Medical school admission is uncommonly competitive, there being many more applicants than slots. The competition is so intense that if black applicants were held to the same admission standards as whites and Asians, we would turn out almost no black physicians.
We now have a double standard for admission to medical school brought about by affirmative action. As a result, two tiers of American physicians have emerged separated by race and ability.
We have seen that law students admitted under affirmative action do not measure up to their white and Asian peers as law-school graduates. Can we say the same for doctors? We will quantify the performance gap for physicians.
A benchmark for medical competence is the National Board of Medical Examiners (NBME) Exam Part I. Every medical student in the US must pass it to become a physician. Students take the exam two years before graduation. It is one of several ways the profession keeps itself honest. The most comprehensive study of NBME pass rates was published in 1994 by Beth Dawson et al (JAMA 1994 272:9 674-9). The authors examined the performance of every medical student in the US taking the June exam for the first time over the years 1986, 1987 and 1988. Dawson and her colleagues found that white medical students passed the NBME test at a rate of 87.7 percent and blacks at 48.9 percent. Again, using methods described in Appendix A, we found these pass rates equivalent to a black-white mean difference of 1.19 SD. Mean differences for the bar and NBME exams are conspicuously similar. The one-plus SD gap does not yield easily.
Notably, when Dawson’s study looked at entering students with similar academic credentials, the pass rates on the NBME exam were independent of race, pointing an accusing finger directly at affirmative action. For all its good intentions, affirmative action has created two levels of competence in American medicine, separated by a bit more than one standard deviation. When you are wheeled into the ER at 2:00 a.m., if you pray, pray that the black doctor who greets you entered medical school through the front door.
