Diversity, Inclusion, and Equity: Evolution of Race and Ethnicity Considerations for the Cardiology Workforce in the United States of America From 1969 to 2019

From the Journal of the American Heart Association:

* The AAMC “Project 3000 by 2000” began in 1990.24 The goal was to enroll 3000 “underrepresented in medicine” students per year in medical schools by the year 2000.31 Despite additional “pipeline” efforts, the program failed as year 2000 acceptees consisted of 1168 blacks, 1082 Hispanics, and 126 American Indians.32 Nationally, it was felt that progress had been attained only by lowering admissions standards for objective academic achievements.2

* In 2009, the US Department of Education’s LCME issued diversity standards MS-8 and IS-16.13 This marked a seismic transformation. Previously, racial and ethnic preferences were voluntary; created and implemented at the state or institutional level; limited to the premedical and medical school stages; and, in theory, temporary. Although AAMC initiatives were national, it was limited to advocacy. The distinguishing features of the “diversity” programs are that racial and ethnic preferences are mandatory; created and implemented at the national level; imposed throughout all stages of academic medicine and cardiology; and intended to be permanent.

* At George Mason University Law School, racial preferences were gradually phased out between 1996 and 2000.45 In 2000, the American Bar Association issued a warning for failure to comply with Standard 211, a diversity provision, thereby risking loss of accreditation. As reported, there was a “lack of progress in achieving student diversity. The number of minority students, especially African-American, Hispanic, and Native American students, continue[d] to be extremely low.” The school was ultimately forced to reinstate racial preferences until black matriculants were “more than 13 times as likely to be dismissed for academic cause, and almost twice as likely to fail the bar exam on their first attempt” when compared with students who did not receive preferences. After receiving reaccreditation, Dean Daniel Polsby stated, “What did become quite clear to us during
the ordeal was that our efforts to attract minority students would never satisfy the Committee until they produced some unspecified increase in minority enrollment, especially of certain groups. But we were never told how many students of which races and ethnicities we had to enroll to satisfy the [American Bar Association]… this process was unfair to us, as well as to some of the students whom we were pressured to admit, and who later failed out of the law school at great cost to them in terms of time, money, and emotional distress.”

* Using data from the AAMC and the US Census, marked differences for applicants per 100 000 people in the 20-to 29-year age band exist between racial and ethnic groups: 105.4 for whites, 62.9 for blacks, 46.6 for Hispanics, and 373.4 for Asians.58,59 Second, blacks and Hispanics have greater unadjusted odds for medical school acceptance when compared with whites and Asians when considering applicants with total Medical College Admission Test (MCAT) scores of ≥21 (Table 2) (a total MCAT score of 21 was the 27th percentile for exams administered between January 2012 and September 201463). Third, they do not account for differences in academic qualifications. Fourth, targeting population parity of medical school graduates would necessitate “overrepresentation” of black and Hispanic acceptees, given higher attrition rates.

* The MCAT has been shown to correlate with unimpeded progress through medical school…

* Blacks and Hispanics are overrepresented and whites and Asians are underrepresented in the lenient model. This is attributable to substantial numbers of Hispanics and blacks in the ≤23 group (Figure 3). The effect is accentuated further in the strict model.

Considering the qualified applicant pool has added importance because of concerns that implicit bias, or subconscious racial or ethnic discrimination, contributes to the low numbers of blacks and Hispanics.69 National data refute this hypothesis, given medical school acceptance rates for racial and ethnic groups when MCAT scores are considered.55 More refined analyses of institutional data, such as the 2001 University of Maryland report,35 provide indisputable evidence that medical schools are going to great lengths to recruit and support blacks and Hispanics. The qualified applicant pool is simply too small.

* Differences for MCAT scores by racial and ethnic groups have been long been observed, even when accounting for parental income.34 Racial and ethnic bias has been investigated, but its existence has not been supported…

* There exists no empirical evidence by accepted standards for causal inference to support the mantra that “diversity saves lives.”

* Healthcare disparities may be due to clustering of biological risk factors for disease and socioeconomic conditions…

* Continuation of racial and ethnic preferences for 5 decades results from the small pool of qualified black and Hispanic medical school applicants.

* An evolving theory for low numbers of blacks and Hispanics in Science, Technology, Engineering, and Math (STEM) and professional fields revolves around the paradoxically harmful effects of affirmative action known as mismatch. Racial and ethnic preferences at both the undergraduate and professional school levels for blacks and Hispanics result in relatively weak academic starting positions in classes. This has been postulated to lead to poor performance through compounding “academic mismatch,” stress-related interference, and disengagement.95 Many do not complete their intended programs or do not attain academic success to be attractive candidates for subsequent educational programs or employment.

* Most medical schools now require students to pass the US Medical Licensing Examination Step 1 to advance.68 Introduced in 1992, poor performance of blacks and Hispanics on the US Medical Licensing Examination Step 1 was described as early as 1996. First-try passing rates for the graduating class of 1994 were 93.4% for whites, 58.2% for blacks, 77.5% for Hispanics, and 86.8% for Asians. In fact, 11.8% of blacks had not passed both Steps 1 and 2 by May 1996.

The American Heart Association then announced:

The Wang paper has rightfully drawn criticism for its misrepresentations and conclusions. As an organization focused on the relentless pursuit of longer, healthier lives for everyone everywhere, the American Heart Association (AHA) denounces the views expressed in the article and regrets its role in enabling those views to be promoted. Those views are a misrepresentation of the facts and are contrary to our organization’s core values and historic commitment to promoting diversity and inclusion in medicine and science.

The American Heart Association remains committed to equity, diversity and inclusion as foundationally essential to its mission. The Association invests in helping to build a diverse health care and scientific research community and actively works to eliminate barriers and increase opportunities in science for people from historically-excluded communities and those impacted by race, ethnicity and class disparities.

The American Heart Association takes the concerns about the Wang paper seriously. We have launched a formal investigation to better understand how a paper that is completely incompatible with the Association’s core values was published. While the Journal of the American Heart Association (JAHA) and the other AHA scientific journals are editorially independent of the Association, we take our responsibility to ensure factual accuracy seriously. The independent editors of JAHA and the American Heart Association are reviewing the journal’s peer-review and publication processes to ensure future submissions containing deliberate misinformation or misrepresentation are never published. The journal can and will do better.

The Association believes much more – not less – needs to be done to increase diversity, equity and inclusion in science, medicine and cardiology. The volunteer and staff leaders of the American Heart Association remain resolved to improve the actions and investments across the organization as well as within the editorially autonomous journals that bear the Association’s trusted name.

From the New York Times today:

After years of training in predominantly white emergency departments, Dr. Otugo has experienced many such microaggressions. The term, coined in the 1970s by Dr. Chester Pierce, a psychiatrist, refers to “subtle, stunning, often automatic, and nonverbal exchanges which are ‘put downs’” of Black people and members of other minority groups; “micro” refers to their routine frequency, not the scale of their impact. Dr. Otugo said the encounters sometimes made her wonder whether she was a qualified and competent medical practitioner, because others did not see her that way.

Other Black women doctors, across specialties, said that such experiences were all too common. Dr. Kimberly Manning, an internal medicine doctor at Grady Memorial Hospital in Atlanta, recalled countless microaggressions in clinical settings. “People might not realize you’re offended, but it’s like death by a thousand paper cuts,” Dr. Manning said. “It can cause you to shrink.”

…Discussions about lack of diversity in medicine resurfaced in early August, when the Journal of the American Heart Association retracted a paper that argued against affirmative action initiatives in the field and said that Black and Hispanic trainees were less qualified than their white and Asian counterparts.

That’s the only mention of affirmative action in the Times article. There’s no mention of the astronomical rate of malpractice lawsuits against black doctors.

Here are some comments to the Times:

* Easily, the scariest episodes in my life surround when me or my loved ones are under medical care. These are life and death situations. I try to research the doctors providing care, as best I can.

What this article says is that we need to bend medical care to make it politically correct and use the medical system, particularly how we treat doctors, as a social engineering tool.

We entrust doctors with our lives. They are the most highly trained and vetted professionals. It is absolutely true, that this vetting has been hindered by affirmative action. Now the NYTimes wants further hindrance in the name of political correctness…

Doctors are people, but they are people who have our lives in their hands. If “microaggressions” affect them, then they shouldn’t be doctors. Doctors run medicine, only a select few of us are worthy of that burden. As a patient, I demand no less.

* “Microaggressions” ???
Pull-ease !!!

As an Ashkanazie I have been dealing with these “Microaggressions” since kindergarten and I’m now over 60…

I call it “Dealing with Life as it is, has been and always will be.”
I deal with it and them, make the best of it, turn it to my advantage if possible, turn the other cheek and GET ON with my life…..

File this article under the heading SNOWFLAKES.

* If you can’t handle or accept that everyone is not going to like you, than stay home and find a job where you don’t have to interact with people.

* Read the retraction. It does not factually dispute any of the paper’s assertions. Only that it runs counter to the AHA’s “values”. Scary. The medical community should have the opportunity to evaluate the paper for themselves.

* “When she was first admitted to her residency, at Harvard, a medical school classmate suggested that she had had an “edge” in the selection process because of her race.” Is this untrue? Harvard does use affirmative action, correct?

* The reason is because Black applicants to medical school who are relatively less qualified, are admitted over more qualified candidates, by a large margin.


Specifically: “black applicants were almost 4 times more likely to be accepted to US medical schools than Asians” with the same MCAT score.

And black applicants were “2.8 times more likely [to be accepted] than white applicants”

Just seems fundamentally unfair, esp. because most people want the most qualified doctor operating on them.

* Between 2013-2016 an African American medical school applicant with 3.40-3.59 GPA & 27-29 MCAT had an 81% likelihood of acceptance to a U.S. M.D. program. Considering those same statistics, a white student had a 29% chance. Asian applicants had it even worse at 20.6%. These statistics don’t account for gender.

* If admissions standards are lower for certain groups, I think it’s understandable why some people might question implicitly or explicitly whether someone deserves to be in a certain position.

I have no doubt that many of these incidents are faux pas as humans are clumsy and some can be insensitive jerks. That said, I’d guess that in some instances, the feeling of being “microaggressed” is simply insecurity on the part of the microaggressed, and that’s on them.

About Luke Ford

I've written five books (see Amazon.com). My work has been covered in the New York Times, the Los Angeles Times, and on 60 Minutes. I teach Alexander Technique in Beverly Hills (Alexander90210.com).
This entry was posted in Affirmative Action. Bookmark the permalink.