeit modestly, with the “pure meritocracy” tradition of the rest of the continent and embraced a form of affirmative action—called “positive discrimination” there—that partly resembles the “visible minority” recruitment practices of Canada, particularly for Caribbean, African and Asian-origin (especially Pakistani-origin) applicants. However, much of this has to do simply with “reverse colonial” influence from the US and Canada, with their affirmative action practices, upon Britain itself.

The more “Continental” pure meritocratic tradition by contrast, like other cultural and administrative standards, has been adopted as the template throughout most of South America. Some even argue that the lack of affirmative action in South America has contributed to the region’s inequality (and thus much of the heavy immigration to the US), but that’s a topic for a different FAQ. For now, it’s probably relevant only if you’re seriously looking at applying to medical school outside the US, learning the language and potentially practicing there after licensure. In that case, as indicated before, it’s doubtful that the “pure meritocracy” of med school admissions in these countries should sway your decision that much. If anything, the low tuition fees, or absence of them, should probably be the main appeal.


All of us on the adcoms know this can be an uncomfortable topic, but I hope the detail and frank talk in the FAQ above can help to take the mystery out of medical school URM recruitment and why we do it. I also hope that the FAQ perhaps removes some of the "sting" and emotional nature of this difficult debate by demonstrating that our affirmative action policies are based on very practical, and largely immediate needs. Remember that we were once in your shoes as applicants, we know how stressful this can be. Just stay true to your goals, always work to improve yourself and don't sweat all the little extra factors that go into the unpredictable process of admissions decisions, above all it's still a matter of bringing in the best talent of any background. Best of luck to all of you in your applications and medical careers.
 
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How did you deal with legacy admissions? (If you tell me that that is not a thing, I will probably not believe you)

What is your opinion on an income based med school admissions model, where the entering class average income is capped at a fixed number to encourage med schools to admit low income students?

How does immigrant status affect admissions?

Last and most loaded question. Do you believe that an African American patient coming from an extremely poor background would be best served by an African American physician coming from a wealthy background and lifestyle, or by a white physician who happened to have come from a similarly poor background?
 

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Do you believe that an African American patient coming from an extremely poor background would be best served by an African American physician coming from a wealthy background and lifestyle, or by a white physician who happened to have come from a similarly poor background?

Obviously I'm not OP but I'd like to throw in my 2c as a Black person who immigrated to this country at a relatively young age and lived among, went to school with and work with poor and working-class White Americans. Considering the amount of overt racism directed towards Blacks from working-class Whites, both historically and in the contemporary era, I'd be disinclined to believe that similarly-experienced poverty would be enough to bridge that gap. It should (and in a perfect world would) be enough, but history + my personal experiences give me alot of doubt that that would be the case. Not to say that all working class whites are racists who hate blacks, but based on the discourse I've heard from my White peers in high school and college, the things I've had patients (and even attendings) from those backgrounds say to my face as a med student and now as a resident, I'm not optimistic about it.
 
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Obviously I'm not OP but I'd like to throw in my 2c as a Black person who immigrated to this country at a relatively young age and lived among, went to school with and work with poor and working-class White Americans. Considering the amount of overt racism directed towards Blacks from working-class Whites, both historically and in the contemporary era, I'd be disinclined to believe that similarly-experienced poverty would be enough to bridge that gap. It should (and in a perfect world would) be enough, but history + my personal experiences give me alot of doubt that that would be the case. Not to say that all working class whites are racists who hate blacks, but based on the discourse I've heard from my White peers in high school and college, the things I've had patients (and even attendings) from those backgrounds say to my face as a med student and now as a resident, I'm not optimistic about it.
Thanks a lot for the insight. I suppose our society has quite a lot to go still.
 

Lexdiamondz

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Thanks a lot for the insight. I suppose our society has quite a lot to go still.

Again, I'm not saying all poor and working-class Whites are racist. But, given some of the attitudes that are prevalent among people of that demographic, plus the rampant de-facto segregation that occurs at that socioeconomic level I'm disinclined to say that a White person who grew up poor would necessarily be the best patient advocate for a Black person who grew up in a similar circumstance because, unfortunately, the barriers between the races still exist in both literal and figurative terms.
 
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So basically the TL,DR is, "we need to, deal with it, life isn't fair, nobody is entitled to go to med school."


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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.

So the answer is not to train and instill cultural competence to physicians (regardless of their race) who got accepted to medical school based on merit , but to accept less qualified students because they belong to a certain group? The answer to a long legacy of discrimination is not more discrimination. Accepting the best students will make the best doctors, it should not be based on what group you were born into. I will agree that taking into account the hardships an individual overcomes is a valid argument towards an applicants merit but the race they were born into is not.

There are more responsible solutions to making sure URM communities are served. It is morally backwards to deny students who may or may not have overcome bigger obstacles than the URM you accepted simply because they weren't born into the right race.
 
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So the answer is not to train and instill cultural competence to physicians (regardless of their race) who got accepted to medical school based on merit , but to accept less qualified students because they belong to a certain group? The answer to a long legacy of discrimination is not more discrimination. Accepting the best students will make the best doctors, it should not be based on what group you were born into. I will agree that taking into account the hardships an individual overcomes is a valid argument towards an applicants merit but the race they were born into is not.

There are more responsible solutions to making sure URM communities are served. It is morally backwards to deny students who may or may not have overcome bigger obstacles than the URM you accepted simply because they weren't born into the right race.
More responsible solutions such as...?
 
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So the answer is not to train and instill cultural competence to physicians (regardless of their race) who got accepted to medical school based on merit , but to accept less qualified students because they belong to a certain group? The answer to a long legacy of discrimination is not more discrimination. Accepting the best students will make the best doctors, it should not be based on what group you were born into. I will agree that taking into account the hardships an individual overcomes is a valid argument towards an applicants merit but the race they were born into is not.

There are more responsible solutions to making sure URM communities are served. It is morally backwards to deny students who may or may not have overcome bigger obstacles than the URM you accepted simply because they weren't born into the right race.

If you turn this process into a fully meritocratic one, then you will reinforce and widen the gap in upward mobility for minority groups. Unfortunately the country still has a rift in educational opportunity and many minority groups won't even be in a position to apply to medical school, let alone become a doctor. If a student reaches the point of applying and you say, "Sorry, you're MCAT was too low. It doesn't matter that your K-12 schools had no money to build your standardized test taking skills.", then you're punishing them for societal injustices.

AMCAS allows you to highlight a disadvantaged situation regardless of your race and ethnicity. So if you're a Caucasian born into an unfortunate situation, you can tell your story.

It's important to understand that our country's history of racial injustice calls for a period of overcompensation. Say you tear your ACL walking down the street this evening. You'll get surgery and correct the acute problem, but you'll have months of rehabilitation to regain strength and become new. We're only a handful of generations removed from slavery, we're still in our cultural rehabilitation.
 
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More responsible solutions such as...?
Incentives for physicians to work these areas (loan repayment), some schools are doing specific tracks designed for students to ultimately work in rural areas. I'm not saying these are the perfect solutions. I'm arguing that accepting less deserving students just because they are an URM is not the answer.

I know plenty of great students who would make atrocious doctors.


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I agree and understand what you're saying here, but I'm talking on average. On average the applicant with the more merit and deserving of an acceptance to medical school based on a plethora of factors including the interview will make better doctors than those who don't have as good of an application. So maybe I wasn't specific enough when I said "best students". Accepting students with better applications with the idea that they will make the better doctors is the whole basis of how medical schools accept students to begin with. Of course there are students with stellar applications that turn out to be terrible doctors, but that doesn't mean we stop accepting the best applicants. What does being born to a certain group add to the merit of an applicant?
 
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Lexdiamondz

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So the answer is not to train and instill cultural competence to physicians (regardless of their race) who got accepted to medical school based on merit , but to accept less qualified students because they belong to a certain group? The answer to a long legacy of discrimination is not more discrimination. Accepting the best students will make the best doctors, it should not be based on what group you were born into. I will agree that taking into account the hardships an individual overcomes is a valid argument towards an applicants merit but the race they were born into is not.

There are more responsible solutions to making sure URM communities are served. It is morally backwards to deny students who may or may not have overcome bigger obstacles than the URM you accepted simply because they weren't born into the right race.

Firstly, whether or not an applicant is qualified for a spot in a given school is not simply a function of their grades. In a school like Columbia, for example, where 80% of the patient population are non-English speaking immigrants living below the poverty line, someone with a 4.0 GPA and 520 MCAT who grew up in a suburb in Missouri to two doctor parents, never lived in a large city in their life, never knew any immigrants and wants to be an orthopaedic surgeon isn't actually any more qualified a candidate than a URM born in the Dominican Republic with a 3.5 and 513. One applicant brings with them a wealth of experiences and skills as well as a desire to apply those skills towards helping a group of people that don't often get talked about whereas the other is just bringing grades. Furthermore, having "overcome obstacles" isn't necessarily the biggest part of the equation - medicine, for better or worse, is a public good and medical schools are in the business of producing doctors who will serve the public.

Secondly, the idea that the best undergraduate students will make the best doctors is naïve and isn't really rooted in anything other than your limited perspective as someone who likely hasn't done much more than take multiple choice tests. Filling in bubbles or clicking A,B,C or D on a screen does not make you a better doctor, it just makes you a good test taker. I had classmates who I crushed on the boards who I would readily admit are stronger clinicians than I am. The only thing these metrics are really good for is cutting down the number of applications you have to read for residency, and making sure that everyone passes the exam and has a baseline fund of knowledge necessary to practice safely once they graduate. How you connect with people, how you form relationships, how you work with others and how you respond to feedback and adapt to challenges are far, far more important in practical terms than the difference between a 220 and 240 on the boards.

Finally, the idea that it is morally more responsible to try and teach people to give a sh!t about poor people and people of colour and hope that they "get it", rather than empower URMs to take care of their own communities is kind of silly. We have data that shows that URMs are much more likely to serve URM communities, and that patients generally feel more comfortable and are more open with physicians that share their cultural background - especially immigrants with limited English-language proficiency. How would we even go about teaching cultural competence? Competence in which culture? What you're saying doesn't make sense and flies in the face of actual data that we have which supports why having more URMs is a good idea.
 
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So the answer is not to train and instill cultural competence to physicians (regardless of their race) who got accepted to medical school based on merit , but to accept less qualified students because they belong to a certain group? The answer to a long legacy of discrimination is not more discrimination. Accepting the best students will make the best doctors, it should not be based on what group you were born into. I will agree that taking into account the hardships an individual overcomes is a valid argument towards an applicants merit but the race they were born into is not.

There are more responsible solutions to making sure URM communities are served. It is morally backwards to deny students who may or may not have overcome bigger obstacles than the URM you accepted simply because they weren't born into the right race.

SDNers are advised not to confuse mere stats with being qualified to survive medical school. I could take the entire class at Western or U KS and plop them into Harvard and they'll handle the material just fine.

As we keep trying to remind you, it's not always about the grades.

The "best" don't have to be the brightest, nor do the "brightest" have to be the best.

It's not about what applicants want, it's what the schools want.

No one is entitled to a seat in medical school merely on the basis of the stats. The system is, surprisingly, meritocratic. Do try to remember that merit doesn't always mean numbers; it can also mean the road traveled.

SDNers are also reminded applicants coming from a disadvantaged background aren't being discriminated against. In fact, the majority of ORM applicants are from the upper economic strata, and are frequently the children of clinicians. Again, there's that road travelled business.
 
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DrDarce

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Firstly, whether or not an applicant is qualified for a spot in a given school is not simply a function of their grades. In a school like Columbia, for example, where 80% of the patient population are non-English speaking immigrants living below the poverty line, someone with a 4.0 GPA and 520 MCAT who grew up in a suburb in Missouri to two doctor parents, never lived in a large city in their life, never knew any immigrants and wants to be an orthopaedic surgeon isn't actually any more qualified a candidate than a URM born in the Dominican Republic with a 3.5 and 513. One applicant brings with them a wealth of experiences and skills as well as a desire to apply those skills towards helping a group of people that don't often get talked about whereas the other is just bringing grades. Furthermore, having "overcome obstacles" isn't necessarily the biggest part of the equation - medicine, for better or worse, is a public good and medical schools are in the business of producing doctors who will serve the public.

Secondly, the idea that the best undergraduate students will make the best doctors is naïve and isn't really rooted in anything other than your limited perspective as someone who likely hasn't done much more than take multiple choice tests. Filling in bubbles or clicking A,B,C or D on a screen does not make you a better doctor, it just makes you a good test taker. I had classmates who I crushed on the boards who I would readily admit are stronger clinicians than I am. The only thing these metrics are really good for is cutting down the number of applications you have to read for residency, and making sure that everyone passes the exam and has a baseline fund of knowledge necessary to practice safely once they graduate. How you connect with people, how you form relationships, how you work with others and how you respond to feedback and adapt to challenges are far, far more important in practical terms than the difference between a 220 and 240 on the boards.

Finally, the idea that it is morally more responsible to try and teach people to give a sh!t about poor people and people of colour and hope that they "get it", rather than empower URMs to take care of their own communities is kind of silly. We have data that shows that URMs are much more likely to serve URM communities, and that patients generally feel more comfortable and are more open with physicians that share their cultural background - especially immigrants with limited English-language proficiency. How would we even go about teaching cultural competence? Competence in which culture? What you're saying doesn't make sense and flies in the face of actual data that we have which supports why having more URMs is a good idea.

You make a few good points here, and I'm not arguing against looking at applications holistically. As I clarified earlier, when I said best students I should have been more specific and say those with better applications. We know that those with the best grades aren't the best applicants, and I would say ADCOMS have historically agreed with that. A student with a 3.8 and a very well rounded application and great interview is looked at more favorably than the 4.0 with a less complete application who came off as a psychopath. I wasn't insinuating that you don't look at the skills and experiences of an applicant, what I am arguing is just being an URM does not make you a better applicant in itself.

I understand that being able to connect with people and have social skills are important aspects of being a good physician. Hell, we've all seen physicians who were great students but couldn't be more awkward. If you want to argue that the process for selecting medical students should take that more into account, then I am in agreement. I'm not against looking at applicants more closely if we can figure out a better way to choose applicants that will have the well roundness to make a better physician. That includes applicants that have demonstrated an interest in service in under served communities. Again though, it's based on the individual applicant and not just because they belong to a group.
 
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What is your opinion on an income based med school admissions model, where the entering class average income is capped at a fixed number to encourage med schools to admit low income students?

Are you suggesting that med students from low income backgrounds are more likely to choose to practice in low income areas? Because I'm not sure research bears that out. And the OP's major point is that URMs (or visible minorities) are more likely (and have proven to be such) to practice in their own communities.
 
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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.
I'd like to see the data supporting this statement. African and African-American culture are completely different. That's like taking a Chinese person who is born and raised in South America and dropping them in the middle of Beijing and assuming they'll want to stay there because they look like everyone else. I'm also curious whether this African student with no ties to the African-American community would be chosen over a non-URM with demonstrated connection and history of working with the African-American community, everything else equal, on the basis of appearance alone, when the ostensible goal of affirmative action is to provide doctors who will practice in these communities.
 
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DokterMom

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So the answer is not to train and instill cultural competence to physicians (regardless of their race) who got accepted to medical school based on merit , but to accept less qualified students because they belong to a certain group? The answer to a long legacy of discrimination is not more discrimination.

Have you read studies supporting the efficacy of instilling cultural competence into privileged populations? Can't say that I have. Try talking to a group of young white men about white privilege and the cultural obstacles faced by women and racial minorities and enjoy the backlash...
 
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el_duderino

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Incentives for physicians to work these areas (loan repayment), some schools are doing specific tracks designed for students to ultimately work in rural areas. I'm not saying these are the perfect solutions. I'm arguing that accepting less deserving students just because they are an URM is not the answer.




I agree and understand what you're saying here, but I'm talking on average. On average the applicant with the more merit and deserving of an acceptance to medical school based on a plethora of factors including the interview will make better doctors than those who don't have as good of an application. So maybe I wasn't specific enough when I said "best students". Accepting students with better applications with the idea that they will make the better doctors is the whole basis of how medical schools accept students to begin with. Of course there are students with stellar applications that turn out to be terrible doctors, but that doesn't mean we stop accepting the best applicants. What does being born to a certain group add to the merit of an applicant?

"I'm only working in this part of town for the money" isn't nearly as good a solution for that part of town as properly training people from there or who want to be there.
 
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OP, you write a lot about racial URMs because "it is our duty to help train more URM physicians to meet this pressing need." What about gender and sexual URMs? It feels as if that's a significant segment of the population getting neglected considering there's still a fair amount of healthcare bias and discrimination against those groups
 

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OP, you write a lot about racial URMs because "it is our duty to help train more URM physicians to meet this pressing need." What about gender and sexual URMs? It feels as if that's a significant segment of the population getting neglected considering there's still a fair amount of healthcare bias and discrimination against those groups
Aren't most classes 50/50 male and female?
 
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There is no such thing as more or less qualified to become a physician. There is qualified and unqualified. Half of doctors we train don't even want to do the job after all is said and done.

Also, this thread is about the content in the Op and having questions answered about one adcom's experience, if things get too political I won't hesitate to move this to SPF.
 
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OP, you write a lot about racial URMs because "it is our duty to help train more URM physicians to meet this pressing need." What about gender and sexual URMs? It feels as if that's a significant segment of the population getting neglected considering there's still a fair amount of healthcare bias and discrimination against those groups
I know a guy who applied for LGBT scholarships even though he wasn't LGBT. He said "what are they gonna do, make me suck a ****?" It would probably be hard to catch people lying about their sexuality, as it isn't as immediately obvious as something like race.
 
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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.

I'm a little confused by this. I definitely identify with my URM community, but I'm not necessarily aiming to have my medical career focus specifically on their health needs. Does this mean I shouldn't put down my URM identity on the application?
 

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OP, you write a lot about racial URMs because "it is our duty to help train more URM physicians to meet this pressing need." What about gender and sexual URMs? It feels as if that's a significant segment of the population getting neglected considering there's still a fair amount of healthcare bias and discrimination against those groups
Many med schools now consider LGBT as URM, including JHU and U Chicago.
 

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I know a guy who applied for LGBT scholarships even though he wasn't LGBT. He said "what are they gonna do, make me suck a ****?" It would probably be hard to catch people lying about their sexuality, as it isn't as immediately obvious as something like race.

Because applicants are more willing to lie about stuff like this (like the kids who suddenly discover their Native American ancestry at application time), service to one's community is also looked at. People are expected to not merely talk the talk, but walk the walk. Your colleague had also hope not to come up against an interviewer with good gaydar, BTW.
 
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So the answer is not to train and instill cultural competence to physicians (regardless of their race) who got accepted to medical school based on merit , but to accept less qualified students because they belong to a certain group? The answer to a long legacy of discrimination is not more discrimination. Accepting the best students will make the best doctors, it should not be based on what group you were born into. I will agree that taking into account the hardships an individual overcomes is a valid argument towards an applicants merit but the race they were born into is not.

There are more responsible solutions to making sure URM communities are served. It is morally backwards to deny students who may or may not have overcome bigger obstacles than the URM you accepted simply because they weren't born into the right race.
What is the "right" race? Just asking so next time I'll choose it.
 
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Are you suggesting that med students from low income backgrounds are more likely to choose to practice in low income areas? Because I'm not sure research bears that out. And the OP's major point is that URMs (or visible minorities) are more likely (and have proven to be such) to practice in their own communities.
My thought was that a physician who has suffered through improvishment through childhood and adolescence would be able to better relate to low income patient base and would be more thoughtful of some of the income based issues that the patients would come across.
 

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My thought was that a physician who has suffered through improvishment through childhood and adolescence would be able to better relate to low income patient base and would be more thoughtful of some of the income based issues that the patients would come across.

I sure hope my application reviewers share this thought since it's what my app is ostensibly predicated on.

In other news, I also agree with the post from awhile ago about impoverished ORMs connecting to impoverished persons of color. By no means is every working class white person discriminatory towards POCs (especially AAs), but I know a fair share of people from my home area that held this sentiment. IMHO far too prevalent for say, a black working class patient, to wholly connect with a white physician raised in the working class. They have probably had their fair share of **** experiences with working class white individuals.


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I know a guy who applied for LGBT scholarships even though he wasn't LGBT. He said "what are they gonna do, make me suck a ****?" It would probably be hard to catch people lying about their sexuality, as it isn't as immediately obvious as something like race.
He can lie all he wants, but that won't give him the perspective of actually identifying as LGBT, which will come across in his writing.
 
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He can lie all he wants, but that won't give him the perspective of actually identifying as LGBT, which will come across in his writing.
The consensus from adcoms seems to be that you can't just talk the talk, you have to walk the walk.

Which is rather unfortunate for those of us in the LGBT+ community who haven't had the chance to walk the walk because of the nature of our situation/location, especially since that would probably be a fairly valuable perspective to a class :p
 

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So the answer is not to train and instill cultural competence to physicians (regardless of their race) who got accepted to medical school based on merit , but to accept less qualified students because they belong to a certain group? The answer to a long legacy of discrimination is not more discrimination. Accepting the best students will make the best doctors, it should not be based on what group you were born into. I will agree that taking into account the hardships an individual overcomes is a valid argument towards an applicants merit but the race they were born into is not.

There are more responsible solutions to making sure URM communities are served. It is morally backwards to deny students who may or may not have overcome bigger obstacles than the URM you accepted simply because they weren't born into the right race.
It doesn't matter how good physicians are if people won't go see them.

Everyone can be racist/prejudiced - even URMs. I had a patient once who refused to let me touch her because I was white. She also refused to listen to white physicians and insisted on only black physicians and caregivers. My personal opinion is that if you're dumb enough to not let a highly trained professional work on you just because of the color of his/her skin, you deserve whatever complications you get. I don't care what color my physician is as long as he/she is competent, but lots of people do care, and those people will NOT seek care if there aren't more physicians whose skin colors match theirs. So, we have to have URM physicians to keep the racist people who are also URMs from dying, and that's just how it is.
 

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It doesn't matter how good physicians are if people won't go see them.

Everyone can be racist/prejudiced - even URMs. I had a patient once who refused to let me touch her because I was white. She also refused to listen to white physicians and insisted on only black physicians and caregivers. My personal opinion is that if you're dumb enough to not let a highly trained professional work on you just because of the color of his/her skin, you deserve whatever complications you get. I don't care what color my physician is as long as he/she is competent, but lots of people do care, and those people will NOT seek care if there aren't more physicians whose skin colors match theirs. So, we have to have URM physicians to keep the racist people who are also URMs from dying, and that's just how it is.

You're looking at this wrong.

While yes, there are definitely racist URMs, you still have to remember the position that URMs are in American society vis-à-vis Whites. Your average 60 year old Black person with diabetes and hypertension remembers the civil rights era. They remember eugenics. They remember the Tuskegee experiment. They remember all of that and they also remember the overt racism that this government and this country's medical establishment espoused during their lifetime. For most of their lives, the medical establishment has not been an advocate for them.You can't really expect someone who lived through all of that to simply forget formative experiences they've had growing up and you aren't likely to change their views, any more than you would be likely to change a racist 60 year old White person's worldview, and quite naturally those views are going to be passed on to their children, and grandchildren, etc.

We forget that most of the adults living today remember a world that was much more racist and much more segregated that the one millenials live in. Your patients aren't going to be predominantly 20 something college students because 20 something year old college students generally don't get sick - they're going to be that 60 year old Black man who's older brother marched at Selma and got his head kicked in. They're gonna be that 80 year old Japanese man who's family was interned during WWII when he was a kid even though he was born here. They're gonna be that 50 year old Mexican who never learnt English because he was too busy working 3 jobs to put his kids through school. You can't assume someone three decades your senior sees the world they way you do - they have more experiences (both positive and negative) than you can conceive of, and we as physicians need to meet them where they're at, not expect them to conform to our values.
 
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Inspired Chaos

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It doesn't matter how good physicians are if people won't go see them.

Everyone can be racist/prejudiced - even URMs. I had a patient once who refused to let me touch her because I was white. She also refused to listen to white physicians and insisted on only black physicians and caregivers. My personal opinion is that if you're dumb enough to not let a highly trained professional work on you just because of the color of his/her skin, you deserve whatever complications you get. I don't care what color my physician is as long as he/she is competent, but lots of people do care, and those people will NOT seek care if there aren't more physicians whose skin colors match theirs. So, we have to have URM physicians to keep the racist people who are also URMs from dying, and that's just how it is.
It isn't racist to want a doctor that looks like you. Do you understand racism? I'd feel really uncomfortable with an extremely religious doctor or one who wasn't a native or functionally native English speaker. That doesn't mean I'm xenophobic. It means that cultural factors influence the way people work and live, including doctors.
 
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calivianya

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You're looking at this wrong.

While yes, there are definitely racist URMs, you still have to remember the position that URMs are in American society vis-à-vis Whites. Your average 60 year old Black person with diabetes and hypertension remembers the civil rights era. They remember eugenics. They remember the Tuskegee experiment. They remember all of that and they also remember the overt racism that this government and this country's medical establishment espoused during their lifetime. For most of their lives, the medical establishment has not been an advocate for them.You can't really expect someone who lived through all of that to simply forget formative experiences they've had growing up and you aren't likely to change their views, any more than you would be likely to change a racist 60 year old White person's worldview, and quite naturally those views are going to be passed on to their children, and grandchildren, etc.

We forget that most of the adults living today remember a world that was much more racist and much more segregated that the one millenials live in. Your patients aren't going to be predominantly 20 something college students because 20 something year old college students generally don't get sick - they're going to be that 60 year old Black man who's older brother marched at Selma and got his head kicked in. They're gonna be that 80 year old Japanese man who's family was interned during WWII when he was a kid even though he was born here. They're gonna be that 50 year old Mexican who never learnt English because he was too busy working 3 jobs to put his kids through school. You can't assume someone three decades your senior sees the world they way you do - they have more experiences (both positive and negative) than you can conceive of, and we as physicians need to meet them where they're at, not expect them to conform to our values.
These are great points. Thank you for that well thought out reply.

It isn't racist to want a doctor that looks like you. Do you understand racism? I'd feel really uncomfortable with an extremely religious doctor or one who wasn't a native or functionally native English speaker. That doesn't mean I'm xenophobic. It means that cultural factors influence the way people work and live, including doctors.
Most of the patients who've acted like the aforementioned patient I dealt with have not been polite about their requests. They've interrupted me when I was introducing myself to them with something along the lines of, "No damn cracker is going to touch me." I would say that crosses the line from simply preferring someone of a different skin color into being racist. I didn't clarify that earlier.
 

Lucca

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This thread never really stayed on the original topic and Op is not replying. Closing. Start a thread in the SPF if you want to continue this discussion, or Pm each other.
 
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