NEJM perspectives (03/09/2023) on “Diversifying the Physician Workforce- From Rhetoric to Positive Action”

[deleted1156722]

https://www.nejm.org/doi/full/10.1056/NEJMp2211874

I thought NEJM is a respectable and high quality journal for original medical articles and meaningful perspectives in medicine…and definitely not for pushing an agenda based on biased perspectives.
No thanks…I am cancelling my subscription!

---

Members don't see this ad.

 

[coffeebythelake]

This is an opinion piece.
Just as the author has their opinion you can have yours.
Why does this bother you so much?
Perhaps you can write your counter argument and submit it to NEJM.

 

[BLADEMDA]

"I propose that institutions add “enhancing diversity” to the list of metrics for reappointment as a leader in academic medicine."


Most Medical Schools and Universities have a DEI department leader. Some sections/departments have a dedicated DEI professor. While I can't agree that a sitting "leader" should be replaced with a DEI candidate I can assure you DEI is part of the hiring process when leadership positions become available. This author goes a step further and wants to replace White/Asian males with DEI candidates. That's the type of equity we should all be against.

The author also suggest that current metrics for medical school be eliminated or reduced for DEI applicants. I would counter that all schools already reduce standards for DEI applicants and that elimination of these metrics is unnecessary and unfair to the rest of the applicants.

 

[BLADEMDA]

"My colleagues and I recently described a system for rating fellowship applicants in which merit was defined as evidence of clinical excellence, leadership potential, collegiality, academic curiosity, and “diversity competency,” or potential for advocating for health equity in the field."
_________________________________________

Health Equity or Diversity Competency has now become the a major factor in the MATCH and for fellowships. Those of you who are White or Asian will now be discriminated against based on your skin color. Gender has been a major factor for decades but today, we can add LBGQT to that list. Medical Students have become keenly aware that their chances at Matching into a specialty are no longer based on hard metrics; now the same selection factors which are used at Medical Schools are being used for Residency/Fellowship. This means the available positions for a White/Asian male are less than half the spots for that class in some specialties. Rather than select those who have the best grades, test scores, research, etc the committees now select based on DEI as the primary factor then they consider metrics.

 

[Guillemot]

I used to worry about affirmative action allowing unqualified people into medicine, but after further life experience, I realized that the majority of the stupid people I've worked with in medicine have actually been white males. So why should only stupid white males be allowed into medicine? Dumb people of all races, sexes, and creeds should be allowed an equal opportunity IMO.

 

[rowsdower88]

"My colleagues and I recently described a system for rating fellowship applicants in which merit was defined as evidence of clinical excellence, leadership potential, collegiality, academic curiosity, and “diversity competency,” or potential for advocating for health equity in the field."
_________________________________________

Health Equity or Diversity Competency has now become the a major factor in the MATCH and for fellowships. Those of you who are White or Asian will now be discriminated against based on your skin color. Gender has been a major factor for decades but today, we can add LBGQT to that list. Medical Students have become keenly aware that their chances at Matching into a specialty are no longer based on hard metrics; now the same selection factors which are used at Medical Schools are being used for Residency/Fellowship. This means the available positions for a White/Asian male are less than half the spots for that class in some specialties. Rather than select those who have the best grades, test scores, research, etc the committees now select based on DEI as the primary factor then they consider metrics.

Have you ever read the IOM's report "Unequal Treatment"? It's over twenty years old now, but it argues for diversity competency on evidence based medicine grounds. Among other recommendations, it argues for promoting diversity hiring and promotion as a means of addressing the disparities in healthcare received by minority populations.

Recommendation 5-3 Increase the proportion of underrepresented U.S. racial and ethnic minorities among health professionals.

Patient and provider relationships will also be strengthened by greater racial and ethnic diversity in the health professions. Racial concordance of patient and provider is associated with greater patient participation in care processes, higher patient satisfaction, and greater adherence to treatment (Cooper-Patrick et al., 1999). In addition, racial and ethnic minority providers are more likely than their non-minority colleagues to serve in minority and medically underserved communities (Komaromy et al., 1996). The benefits of diversity in health professions fields are significant, and illustrate that a continued commitment to affirmative action is necessary for graduate health professions education programs, residency recruitment, and other professional opportunities. This is not intended to suggest, however, that racial concordance of patients and providers should be encouraged as a matter of policy. Rather, it is expected that the benefits of diversity in the health professions will accrue broadly, as this diversity helps to expand the disciplines' ability to conceptualize and respond to the health needs of increasingly culturally and linguistically diverse populations.

Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care - PubMed

Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. There is, however, increasing evidence that even after such differences are accounted for, race and ethnicity remain significant predictors of the...

pubmed.ncbi.nlm.nih.gov

Hiring ethnic minority providers can result in better patient outcomes in some areas of medicine. There's plenty of room to be skeptical of some of the studies in the report (I think the Cooper-Patrick study is a telephone survey) and I haven't kept up with more modern research... But as far as I know, this is where the limited data on physician-patient racial concordance points.

There are evidence based reasons to suggest some preferential minority hiring will result in better patient outcomes in minority populations. Take a look at the Executive Summary if you're curious.

 

[kidthor]

I've seen plenty of implicit and explicit bias that excluded certain groups. As an example, many residency programs tend to repeatedly match exact same demographic every year in a way that doesn't match their applicant pool. I think it's important for programs to think about why they may be causing such disparate or un-diverse results rather than blaming the applicants or ignoring the issue, as I've seen too many times.

That said I also don't like the notion of forcing quotas or metrics with an air of thought-policing.

There's a right way to promote diversity and I'm on board with the NEJM author's concept overall, even if I don't agree with his entire suggested approach.

 

[Beeftenderloin]

I've seen plenty of implicit and explicit bias that excluded certain groups. As an example, many residency programs tend to repeatedly match exact same demographic every year in a way that doesn't match their applicant pool. I think it's important for programs to think about why they may be causing such disparate or un-diverse results rather than blaming the applicants or ignoring the issue, as I've seen too many times.

That said I also don't like the notion of forcing quotas or metrics with an air of thought-policing.

There's a right way to promote diversity and I'm on board with the NEJM author's concept overall, even if I don't agree with his entire suggested approach.

There was unquestionably a dominant ethnic group in my residency and it definitely wasn’t Caucasian. Funnily enough it just so happened to match the dominant ethnic group amongst the faculty.

 

[deleted1156722]

For the good of everyone, both patients and physicians, medical schools and adcoms needs to stop obsessing over gender and race, and start refocusing on merit, fairness, and inclusiveness.

Even as the author suggests that affirmative action measures are necessary to overcome past discrimination, how does fighting past discrimination with reverse discrimination ever make anything better, as our ultimate goal is to end discrimination altogether?

There is value to diversity, but not at the expense of merit. Really, this explanation about URM physicians serving URM communities in rural and underserved communities is hyperbole!

Not using Transparent objective criteria and instead using this opaque holistic criteria undermines meritocracy in medicine. Does a patient really care if a white/black/asian/hispanic doctor has cured his cancer?

Even a cursory reading of SDN posts of WAMC forum for premeds shows there are way too many ORM students who are denied admissions due to factors beyond their control- i.e race. What a pity!

Hoping SCOTUS rules against the unfair race-conscious decision by med schools that penalizes hardworking ORMs while rewarding other candidates with far below stats and EAM-Experiences/Attributes/Metrics, only because they happen to be URMs.

 

[rowsdower88]

Not using Transparent objective criteria and instead using this opaque holistic criteria undermines meritocracy in medicine. Does a patient really care if a white/black/asian/hispanic doctor has cured his cancer?

The report I included above suggests a minority physician may be more likely to screen for a cancer, or spend more time talking with a patient about their diabetes, or take a patient's complaint of pain more seriously... in certain populations.

 

[TheLoneWolf]

The Corruption of Medicine

The post–George Floyd racial reckoning has hit the field of medicine like an earthquake. Medical education, medical research, and standards of competence have been upended by two related hypotheses: that systemic racism is responsible both for racial disparities in the demographics of the...

www.city-journal.org

 

[deleted1156722]

This is an opinion piece.
Just as the author has their opinion you can have yours.
Why does this bother you so much?
Perhaps you can write your counter argument and submit it to NEJM.

Ask yourself-Is NEJM reputed for Academic Medicine or for discussing political issues? Why is this article published in an eminent academic journal that caters to national and international readers in the medical community. Maybe the author should have taken it to NY times or WaPo. This is how the gaslighting of the next generation of physicians begins…

 

[rowsdower88]

Ask yourself-Is NEJM reputed for Academic Medicine or for discussing political issues? Why is this article published in an eminent academic journal that caters to national and international readers in the medical community. Maybe the author should have taken it to NY times or WaPo. This is how the gaslighting of the next generation of physicians begins…

It would be "academic medicine" to seriously consider ways to address the disparate outcomes that minority populations are receiving. One small aspect of that could be physician hiring/training. It is impossible to avoid politics on this.

 

[deleted1156722]

The report I included above suggests a minority physician may be more likely to screen for a cancer, or spend more time talking with a patient about their diabetes, or take a patient's complaint of pain more seriously... in certain populations.

It would be "academic medicine" to seriously consider ways to address the disparate outcomes that minority populations are receiving. One small aspect of that could be physician hiring/training. It is impossible to avoid politics on this.

The ultimate goal of medicine is to achieve the best possible health outcomes for everyone, regardless of the race or ethnicity of patients and physicians. This can be achieved by training academically, structurally and culturally competent physicians ( regardless of their race), and not by social engineering.

 

[anbuitachi]

This is an opinion piece.
Just as the author has their opinion you can have yours.
Why does this bother you so much?
Perhaps you can write your counter argument and submit it to NEJM.

he will be immediately cancelled if NEJM publishes his counter piece. but no worries NEJM would never publish a counter piece

 

[rowsdower88]

The ultimate goal of medicine is to achieve the best possible health outcomes for everyone, regardless of the race or ethnicity of patients and physicians. This can be achieved by training academically, structurally and culturally competent physicians ( regardless of their race), and not by social engineering.

It could be achieved, I agree, but it hasn't been based on the report I cited above. It was "social engineering" that resulted in the poor healthcare outcomes we see in minority populations relative to white populations.

Here's a hypothetical:

Suppose the existing healthcare disparities could be resolved in 100 years if we continue the status quo "meritocracy". In an alternative world, we are able to eliminate these healthcare disparities through mild preferential racial hiring/training practices in 50yrs. I think the second world would be preferable and I hope you would too, because as you stated above "The ultimate goal of medicine is to achieve the best possible health outcomes for everyone".

Now we could quibble about the degree to which hiring minority doctors legitimately benefits those populations or the timeline or whatever, but I think the principle is sound (assuming my interpretation of the research is correct).

Edit: For anyone curious, the research I'm talking about is on "Patient-Physician Racial Concordance".

 

[anbuitachi]

why is US healthcare way worse than other developed countrys? european countries? is it because our doctors are too white? i dont know.

 

[Guillemot]

Has any position anywhere ever been awarded based strictly on merit? Now we are just admitting it out loud. The criteria may have shifted some, but in principle it’s really not any different. So why should anyone really give a ****?

 

[deleted1156722]

It could be achieved, I agree, but it hasn't been based on the report I cited above. It was "social engineering" that resulted in the poor healthcare outcomes we see in minority populations relative to white populations.

Here's a hypothetical:

Suppose the existing healthcare disparities could be resolved in 100 years if we continue the status quo "meritocracy". In an alternative world, we are able to eliminate these healthcare disparities through mild preferential racial hiring/training practices in 50yrs. I think the second world would be preferable and I hope you would too, because as you stated above "The ultimate goal of medicine is to achieve the best possible health outcomes for everyone".

Now we could quibble about the degree to which hiring minority doctors legitimately benefits those populations or the timeline or whatever, but I think the principle is sound (assuming my interpretation of the research is correct).

Study Finds Patients Prefer Doctors Who Share Their Same Race/Ethnicity - Penn Medicine

Patients who shared the same racial or ethnic background as their physician were more likely to give the maximum patient rating score, according to a new analysis of 117,589 patient surveys from 2014 to 2017.

www.pennmedicine.org

Looking at this study by Penn Medicine published in JAMA, can I conclude that it is the “minority” patients who are racist when they score the “minority” physicians higher than white/asian physicians… The other factor being this term “minority/ POC” being thrown around carelessly by these so called “experts”… we all know for a fact that asians are “minorities” and can also be classified as “POC” or “Brown people” too, but that is an inconvenient fact and doesn’t fit their narrative!

 

[rowsdower88]

Study Finds Patients Prefer Doctors Who Share Their Same Race/Ethnicity - Penn Medicine

Patients who shared the same racial or ethnic background as their physician were more likely to give the maximum patient rating score, according to a new analysis of 117,589 patient surveys from 2014 to 2017.

www.pennmedicine.org

Looking at this study by Penn Medicine published in JAMA, can I conclude that it is the “minority” patients who are racist when they score the “minority” physicians higher than white/asian physicians… The other factor being this term “minority/ POC” being thrown around carelessly by these so called “experts”… we all know for a fact that asians are “minorities” and can also be classified as “POC” or “Brown people” too, but that is an inconvenient fact and doesn’t fit their narrative!

Y/N is it a problem if a patient doesn't feel comfortable with their doctor?

If you aren't comfortable with your doctor, and you live in a location with few options to choose from, it makes sense that you would be more likely to experience worse outcomes.

Not to get too deviated, but we have to treat racist patients too. I don't know how many patients I've put under with swastika tats or any number of white supremacist symbols. Looking at the article you cited, I don't necessarily conclude that the patients are personally racist towards white physicians just as I don't conclude white physicians are personally racist towards their minority patients. But there exist a confluence of factors (like having different backgrounds and life experiences) that can make racially discordant patient-physician interactions more challenging.

 

[anbuitachi]

Y/N is it a problem if a patient doesn't feel comfortable with their doctor?

If you aren't comfortable with your doctor, and you live in a location with few options to choose from, it makes sense that you would be more likely to experience worse outcomes.

Not to get too deviated, but we have to treat racist patients too. I don't know how many patients I've put under with swastika tats or any number of white supremacist symbols. Looking at the article you cited, I don't necessarily conclude that the patients are personally racist towards white physicians just as I don't conclude white physicians are personally racist towards their minority patients. But there exist a confluence of factors (like having different backgrounds and life experiences) that can make racially discordant patient-physician interactions more challenging.

the reverse would be viewed as racist. if a white person says i prefer white because im not comfortable with a minority doctor... think how that sounds...

 

[BLADEMDA]

When I was very young the term "token black" was used to describe why a black person has that particular job or profession. Rather than see the merits of the individual, people were focused on skin color as the reason that person got the job, spot or admittance. Then, in the 1980s we began to move away from race slowly but continually reaching a peak around 2008. Since then, race has become the PRIMARY reason a person gets a job or acceptance rather than merit. I see our current system as a backwards step in terms of how many Whites/Asians now view POC/minorities in positions of authority or med school. Did that person "earn" the position or are they just the "token blacks" like the 1960s.

We want a meritocracy in America. If you want to award a few points for "diversity" then okay. But, I and many others draw the line when DIVERSITY is the focus of everything in America rather than merit. Let's not go backwards in time. What kind of society are we leaving our children? How will we compete against the rest of the world if we no longer use merit to guide us? Are we now using RACE as the basis for success in America circa 1930? Why can't people see this is just as wrong as Jim Crow was back in the day.

 

[rowsdower88]

the reverse would be viewed as racist. if a white person says i prefer white because im not comfortable with a minority doctor... think how that sounds...

If that patient-physician racial discordance resulted in worse patient outcomes, I would be concerned (Ex.white patient - black physician). I don't think we see worse outcomes with that dynamic fortunately.

It doesn't seem to be the case that white patients are worse off with black docs, but the reverse seems to be the case. By "worse off", I can be referring to any number of things from experiencing discomfort to being given less time for patient interviews.

I could be mistaken though, I don't want to be seen as an expert on this literature.

 

[rowsdower88]

Then, in the 1980s we began to move away from race slowly but continually reaching a peak around 2008. Since then, race has become the PRIMARY reason a person gets a job or acceptance rather than merit.

What evidence do you have for this? Where has race become the primary reason for employment today?

 

[BLADEMDA]

The Corruption of Medicine

The post–George Floyd racial reckoning has hit the field of medicine like an earthquake. Medical education, medical research, and standards of competence have been upended by two related hypotheses: that systemic racism is responsible both for racial disparities in the demographics of the...

www.city-journal.org

The author does a great job of showing the facts of this lie called "DEI" in the Medicine. But, it won't matter because the woke agenda is here and will prevail.

"Such stories are rife. A UCLA doctor says that the smartest undergraduates in the school’s science labs are saying: “Now that I see what is happening in medicine, I will do something else.”

 

[BLADEMDA]

What evidence do you have for this? Where has race become the primary reason for employment today?

Your question is absurd. Every major US Company, University, Grad School, etc uses DEI to promote hiring and acceptances. This is America today. Did you know CBS has a rule that 50% of the writers need to be "people of Color"? Bill Maher said this on his show recently. DEI Is now the MAIN reason to hire a person. DEI is the reason to promote someone. DEI is the reason to accept a less qualified student over a more qualified one.

 

[anbuitachi]

Your question is absurd. Every major US Company, University, Grad School, etc uses DEI to promote hiring and acceptances. This is America today. Did you know CBS has a rule that 50% of the writers need to be "people of Color"? Bill Maher said this on his show recently. DEI Is now the MAIN reason to hire a person. DEI is the reason to promote someone. DEI is the reason to accept a less qualified student over a more qualified one.

so i guess our healthcare quality will improve soon. we have the most diverse workers. soon to be #1 best healthcare outcome in the world

 

[rowsdower88]

Your question is absurd. Every major US Company, University, Grad School, etc uses DEI to promote hiring and acceptances. This is America today. Did you know CBS has a rule that 50% of the writers need to be "people of Color"? Bill Maher said this on his show recently. DEI Is now the MAIN reason to hire a person. DEI is the reason to promote someone. DEI is the reason to accept a less qualified student over a more qualified one.

So you actually haven't researched this. One CBS policy doesn't mean Frank's Diner in Podunk, Idaho is diversifying its workforce much less making diversity the PRIMARY reason a person gets a job there.

I'll ask my absurd question again: do you have any evidence (studies) that diversity hiring is the PRIMARY reason driving employment?

Edit: if you want to walk back your absurd claim and just say "I disagree with this hiring practice at CBS or wherever" by all means do so.

 

[deleted1156722]

Top Med Schools Weed Out DEI-Skeptical Applicants, New Report Finds | National Review

Thirty-six of the top 50 med schools ask applicants about their commitment to DEI, the report found.

www.nationalreview.com

AAMC is pushing its agenda down the throats of every med school in the country, and literally every med school applicant has to prove his/her DEI credentials on a secondary essay devoted to this topic! Meritocracy and diversity can co-exist peacefully if the yardstick can be changed to social-economic status instead of race. Keep the metrics - MCAT/GPA/ standardized test scores and add the SE status in place of the race.

How is a URM applicant who is a privileged child of 2 ivy-league physicians and has had no hardships in anyway contributing to the diversity more than a white applicant who has worked in his parents’ farm or the asian applicant who has worked in his family’s laundromat while they were juggling academics and life.

I listened to the entire supreme court arguments on Affirmative action, lasting (5+ hours) between SFFA and Harvard/UNC. I was appalled by the 3 liberal justices who were indistinguishable from the defendants representing Harvard/UNC and Biden administrations’s solicitor general…they are all complicit in race-baiting and gaslighting America and Academia!

 

[BLADEMDA]

The Blindness of ‘Color-Blindness’

When the Supreme Court heard oral arguments on the future of affirmative action, I knew I had to be there.

www.theatlantic.com

I read the article and came away with the idea that the time has come to end race based admissions period. In 50 years, our kids will look back at this decision as the correct one to no longer use race as a factor in a color blind society based On merit. I agree with using socioeconomic status as part of the admissions process to create a diverse student body. But, using race as the primary factor for admittance, hiring or promotion doesn’t create any true equity in America. It does just the opposite. It’s an excuse to practice reverse racism on a large scale.

I fully understand the history of racism in America and even agree it exists today. But, the answer isn’t to institutionalize reverse racism in society.

 

[Iso4ane]

For the good of everyone, both patients and physicians, medical schools and adcoms needs to stop obsessing over gender and race, and start refocusing on merit, fairness, and inclusiveness.

As an Asian Male who came from a family that grew from lower middle class to upper middle/lower upper class by the time I was in high school/college, I've been of the opinion that it's not race that should have the most weight but socioeconomic status. We cannot deny that having money makes things a little bit easier. You still need drive and talent, but money does help it shine a little brighter. People should be judged on the resources given to them. A million dollar sports car will likely outperform a cheaper one, but if the cheaper on can keep up, that's worth throwing money at.

 

[gunnershow]

As an Asian Male who came from a family that grew from lower middle class to upper middle/lower upper class by the time I was in high school/college, I've been of the opinion that it's not race that should have the most weight but socioeconomic status. We cannot deny that having money makes things a little bit easier. You still need drive and talent, but money does help it shine a little brighter. People should be judged on the resources given to them. A million dollar sports car will likely outperform a cheaper one, but if the cheaper on can keep up, that's worth throwing money at.

Schools don't want "socioeconomic diversity" because this would just result in classes full of Asian immigrants. Asians have the highest poverty rate of any ethnic group in NYC but they have the best academic outcomes all the same.

When they say their goal is diversity, that means more black admits. They don't care if they came from rich families and have had every privilege.

 

[rowsdower88]

The Blindness of ‘Color-Blindness’

When the Supreme Court heard oral arguments on the future of affirmative action, I knew I had to be there.

www.theatlantic.com

I read the article and came away with the idea that the time has come to end race based admissions period. In 50 years, our kids will look back at this decision as the correct one to no longer use race as a factor in a color blind society based On merit. I agree with using socioeconomic status as part of the admissions process to create a diverse student body. But, using race as the primary factor for admittance, hiring or promotion doesn’t create any true equity in America. It does just the opposite. It’s an excuse to practice reverse racism on a large scale.

I fully understand the history of racism in America and even agree it exists today. But, the answer isn’t to institutionalize reverse racism in society.

I'm going to make two assumptions:

1. You want to see racial disparities in US healthcare decrease over time.
2. Patient-Physician racial concordance results in some improved outcomes in minority populations that the status quo underserves. This is due to direct patient interactions being improved as well as minority physicians tending to practice in underserved communities.

When I make those two assumptions, I see the value in some mild affirmative action programs to help those communities.

Assuming those two assumptions are true, could you get on board with some mild AA programs? Can you get on board with this idea being for the greater good, or is the idea of a couple white med school applicants not matriculating not worth it? If no, can you at least understand how someone could arrive at that conclusion?

(In my opinion, you dramatically overstate the degree to which affirmative action programs are hurting white/asian students/physicians. To give some perspective, the average white med school applicant is FAR more likely to "lose" their seat to a lower scoring white applicant than to a black applicant regardless of their score. The average applicant is more likely to increase their odds of getting in by answering three more questions correctly on the MCAT or by getting a B+ instead of a B in undergrad than if we eliminated ALL affirmative action for black applicants.)

Affirmative action doesn't hurt white medical school applicants

Quit whining that a black applicant "stole your spot" in medical school. She didn't.

www.statnews.com

 

[deleted1156722]

Indeed if Affirmative Action is so inconsequential to the admissions process to whites/asians, then clearly you wouldn’t mind eliminating the “race box”?
First of all, race is self-reported and allows too much latitude with reporting and no actual verification process exists unlike SE status which can be confirmed with W-2/ parental income and wealth status etc.
Needless to state, do we have any accounting of how much % of people are actually who they state they are on the “race box”, including. our politicians who have checked the wrong race box to game the system.
Did Senator Liz Warren get any consequences for her egregious error in choosing the “native american” box for her 1/million probability of Cherokee descent, and get into the ivy league law school by depriving another eligible candidate?
Of course not, and Harvard continues to argue for that very same race box!

Case-in-point from the SCOTUS arguments:

“Justice Samuel Alito pressed North Carolina Solicitor General Ryan Park on this latter point, asking Park when an applicant could rightly be considered a minority according to the University of North Carolina. If an applicant is half-black and half-white, can he claim to be black? Or what about an applicant whose great-grandmother was Native American? Can she claim to be Native American?

Park responded by saying the school depends on self-reporting and generally trusts that what the applicant reports is the truth.

Alito pressed forward: “Well, I identify as an American Indian because I’ve always been told that some ancestor back in the old days was an American Indian,” he said.

Park responded: “In that circumstance, it would be very unlikely that that person was telling the truth.”

But neither UNC nor Harvard admissions ever explained to the court how the schools would determine or dispute these claims.

This is fundamentally because there is no definitive definition of race, nor is there an agreed upon standard-at least, not when it comes to race conscious college admissions. This is my argument for eliminating the race box and using grades/test scores and SES instead. Race box fundamentally divides us all, and we need to get rid of it. Everyone deserves equal opportunities but not Equal outcomes- merit needs to be rewarded and that is fundamentally the american dream!

 

[rowsdower88]

Indeed if Affirmative Action is so inconsequential to the admissions process to whites/asians, then clearly you wouldn’t mind eliminating the “race box”?
First of all, race is self-reported and allows too much latitude with reporting and no actual verification process exists unlike SE status which can be confirmed with W-2/ parental income and wealth status etc.
Needless to state, do we have any accounting of how much % of people are actually who they state they are on the “race box”, including. our politicians who have checked the wrong race box to game the system.
Did Senator Liz Warren get any consequences for her egregious error in choosing the “native american” box for her 1/million probability of Cherokee descent, and get into the ivy league law school by depriving another eligible candidate?
Of course not, and Harvard continues to argue for that very same race box!

Case-in-point from the SCOTUS arguments:

“Justice Samuel Alito pressed North Carolina Solicitor General Ryan Park on this latter point, asking Park when an applicant could rightly be considered a minority according to the University of North Carolina. If an applicant is half-black and half-white, can he claim to be black? Or what about an applicant whose great-grandmother was Native American? Can she claim to be Native American?

Park responded by saying the school depends on self-reporting and generally trusts that what the applicant reports is the truth.

Alito pressed forward: “Well, I identify as an American Indian because I’ve always been told that some ancestor back in the old days was an American Indian,” he said.

Park responded: “In that circumstance, it would be very unlikely that that person was telling the truth.”

But neither UNC nor Harvard admissions ever explained to the court how the schools would determine or dispute these claims.

This is fundamentally because there is no definitive definition of race, nor is there an agreed upon standard-at least, not when it comes to race conscious college admissions. This is my argument for eliminating the race box and using grades/test scores and SES instead. Race box fundamentally divides us all, and we need to get rid of it. Everyone deserves equal opportunities but not Equal outcomes- merit needs to be rewarded and that is fundamentally the american dream!

Do you have evidence that a significant number of students are lying about their reported race? That would be interesting. Until I see evidence of that happening frequently, I'll view it the same way I view voter fraud in the US (easy to do, very low evidence it actually happens).

 

[deleted1156722]

Do you have evidence that a significant number of students are lying about their reported race? That would be interesting. Until I see evidence of that happening frequently, I'll view it the same way I view voter fraud in the US (easy to do, very low evidence it actually happens).

This is a rhetorical question-
Race is self-reported and allows a huge latitude. ( e.g. as above of Senator Warren)
Race does not convey the actual story of the background/ the needs of the applicant- Are you okay with President Obama’s daughters being favored over a poor/ hardworking Asian/White applicant just because they check the right “race box”.

We can argue all day, and the truth is that no one ever changes their minds based on the conversation in these forums… however it doesn’t hurt to try! 🙂

 

[rowsdower88]

This is a rhetorical question-
Race is self-reported and allows a huge latitude. ( e.g. as above of Senator Warren)
Race does not convey the actual story of the background/ the needs of the applicant- Are you okay with President Obama’s daughters being favored over a poor/ hardworking Asian/White applicant just because they check the right “race box”.

We can argue all day, and the truth is that no one ever changes their minds based on the conversation in these forums… however it doesn’t hurt to try! 🙂

So no evidence to back up your concern aside from Warren? Dude, you have to at least try to convince me with something besides your vibes. If you had evidence I would read it. If you don't have evidence to back up your own concerns you should question them.

Edit: To answer your question, I don't really care about Obama's daughters. They're going to have other far greater advantages in life aside from any affirmative action.

 

[deleted1156722]

So no evidence to back up your concern aside from Warren? Dude, you have to at least try to convince me with something besides your vibes. If you had evidence I would read it. If you don't have evidence to back up your own concerns you should question them.

Nice try to deviate from the crux of the conversation which is: “ Affirmative Action is wrong and Race conscious admissions needs to be eliminated”
The collateral argument is the potential for false claims in the race box, but this has never been the point of the back-forth even if you would like to side-step the main argument for your convenience. Even if I give it to you that 💯 percent of the race box is correct, does it make affirmative action any better? NOT!
As I stated before, everyone regardless of their race, deserves equal opportunities but not equal outcomes- meritocracy trumps over diversity.

 

[rowsdower88]

Nice try to deviate from the crux of the conversation which is: “ Affirmative Action is wrong and Race conscious admissions needs to be eliminated”
The collateral argument is the potential for false claims in the race box, but this has never been the point of the back-forth even if you would like to side-step the main argument for your convenience. Even if I give it to you that 💯 percent of the race box is correct, does it make affirmative action any better? NOT!
As I stated before, everyone regardless of their race, deserves equal opportunities but not equal outcomes- meritocracy trumps over diversity.

I'm just asking you very basic questions and you won't even try to answer them. If you were interested in persuading me you could try and do some research. Maybe address some of the concerns I've brought up or counter the studies I've pointed to.

Watching SCOTUS doesn't make you an expert on a subject. Pointing to anecdotes like Warren or Malia Obama isn't going to persuade me.

I believe there are good arguments that suggest AA for med students/residents results in better outcomes for minority communities and is worth the cost of fewer white/asian matriculants (see above posts). I'm making a utilitarian calculation there. Can you address that or try to persuade me on utilitarian grounds? There is a lot of research you could read if you're interested in this topic!

meritocracy trumps over diversity.

I don't think we live in a perfect meritocracy, we absolutely should take other concerns into account when making decisions that affect us at the population level. If we lived in a perfect meritocracy, I would be more sympathetic to your position.

 

[Iso4ane]

I'm going to make two assumptions:

1. You want to see racial disparities in US healthcare decrease over time.
2. Patient-Physician racial concordance results in some improved outcomes in minority populations that the status quo underserves. This is due to direct patient interactions being improved as well as minority physicians tending to practice in underserved communities.

When I make those two assumptions, I see the value in some mild affirmative action programs to help those communities.

Assuming those two assumptions are true, could you get on board with some mild AA programs? Can you get on board with this idea being for the greater good, or is the idea of a couple white med school applicants not matriculating not worth it? If no, can you at least understand how someone could arrive at that conclusion?

(In my opinion, you dramatically overstate the degree to which affirmative action programs are hurting white/asian students/physicians. To give some perspective, the average white med school applicant is FAR more likely to "lose" their seat to a lower scoring white applicant than to a black applicant regardless of their score. The average applicant is more likely to increase their odds of getting in by answering three more questions correctly on the MCAT or by getting a B+ instead of a B in undergrad than if we eliminated ALL affirmative action for black applicants.)

Affirmative action doesn't hurt white medical school applicants

Quit whining that a black applicant "stole your spot" in medical school. She didn't.

www.statnews.com

Previous studies and simulation suggest that White people are minimally affect with the presence of affirmative action policies. But, thats not always true when it comes to Asians.

 

[rowsdower88]

Previous studies and simulation suggest that White people are minimally affect with the presence of affirmative action policies. But, thats not always true when it comes to Asians.

That's interesting. Are there any studies you can point to that discuss that? Does it have to do with the greater heterogeneity in the asian american population (# of bachelor degrees held by Hmong Americans are lower than Taiwanese Americans for example)?

 

[Gern Blansten]

That's interesting. Are there any studies you can point to that discuss that? Does it have to do with the greater heterogeneity in the asian american population (# of bachelor degrees held by Hmong Americans are lower than Taiwanese Americans for example)?

And below is more recent data:

 

[rowsdower88]

View attachment 367597

White and Asian populations appear to be pretty similar in this chart, that doesn't suggest to me that Asian students are markedly discriminated against relative to White students. Sub group analysis would be interesting if you had it, or if you included the paper you got this from. For instance, maybe Taiwanese Americans are markedly different from Hmong Americans; that would be interesting.

As I suggested above in a previous post, the actual harm to White applicants is very small. For the average White applicant, correctly answering 3 more questions on the MCAT or getting a B+ instead of a B could negate the entire effect of Affirmative Action received by black students. IMO, trivial harm to White students relative to the significant benefit to black students.

Edit: The average white applicant is more likely to "lose" their spot to another white applicant with lower scores than to a black applicant.

Affirmative action doesn't hurt white medical school applicants

Quit whining that a black applicant "stole your spot" in medical school. She didn't.

www.statnews.com

 

[Gern Blansten]

White and Asian populations appear to be pretty similar in this chart, that doesn't suggest to me that Asian students are markedly discriminated against relative to White students. Sub group analysis would be interesting if you had it, or if you included the paper you got this from. For instance, maybe Taiwanese Americans are markedly different from Hmong Americans; that would be interesting.

I see it differently. Just because the difference isn't astronomical between whites and asians like it is for the other "minorities," does not mean that it is not significant. Especially when you consider that asians are also a minority and thus should be expected to get the same bump as other minorities in a "fair" system. However, instead they go the opposite direction and are the lowest of all. So, in essence, I believe that you are comparing them to the wrong demographic when you compare asians to whites. They should be compared with their similar minorities (Hispanic and black). Now would you describe the difference as minor? In essence, they are the victims of their own success. They generally are super high performers as a group and thus people reverse discriminate against them to try to make sure they do not make up too high a percentage of the medical school classes.

 

[rowsdower88]

I see it differently. Just because the difference isn't astronomical between whites and asians like it is for the other "minorities," does not mean that it is not significant. Especially when you consider that asians are also a minority and thus should be expected to get the same bump as other minorities in a "fair" system. However, instead they go the opposite direction and are the lowest of all. So, in essence, I believe that you are comparing them to the wrong demographic when you compare asians to whites. They should be compared with their similar minorities (Hispanic and black). Now would you describe the difference as minor? In essence, they are the victims of their own success. They generally are super high performers as a group and thus people reverse discriminate against them to try to make sure they do not make up too high a percentage of the medical school classes.

So the difference in average MCAT scores you listed between white and asian students is about 2 points. Isn't that equivalent to 1-3 questions? I dunno, I guess I don't see that as significant.

Edit: The reason I compared asian students to white students was because I was responding to another person who commented on my post.

The reason to give "a bump" is not simply minority status or historical inequity.

Let me be clear, the reason I give think black populations deserve "a bump" is because they're measurably providing a better service to underserved communities (see references above to Patient-Physician racial concordance and Unequal Treatment report) through direct patient care and being more likely to work in the underserved communities which contribute to the healthcare outcomes disparity.

If you had information that asian physicians were contributing to resolving the healthcare disparity to the same degree as black physicians, then I would totally be on board with AA for them as well. I don't know if that research exists, but I would be persuaded if it does!

 

[Gern Blansten]

So the difference in average MCAT scores you listed between white and asian students is about 2 points. Isn't that equivalent to 1-3 questions? I dunno, I guess I don't see that as significant.

The reason to give "a bump" is not simply minority status or historical inequity.

Let me be clear, the reason I give think black populations deserve "a bump" is because they're measurably providing a better service to underserved communities (see references above to Patient-Physician racial concordance and Unequal Treatment report) through direct patient care and being more likely to work in the underserved communities which contribute to the healthcare outcomes disparity.

If you had information that asian physicians were contributing to resolving the healthcare disparity to the same degree as black physicians, then I would totally be on board with AA for them as well. I don't know if that research exists, but I would be persuaded if it does!

What I mostly see are first and second generation immigrants from Africa who are taking the medical school spots and end up living in very affluent areas. I just rarely see the people who grew up in impoverished bigger cities of the US who pick themselves up by the bootstraps and make it into medical school. There are some of those, but far more common are the recently immigrated from Africa individuals who are the most affluent in their home countries and make the trip to the US and occupy a med school spot to fill a quota. They are basically taking the spots from the socioeconomically disadvantaged population that the system was trying to help. I see it in medicine and I see it in the CRNA population probably at a rate of 3 or 4 to 1. It is a well oiled machine for those who are able to immigrate and navigate into the system. Immigrate. Get into college and establish residency. Do anywhere from average to well above average in school. Apply for medical school and watch everyone beg for you to attend their school. Or, become a nurse and do the same with CRNA school.
I would personally prefer that the system be geared to help our fellow Americans from the inner cities who have dealt with oppression and disadvantages for generations. I just uncommonly see someone that fits that mold that has actually benefited from the programs in place designed to help them.

 

[rowsdower88]

What I mostly see are first and second generation immigrants from Africa who are taking the medical school spots and end up living in very affluent areas. I just rarely see the people who grew up in impoverished bigger cities of the US who pick themselves up by the bootstraps and make it into medical school. There are some of those, but far more common are the recently immigrated from Africa individuals who are the most affluent in their home countries and make the trip to the US and occupy a med school spot to fill a quota. They are basically taking the spots from the socioeconomically disadvantaged population that the system was trying to help. I see it in medicine and I see it in the CRNA population probably at a rate of 3 or 4 to 1. It is a well oiled machine for those who are able to immigrate and navigate into the system. Immigrate. Get into college and establish residency. Do anywhere from average to well above average in school. Apply for medical school and watch everyone beg for you to attend their school. Or, become a nurse and do the same with CRNA school.
I would personally prefer that the system be geared to help our fellow Americans from the inner cities who have dealt with oppression and disadvantages for generations. I just uncommonly see someone that fits that mold that has actually benefited from the programs in place designed to help them.

I understand that that is your perception. But I would urge you to reconsider your perception in light of the studies/report I shared above which suggests black physicians actually are somewhat better for underserved communities/populations. Hence my support for mild affirmative action programs to resolve the healthcare disparity.

I don't have enough information to comment on whether immigrant black physicians or non-immigrant black physicians are better at resolving healthcare disparities. Language barriers might be an impediment there for immigrant physicians? I honestly can't speak to that at all so I won't try to contest your perception on that.

 

[Gern Blansten]

I understand that that is your perception. But I would urge you to reconsider your perception in light of the studies/report I shared above which suggests black physicians actually are somewhat better for underserved communities/populations. Hence my support for mild affirmative action programs to resolve the healthcare disparity.

I don't have enough information to comment on whether immigrant black physicians or non-immigrant black physicians are better at resolving healthcare disparities. Language barriers might be an impediment there for immigrant physicians? I honestly can't speak to that at all so I won't try to contest your perception on that.

90+% of the ones I have met were taught English at a young age and speak it quite fluently (better than me, sometimes). They often speak 3+ languages.
I am in favor of some degree of Affirm Action and help for the impoverished and disadvantaged. I am not in favor of quotas and reverse discrimination, however.

 

[abolt18]

I understand that that is your perception. But I would urge you to reconsider your perception in light of the studies/report I shared above which suggests black physicians actually are somewhat better for underserved communities/populations. Hence my support for mild affirmative action programs to resolve the healthcare disparity.

I don't have enough information to comment on whether immigrant black physicians or non-immigrant black physicians are better at resolving healthcare disparities. Language barriers might be an impediment there for immigrant physicians? I honestly can't speak to that at all so I won't try to contest your perception on that.

Surprisingly, I have seen a fair amount of prejudice/racism between Africans and African Americans. We have a fairly large population of both (mostly African refugees) and the African kids will spill about how they're made fun of by AAs for being "too black" or excluded due to a myriad of cultural issues. I've also heard them talk badly about AAs and have a generally negative opinion about AA culture. These are generalities I see around me, and are obviously not applicable across the board. But it makes me wonder how applicable that data is about better outcomes between the two populations.

 

[rowsdower88]

Surprisingly, I have seen a fair amount of prejudice/racism between Africans and African Americans. We have a fairly large population of both (mostly African refugees) and the African kids will spill about how they're made fun of by AAs for being "too black" or excluded due to a myriad of cultural issues. I've also heard them talk badly about AAs and have a generally negative opinion about AA culture. These are generalities I see around me, and are obviously not applicable across the board. But it makes me wonder how applicable that data is about better outcomes between the two populations.

Yeah, I can't speak to that at all. I would have to look to see if the studies I reviewed stratified their black physician populations based on immigration status. That might be interesting, but I am not personally curious enough to do that. If it turned out that only non-immigrant black physicians were reducing the disparity (or immigrant black physicians?) that would potentially impact my policy preferences wrt affirmative action.

But I'm just trying to get people here on board with the idea that this tradeoff for improving underserved populations with a compromise on their meritocratic ideal is a good thing. Affirmative action as the utilitarian choice.