Before this week, affirmation action represented a meaningful, albeit insufficient, attempt to make amends for the historical racial legacy upon which our country stands. I grieve for those individuals whose paths are already hard enough, and will be made tougher by the Supreme Court’s elimination of affirmative action in higher education admissions. Among could-be future doctors, this ruling has consequences not only for diverse medical school applicants, but also for the well-being of our patients.
The same populations in our society who suffer devastating health disparities are those same populations who are disenfranchised with respect to educational outcomes. In many ways, I am very much one of the statistics: I am a Black man with a personal and family history of serious mental illness. I grew up in a single-parent household surrounded by violence and with my father in prison. Affirmative action gave people like me a chance to fight against those statistics. I am a face of affirmative action.
My 4 years as an undergraduate at the Massachusetts Institute of Technology (MIT) shattered a glass ceiling in my life, shifting my social class. I received a world class chemical engineering education: I was taught by a Nobel Prize winner, a Pulitzer Prize finalist, and got paid by the institute to work in a cutting-edge bioinorganic synthetic chemistry lab. But the benefits of MIT diffused far beyond my academic coursework. The institute found internships for me and paid for me to live in Mexico and Spain where I became fluent in Spanish, which I now speak with my patients. One of those internships — volunteering in an underserved hospital in Querétaro, Mexico — helped me get into medical school. My college friends are now CEOs of Silicon Valley start-ups. I could go on for days.
MIT was extremely tough for me. I still remember walking out of the lecture hall after my first test at MIT, a multivariable calculus exam. I felt confident as I left. But shortly after, I ran into a white woman peer who I had seen around campus before but never talked to.
“What did you do for question 3?” she asked me.
I told her about the parametric equation I had written. “Oh, that’s wrong, I took multivariable calculus in high school,” she said to me without a care in the world and scurried off. Sadness washed over me as she walked away. My high school didn’t even offer multivariable calculus — I was on our only advanced track just by taking regular calculus.
I worked extremely hard to get to college and have continued to work extremely hard after MIT, gaining access to one elite institution after another — University of California (UC) San Francisco, UC-Berkeley, and University of Washington, where I am now a nephrology fellow.
Still, did I deserve to go to any of these elite institutions? I will never know whether I would have gotten into MIT without affirmative action, but I do know that somewhere along the way I benefitted from affirmative action. My lack of entitlement to MIT is not because affirmative action has helped me. It is because attending MIT is a privilege. Access to elite academic institutions represents access to power. As an education researcher and critical theory scholar (yes, the same “critical” of critical race theory), whose main interest relates to the way identity impacts experiences and assessment in medical education, I see the battle for affirmation action very clearly: this is a battle in which those social groups who have power are desperately fighting to hold onto it while those with less power are clamoring for it.
While the Supreme Court ruling is a crushing blow to educational justice, it was by no means an unexpected one. Those of us in the equity space have been preparing for this day. It also provides an opportunity for growth of future equity oriented educational interventions. Legal challenges to affirmative action should challenge us to see that not only do those in power want to maintain their power, but also, there are many identity groups who are not categorized as underrepresented minorities who are suffering in the United States. Education systems, including medical education, must design thoughtful ways to continue to recruit and admit those who come from underrepresented minoritized groups; those who come from lower socioeconomic status; those who have fled persecution or war; and other underserved groups.
I attempt to support this cause through my research. My colleagues and I have forthcoming data demonstrating how medical trainees productively leverage their identities to help care for patients who share those identities (as well as those who differ from them). We already knew identity-concordant care improves patient health outcomes. But by enriching the evidence for how diversity of identity (including, but well beyond race) benefits minoritized and non-minoritized patients, we lay an evidence-based infrastructure upon which institutions can construct patient-oriented (and hopefully legally defensible) admission policies.
In the words of Olayemi Olurin, a lawyer and one of my favorite political commentators: “Y’all think the status quo became the status quo because the people maintaining it aren’t prepared to fight for it?…If we are all committed in this fight against racial injustice and inequality. It’s a fight my guy. It’s a fight. It’s a fight. You know how a fight works? You blow, I blow.”
As those of us committed to equity and dismantling health disparities collectively figure out a path forward, we must all be prepared to fight in our own contexts in the face of the loss of affirmative action. Fighting through this is our only path forward.
As for me and that woman after the math test, we had differential opportunities, but I do not think we had different potential. Oh, and that test? I got a 100%.
Justin Bullock, MD, is a fellow in Nephrology at the University of Washington School of Medicine.
