Effects of Affirmative Action in Medical Schools

TLDR

Affirmative‑action programs were introduced in the early 1970s to increase minority physicians and improve care for the poor. We analyzed 1975 U.S. medical school graduates to compare specialty choice, practice location, patient mix, and board‑certification rates between minority and nonminority physicians. Minority graduates were more likely to enter primary‑care specialties (55% vs 41%), practice in shortage areas (12% vs 6%) and serve larger Medicaid populations, yet they were less likely to be board‑certified by 1984 (48% vs 80%)—a gap largely explained by pre‑medical differences and patient mix—while overall they served disproportionately their own racial groups and largely met affirmative‑action goals.

Abstract

In the early 1970s, affirmative-action programs were introduced to accomplish a number of social goals, including increasing the supply of minority physicians and improving the health care of the poor. To assess the success of such programs, we analyzed data on people who graduated from U.S. medical schools in 1975 to determine how specialty choice, practice locations, patient populations served, and board-certification rates differ between minority and nonminority graduates. A larger proportion of minority graduates (55 per cent vs. 41 per cent, P less than 0.001) chose the primary-care specialties of family practice, general internal medicine, general pediatrics, and obstetrics-gynecology. Significantly more minority physicians (12 per cent vs. 6 per cent, P less than 0.01) practiced in locations designated as health-manpower shortage areas by the federal government and had more Medicaid recipients in their patient populations (31 per cent for blacks, 24 per cent for Hispanics, 14 per cent for whites; P less than 0.001). Physicians from each racial or ethnic group served disproportionately more patients of their own racial or ethnic group (P less than 0.001), but minority physicians did not serve significantly more persons from other racial or ethnic minority groups than did nonminority physicians. Many minority physicians served patient populations much like those of their nonminority colleagues, which indicates that substantial integration of the medical marketplace has taken place. Significantly fewer minority graduates had become board-certified by 1984 (48 per cent vs. 80 per cent, P less than 0.001), and most of this disparity was associated with differences in premedical-school characteristics and in the patient populations they served. Our analysis shows that minority graduates of the medical school class of 1975 are fulfilling many of the objectives of affirmative-action programs.