Supreme Court’s affirmative action ruling: Impacts on the ID workforce & health equity

In this first installment of a two-part series, the authors provide context on the Supreme Court’s recent decision and explore how it will affect the infectious diseases workforce as well as impacts on health equity and medical education. 

“Today I am sad because I know that the small number of Black and Brown medical professionals is about to become even smaller in the near future,” a colleague texted into a communal messaging thread on June 29. This was a common feeling and notion expressed on social media as millions reacted to the recent rejection of affirmative action in college admissions by the United States Supreme Court.

This decision is an action against equity, inclusion and diversity in the U.S. education system. For 45 years, U.S. universities have practiced affirmative action, which aimed to address historical limitations in college admissions based on sex, gender, religion, ethnicity and race. This ruling was first made in Regents of California v. Bakke (1978), where Allan Bakke challenged that the policies at UC Davis’s medical program, which included the reservation of 16 of every 100 spots for minorities, were discriminatory. While the court struck down the medical school’s quota, it upheld the use of affirmative action to increase the diversity of the student body. Perhaps the most poignant takeaway from the argument came from the sitting justices at the time, who wrote, “The government may take race into account when it acts not to demean or insult any racial group, but to remedy disadvantages cast on minorities by past racial prejudice.” 

This marked a historic moment, where the highest U.S. court acknowledged the consequences of longtime discrimination — or plainly, racism — and agreed that the best opportunity to rectify these would be to develop targeted actions to make college admissions policies more equitable. 

Despite the supposed growth in anti-racist education and attitudes, the thoughts surrounding equity in education have regressed in 2023, which will undoubtedly upend inclusivity across many medical professions. This unequal precedent directly impacts health care professionals from minority or underrepresented groups, both formed in or outside the U.S. Inevitably, this ruling will have downstream effects on the infectious diseases physician and pharmacist workforce, which will in turn have a detrimental impact on equitable patient outcomes. The ID community must focus our attention on how the Supreme Court decision affects our respective institutions and prioritize targeted efforts to increase the recruitment and retention of racially diverse clinicians.

Impacts on the ID workforce and health equity

The underrepresentation of racial and ethnic minorities has been a persistent issue within the U.S. health care system, leading to a significant gap between White professionals and other racial groups. This disparity has had far-reaching consequences, affecting not only professional development and diversification of the health care workforce, but also health care access, quality of care and associated cost for these minority groups. The medical community has familiarity with the exclusion of race in admission and the detriment that it has on the enrollment of Black and other minoritized students.

In 2019, at Texas Tech’s medical school, only 4% of students identified as Black, and 13% identified as Hispanic/Latino — grossly disproportionate compared to the representation of these racial/ethnic groups in the U.S. These disparate numbers are quite representative of the national climate of racial diversity across medical programs. Following the decision to stop considering race in their admissions — in alignment with their pharmacy and undergraduate schools — it was anticipated that those numbers would become even smaller, as previous research on enrollment trends following affirmative-action bans has found. In ID, challenges in filling ID training program positions in the 2023 Fellowship Match — combined with an even lower number of Black and other underrepresent minoritized individuals who will be eligible to matriculate through medical training programs and then specialized ID training — suggest we are faced with several major dilemmas.

First and foremost, the exacerbated underrepresentation of minoritized ID professionals will hinder efforts to achieve national health equity, or the attainment of the highest level of health for all people. One major factor in achieving health equity is cultural competence and establishing racially concordant clinician-patient relationships. Research has shown that having a provider of the same race results in improved health care use and lower health care expenditures in minoritized populations. In the U.S., where at least 2-3 out of every 10 people speak a language other than English, and the “minority” groups are projected to become the majority by mid-century, these relationships have become even more essential.

Furthermore, we are confronted with the stark reality of persistent geographic gaps in health care access. Underrepresented groups are more likely to practice in underserved areas, and reports of health care shortages in rural and urban regions predominantly inhabited by racially and ethnically minoritized individuals are increasingly common. With the likely decrease in the training of individuals with intimate connections to these communities due to underrepresentation, we are moving further away from addressing and reversing these disparities.

Don't miss the authors' second post in this series, which explores impacts of the Supreme Court’s decision on access to — and the quality of — ID education, insights on taking action and resources for those interested in learning more. Please share with IDSA your stories on how diversity impacts health care in the field of ID. Some of these may be featured in future blog posts or in other communications channels as part of the Society’s ongoing inclusion, diversity, access and equity efforts.