New Study Casts Light on Higher Attrition Rates for Underrepresented Groups in Medical School

A recent JAMA Network Open study found that medical students from underrepresented groups have an attrition rate that is over three times higher than other students. The study analyzed allopathic medical student cohorts in years 2014-2015 and 2015-2016, and divided students into groupings for analysis based on personal (race and ethnicity, family income) and structural (youth neighborhood resources) metrics. 

The study showed:

• Attrition was highest among students with all three “marginalized identities”—low income, under-resourced neighborhood, and identifying as a historically underrepresented race and ethnicity. The total attrition for this group was almost four times (3.7) higher than for students who did not report any of the three marginalized identities.

• By race and ethnicity, students who identified as American Indian, Alaska Native, Native Hawaiian, and Pacific Islander had the highest attrition rate (11 percent), followed by Black students (5.7 percent), and Hispanic students (5.2 percent).

• Students from under-resourced neighborhoods had almost double the attrition rate (4.6 percent) of those who were not from under-resourced neighborhoods (2.4 percent). Similarly, those with low family income had an attrition rate of 4.2 percent compared to 2.3 percent for those who did not.

The researchers noted a need for targeted, structural reforms in medical schools to improve retention rates among high-risk groups. “Given the higher attrition rate among marginalized student groups, medical schools should consider reforms that dismantle structural inequities in medical culture and training that equate privilege with merit and physicians as an elite class of citizens,” they wrote. “These reforms may begin with tuition and debt reform and purposeful partnership and support of local and national under-resourced communities.”

New Study Finds that Affirmative Action Bans Result in Fewer Students from Underrepresented Groups in Public Medical Schools

A study published last week in the peer-reviewed journal, Annals of Internal Medicine, found that affirmative action bans negatively impacted enrollment of underrepresented students in public medical schools. The study showed that in states which enacted bans, five years later, the proportion of underrepresented racial and ethnic minority students fell by more than one-third.

The study, which was led by Dan Ly, MD, and an assistant professor of medicine at UCLA’s David Geffen School of Medicine, examined matriculants from 53 medical schools at public universities from 1985 through 2019. The researchers focused on students from underrepresented racial and ethnic groups including: Black, Hispanic, American Indian or Alaska Native, and Native Hawaiian or other Pacific Islander. Of the 53 medical schools, 32 were located within a state without an affirmative action ban and 21 were within a state with an affirmative action ban (Arizona, California, Florida, Michigan, Nebraska, Oklahoma, Texas, and Washington). The bans were enacted between 1997 and 2013, and Texas’s ban was reversed in 2003. On average, in the year prior to a state implementing a ban, underrepresented students made up 14.8 percent of the public medical school enrollment. Five years after the states’ bans, underrepresented student enrollment had fallen by an average of 37 percent.

Dr. Ly describes the importance of the findings. "We know that a more diverse physician workforce leads to better care for racial- and ethnic-minority patients," he said. "Our research shows that bans on affirmative action, like the one California passed in 1996, have had a devastating impact on the diversity of our medical student body and physician pipeline." 

The authors note that the study did have limitations, which included the indirect effects of affirmative action on undergraduate admissions, the impact that public discussion of affirmative action may have had on medical school enrollment prior to the bans, and the possibility that some students may not have identified with the racial and ethnic groups defined by the study. Additionally, the study authors did not confirm if any schools in states without bans opted not to incorporate race or ethnicity in admissions decisions. However, the authors are optimistic that the study will provide policy-makers with a clearer understanding of the lag in diversifying medical student and physician populations, as well as informing them of the impact of affirmative action bans.  

A co-author of the study, Utibe Essien, MD, and an assistant professor of medicine at the University of Pittsburgh, notes that the findings are particularly poignant at this juncture. "As our country has spent the last two years weaving through the twin pandemics of racial health disparities amplified by COVID-19 and structural racism at large, our findings are critically important," he said. "As we observed, affirmative action bans have resulted in a loss of underrepresented physicians, who could have been at the front lines of caring for vulnerable populations throughout the pandemic and helping to alleviate disparities in care.”

Related Blog: Medical Schools Limited on Use of Race in Admissions Decisions but Still Seek to Promote Diversity