The new diversity in medical education.

n engl j med 371;16 nejm.org october 16, 2014 1474 the administration’s rationale, I was told that although developing the early portion of the health-professions pipeline is valuable, “with limited funding we are investing in activities that more directly and immediately impact the supply and distribution of providers.” The AAMC took strong exception to the proposed action, saying that the two programs encouraged at least 459,036 members of underrepresented minority groups to consider careers in the health professions and that their elimination would have “dire consequences for the health workforce” and the communities it serves. Meanwhile, medical educators are increasingly concerned about declining support for affirmative action seen in court cases since the 2003 Supreme Court decision in Grutter v. Bollinger, which upheld the race-conscious admissions policy at the University of Michigan Law School. In June 2013, in the first challenge to such policies that the Court has since considered, Fisher v. University of Texas, it returned the case to a lower court for further action consistent with its opinion. (On July 15, 2014, responding to that directive, the U.S. Court of Appeals for the Fifth Circuit ruled that the University of Texas could continue using affirmative action in its admission policies.) Darrell G. Kirch, the AAMC chief executive officer, issued a statement, saying, “The AAMC is pleased that the Supreme Court continues to recognize the educational benefits of diversity and the appropriateness of individualized, holistic review in admissions. Diversity is a vital component of excellence in education, clinical care, and research at the nation’s medical schools and is a requirement for accreditation by the Liaison Committee on Medical Education.” But in the longer term, affirmative action may be on shaky ground, given that five of the nine Supreme Court justices have never voted in favor of race-based considerations in the enrollment processes of medical schools. In addition, eight states have banned race-based affirmative action steps, and others are considering similar actions.5 One development that may ultimately expand the diversity of the physician workforce is the impending demographic tsunami. According to the Census Bureau, the proportion of the U.S. population accounted for by racial and ethnic minorities is projected to reach 57% by 2060. In keeping with an ongoing demographic shift among young adults in the United States, the number of white applicants to medical schools has dropped by about 22% over the past three decades. However, the influx of millions of people from other countries — with a wide array of racial and ethnic backgrounds — cannot by itself resolve the diversity challenges facing black Americans and U.S. society.