May 09, 2007

National Data, By Edwin S. Rubenstein

Affirmative Action, Immigration, Curing America Of White Doctors

White male medical school graduates declined from 10,064 in 1980 to 5,678 in 2004. As a share of med school graduates, white males fell from more than two-thirds (69.6%) to just above one-third (36.8%) over that period. (Source: Association of American Medical Colleges, Minorities in Medical Education: Facts and Figures 2005, 2005, Figures 15 and 17, pdf]

What’s going on?

In 1978, the U.S. Supreme Court ruled against Allan Bakke, who had claimed he was rejected from medical school because of his race—white. Justice Lewis Powell, in his opinion in the case, admitted that Bakke's Medical College Admission Test (MCAT) scores did indeed place him in the top tier of test-takers, whereas the average scores of the quota beneficiaries placed them in the bottom third. So Bakke was clearly more qualified than those admitted under the quota. Yet Mr. Powell’s opinion ruled that the state had a "substantial interest" in using race as a criterion for admission.

Fast forward to 2003. Jordan Cohen, the head of the Association of American Medical Colleges, is quoted as opining that "medical school admission committees have probably placed a heavier weight on an applicants race than Justice Powell may have envisioned when he wrote the decisive opinion in the landmark Bakke case in 1978." [Achieving the Educational Value of Diversity,  Michael E. Whitcomb, MD, Academic Medicine, May 2003]

The racial composition of medical students has changed dramatically since Bakke, albeit not in the way the pro-quota crowd expected. Here are figures for medical school enrollment - number and percent of total - by race/ethnicity: (Table 1.)

Since 1978, overall white enrollment has declined significantly, to less than two-thirds (63%) of total enrollment. But the gap has primarily been filled by Asians. The Asian share of medical school enrollment—a fifth (20.4 percent) in 2005—was about 5-times larger than their share of the U.S. population. Back in 1978 only 2.4% of med students were Asian. 

Some portion of this enrollment is immigrants and the children of immigrants. But, as usual, the data is not collected.

Meanwhile, the "underrepresented" minorities that Bakke was supposed to help are still underrepresented. The Black and Hispanic shares of medical school enrollment, 7.4 percent and 7.0 percent, respectively, are about half their population shares.

The average quality of white med school applicants appears to have gone up over this period, as evidenced by an increase in their acceptance rates from 40.5 % in 1978 to 52.1% in 2004. Acceptance rates for Asian, Black, and Hispanic applicants in 2004 were, respectively, 48.0 percent, 41.4 percent, and 41.3 percent. [Association of American Medical Colleges, Minorities in Medical Education: Facts and Figures 2005, 2005. Table 19.  PDF]

Total enrollment in U.S. medical schools has remained virtually unchanged for more than twenty years: in the range of 65,000 to 67,000. Yet the AAMC’s Dr. Cohen and other observers have warned of an oversupply of physicians in some communities.

Behind this apparent anomaly: immigrant doctors. The number of foreign-born physicians practicing or doing their residencies in the U.S. has more than tripled since 1970. (Table 2.)

Nationally, an astonishing 23 percent of all physicians are foreign. The heaviest concentration of foreign medical graduates in 2005 was in New Jersey (39.6% of doctors); New York (38.6%); Florida (33.6%); and Illinois (32.3%).

Most foreign doctors come here on the J-1 guest worker visa.  J-1 visa holders are required to return to their native countries after completing their hospital residency, and practice there before applying to return to the U.S.

But most don't go back: A loophole allows them to stay if they are hired by a hospital in a rural or inner city neighborhood. And public policy has stimulated physician demand in exactly these areas.

Additionally, in recent years doctors from India, Pakistan and other countries have by-passed the J-1 entirely.  Instead, they are securing an H1-B, which doesn't require rural or inner-city service, and are working in the big urban areas also preferred by most native-born MDs for professional and lifestyle reasons.

At the end of the day, not just affirmative action but also immigration policy is on the way to curing America of white doctors.