Springfield’s medical school does better than about 90% of its peer institutions across the United States and Canada when it comes to the share of graduates who are Black and members of other underrepresented groups.
But the dean and provost of Southern Illinois University School of Medicine said medical schools in the United States and Canada have a long way to go to reflect the diversity of their patients.
The recent 6-3 ruling of the U.S. Supreme Court in June striking down affirmative action in higher education enrollment decisions could make the task more difficult, Dr. Jerry Kruse said.
“In some ways, it takes the emphasis off of us thinking about issues related to inequity that have been systemically built,” he said.
The court’s conservative majority, in a decision written by Chief Justice John Roberts Jr., said the use of race in diversifying student bodies in higher education is unconstitutional and violates the “equal protection” clause of the 14th Amendment.
The ruling focused on policies at Harvard University and the University of North Carolina, but its impact will be felt throughout higher education, including at U.S. medical schools, Kruse said.
Because of the ruling, the Association of American Medical Colleges, which assists SIU and other medical schools in the selection process, no longer will ask applicants whether they are members of groups underrepresented in the ranks of doctors.
Going forward, schools can only ask whether applicants are a member of a group that is “socially and economically disadvantaged,” Kruse said.
The other change SIU made is in an essay question for applicants.
“We previously asked them to address how they would add to the diversity of our program,” Kruse said. That instruction was replaced with two new questions that ask them about the barriers to medical school they have experienced and the “lived experience that they’ve had that will aid them as a medical professional,” he said.
“They can answer those questions in any way they want,” Kruse said, adding that applicants can voluntarily disclose their race in essays.
SIU uses a “holistic admissions process” that was “validated” by the Supreme Court ruling, he said. “We have faculty who are socially conscious and dedicated to our region” of central and southern Illinois, he said.
SIU’s internal committee that evaluates applications, interviews candidates and decides who will receive offers to attend the medical school has begun to incorporate the changes for applicants who would begin their first year of medical school in summer 2024, he said.
Kruse said the dean doesn’t take part in the selections.
“In essence now, the questions don’t ask about diversity,” he said. “That’s the major change. We don’t think it’s substantive.”
A statement the medical school issued in response to the Supreme Court decision said: “We join our colleagues in academic medicine across the country in stating that today’s court ruling has the potential to decrease diversity in health professions and is contrary to efforts to provide better health for all. The SIU School of Medicine remains committed to strengthening the diversity of the medical student body and will work within all legal limits to ensure racial and ethnic diversity in the health professions.”
Whether the changes will decrease diversity at SIU remains an open question, Kruse said.
“In some ways, the greater focus on this issue might spur some institutions to develop policies that are allowed under this ruling to actually have a greater positive effect, by starting the dialogue,” he said.
Kruse, who disagreed with the court ruling, said greater diversity in health professions is necessary to help address health care inequities for patients and variations in treatments and lifespan that vary by race and ethnicity.
“Obviously, health inequities abound,” he said. “There is inequity in access to care because of the large percentage of our population that is still uninsured, because of the great mistrust that a large portion of the general public has, and because of the dramatically small percentage of African American and Black men who are in medicine. It’s percentage-wise less than it was in the 1970s.”
Black students make up 11% of medical students in the United States, a country where 16% of the population is Black, SIU officials said.
“While there has been an increase in the percentage of Black women in medical school, Black men have not fared so well,” SIU’s statement said. “In 1979, 3.1% of U.S. medical students were Black men; 40 years later in 2019, Black men made up only 2.9% of medical students. In 2019, only 4% of faculty members of medical schools were Black. Similar statistical trends hold true for Latino and Native American populations.”
Kruse said the disturbing trend for Black men was the result of institutional racism. Dr. Christopher Smyre, a Black family medicine physician at SIU, said “over-policing and criminalization of Black men” plays a particular role.
At SIU, 15.4% of medical students, or 49 students, were Black in the 2022-2023 academic year, spokesperson Rikeesha Phelon said, a number that includes both male and female students.
SIU medical students spend their first year at the Carbondale campus, and most medical students in the second, third and fourth years are based at the Springfield campus.
Contributing to SIU’s better-than-most performance on diversity of the student body may be SIU’s history of producing doctors who end up in primary care specialties and the fact that most SIU medical students are required to come from Illinois, Kruse said.
Doctors from diverse backgrounds can help ease patients’ concerns and educate other doctors and make them more sensitive to cultural differences, according to Smyre, director of research and innovation in the SIU School of Medicine’s Office of Equity, Diversity and Inclusion.
“I was very saddened to hear the ruling,” he said.
Promoting diversity in medicine is more than an academic exercise, he said, because patients are the ones most affected.
“We’re talking about human beings and their lives,” he said.
The two programs that SIU runs for students aspiring to become doctors aren’t affected by the court ruling, Kruse said. They are the Carbondale-based Medical/Dental Education Preparatory Program for sociologically disadvantaged college students, and the McNeese Preparatory Pathway Program for Springfield-area high school students.
Medical residency and fellowship programs offered by the medical school aren’t affected by the ruling, either, and are barred by law from taking race into account in admission and hiring decisions, Kruse said.
He said it was interesting that Justice Roberts, in a footnote on page 22 of the 40–page ruling, exempted America’s military academies from the Supreme Court decision.
Roberts wrote in the footnote that the exemption for those higher education institutions, allowing them to keep using race in admissions decisions, was “in light of the potentially distinct interests that military academies may present.” The U.S. government filed documents in the case arguing that race-based admissions programs “further compelling interests at our nation’s military academies,” he said.
But Kruse said, “If they make this exclusion for military academies, they clearly should make this exclusion for health education professional institutions.”
Dean Olsen is a senior staff writer at Illinois Times. He can be reached at dolsen@illinoistimes.com, 217-679-7810 or twitter.com/DeanOlsenIT.
This article appears in Fall Guide 2023.
