Diversity at U.S. Medical Schools and Residency Programs in a Post Affirmative Action World

The path to becoming a doctor in the United States is a long and rigorous journey, beginning with admission to medical school and continuing through years of specialized training in hospitals. For decades, a major factor in shaping who gets to walk this path has been the practice of considering an applicant's race and ethnicity during the selection process. This approach, known as affirmative action, was designed to increase the number of doctors from groups that have historically been left out of the profession, such as Black, Hispanic, and Native American communities. The logic was straightforward: a physician workforce that mirrors the diversity of the patient population leads to better health outcomes for everyone. However, in June 2023, the Supreme Court of the United States issued a ruling that banned the use of race-conscious admissions in higher education. This decision sent a ripple effect through the entire medical education system, raising a critical question for educators and public health experts: without the ability to explicitly consider race, will the pipeline of future doctors remain diverse, or will it narrow?

A team of researchers set out to answer this question by looking at the earliest signs of change following that historic ruling. They examined data from medical school applicants and residents across the country to see how the demographics of the profession were shifting in the years immediately after the ban. Their work focused on two main stages of training: the moment a student first enters medical school, known as matriculation, and the later stage where graduates secure a spot in a residency program, which is the specialized training required to practice medicine. By comparing data from before and after the 2023 decision, the researchers aimed to understand if the diversity gains of previous decades were holding steady or beginning to slip away.

The study began by analyzing records from the Association of American Medical Colleges, the organization that manages applications for most medical schools in the country. The researchers looked at the success rates of different racial and ethnic groups in getting accepted into medical school between the 2023–2024 and 2024–2025 academic years. The results revealed a clear and troubling trend for several groups. The percentage of Black applicants who successfully entered medical school dropped significantly, falling from nearly 39 percent to 31 percent. A similar decline was seen among Hispanic and Latino applicants, whose acceptance rate fell from about 46.5 percent to 38.8 percent. Applicants who identified as Pacific Islander also saw a decrease, moving from 31.1 percent to 25.4 percent. In contrast, the acceptance rates for White and Native American applicants actually increased during this same period, while the rate for Asian applicants remained essentially unchanged. These numbers suggest that the ban on considering race has already begun to alter the composition of incoming medical school classes, reducing the number of students from underrepresented backgrounds.

The researchers then turned their attention to what happens after medical school, specifically looking at residency programs where doctors train in specific fields like surgery, internal medicine, or ophthalmology. They gathered data from two major matching systems used by hospitals to assign residents. One system, which handles most medical specialties, showed a slightly different picture. In this broader pool of active residents, the number of Black, Hispanic, and Asian doctors increased by small margins between 2023 and 2025, while the number of White residents decreased slightly. However, this apparent stability in residency numbers may be misleading. The researchers noted that these current residents likely entered medical school years ago, before the Supreme Court ruling took effect. This means the data reflects the pipeline from the past rather than the immediate impact of the new law.

To get a clearer view of the current situation in highly competitive fields, the team also looked at data specific to ophthalmology, the branch of medicine dealing with eye care. This specialty is known for being particularly selective. The data here told a starker story. The number of Black and Hispanic applicants who successfully matched into ophthalmology residency programs remained stagnant or even declined slightly. While the total number of available spots in these programs grew to meet patient needs, the share of those spots going to underrepresented minorities did not keep pace. In fact, the percentage of White applicants securing positions dropped, while the percentage of Asian applicants increased. This suggests that even in fields where the total number of positions is growing, the distribution of those positions is shifting in ways that may disadvantage certain groups.

To understand the human side of these statistics, the researchers also conducted a survey of residents working in competitive specialties. They asked doctors currently in training about their backgrounds and experiences. The results highlighted a significant imbalance. Among the residents who responded, the vast majority identified as White or Asian, while Black, Hispanic, and Native American doctors made up only a tiny fraction of the group. This underrepresentation was especially pronounced in fields like ophthalmology, dermatology, and orthopedic surgery. The survey also touched on the financial realities of these trainees, revealing that many relied heavily on loans to finance their education, a burden that can be heavier for students from lower-income families.

The authors of the study suggest that these trends are driven by deep-seated structural barriers that go beyond simple admissions policies. They point out that students from underrepresented groups often face greater financial hurdles, such as higher levels of debt and less family support, which can make the application process more difficult and discourage them from reapplying if they are initially rejected. They also note that a lack of mentors and role models who share their background can make it harder for these students to navigate the complex path to becoming a specialist. While some medical schools and residency programs have tried to counter these challenges by creating mentorship programs and using holistic review methods that look at an applicant's whole life story rather than just test scores, the data suggests these efforts are not yet enough to fully offset the loss of race-conscious admissions.

The study concludes that the Supreme Court's ruling is already having a measurable effect on the diversity of the medical workforce, with early signs of decline in the number of underrepresented students entering medical school. While there are small pockets of progress in residency programs, these gains appear to be lagging effects of earlier admissions cycles rather than a sign that the system has successfully adapted. The researchers emphasize that maintaining a diverse physician workforce will require new, creative strategies that address financial barriers, expand mentorship opportunities, and ensure that the path to becoming a doctor remains open to all qualified candidates, regardless of their background. Without these targeted efforts, the medical profession risks becoming less representative of the society it serves, which could ultimately impact the quality of care provided to patients across the country.