Medical Education and Health Care in a Just Society

The U.S. Department of Justice (DOJ), representing the president’s administration, has taken aim at three of the nation’s top medical schools. The DOJ’s assistant attorney general for civil rights, Harmeet Dhillon, recently issued letters to at least three medical schools, including the University of California San Diego School of Medicine, Stanford University School of Medicine, and Ohio State University College of Medicine, demanding information about the schools’ admissions policies and practices. She specified that the principal interest of the DOJ Civil Rights Division is to investigate possible racial discrimination in medical school admissions, ostensibly looking for violations of Title VI of the Civil Rights Act of 1964, which prohibits discrimination based on race, color, or national origin by institutions receiving federal financial assistance. This unprecedented action has alarming implications for medical education and the nation’s physicians.

This action comes at a time when growing threats challenge the physician workforce through unsustainable costs of medical education, distracting administrative burdens for clinicians, and widespread occupational burnout. In addition, the U.S. faces a predictable and growing shortage of physicians. The Health Resources and Services Administration (HRSA) reported that in 2025, there was a deficit of 57,000 U.S. physicians, and the HRSA Workforce Simulation Model predicts that by 2035, the deficit will increase to 81,000.  This shortage is exacerbated by the longstanding maldistribution of physicians that continues to disproportionately affect rural areas and less advantaged populations. Primary care and pediatrics are currently facing significant recruitment challenges. 

There is strong evidence that individual and population health can be optimized when the physician workforce reflects a range of life experiences, values, attitudes, perspectives, and beliefs. A physician workforce that is representative of our increasingly heterogeneous society improves health outcomes. Furthermore, studies have shown that a racial or ethnic correspondence between physician and patient may be associated with clinical benefit.Representation among physicians according to race, ethnicity, and sex is central to achieving optimal health care for the nation. The U.S. Census Bureau reported the 2020 racial and ethnic distribution as 57.8 percent white (non-Hispanic), 18.7 percent Hispanic or Latino, 12.1 percent Black or African American, 5.9 percent Asian, and 4.1 percent two or more races, with all other groups comprising less than 1 percent each. The Association of American Medical Colleges 2023 data indicate that the current physician workforce is not representative of the U.S. population, with 56.3 percent white physicians, 19.3 percent Asian physicians, but only 5.2 percent Black physicians and 6.5 percent Hispanic physicians.  

The nation’s medical schools play a critical role in selecting, matriculating, and educating individuals who have optimal motivation, character, and intellect to become physicians. Medical school admissions officers continuously refine the daunting task of selecting applicants. Many schools use holistic admissions processes, in recognition of problems associated with dogmatic adherence to quantitative academic metric thresholds, such as Medical College Admission Test scores or grade point averages. These efforts to create medical school class cohorts that reflect the U.S. population improves the learning environment for students. Students from varied backgrounds bring different experiences, perspectives, and personal qualities, which may positively contribute to the overall learning environment. Such characteristics may also increase appreciation of health care needs for a larger spectrum of individuals and populations among graduating physicians.

Physicians of all races and ethnicities must be prepared to care for patients of all races and ethnicities. Although correspondence between physician race or ethnicity and that of the patient is not required to achieve high-quality care, some patients prefer a physician of their own race or ethnicity. In opposition to the important goal of diversifying the physician workforce, the current administration is exerting political pressure in several ways. In addition to the DOJ’s unwarranted demand for medical schools’ admission information, the administration has also recently pressured the Liaison Committee on Medical Education (LCME), the entity responsible for medical school accreditation, to eliminate its requirement for medical schools to educate students on the subject of health inequities. The LCME has capitulated by removing the curriculum requirement from its standards for certification. Although medical schools can continue to include these topics in their curriculum, the clear message from the current political administration is that it is acceptable to reduce or even eliminate this important aspect of medical student education. 

What is the DOJ attempting to accomplish with launching this investigation? Following the Supreme Court’s 2023 decision in Students for Fair Admissions v. President & Fellows of Harvard College, admissions and matriculations of Black students to undergraduate colleges and medical schools have significantly declined. This outcome is hardly surprising. It is evident that the DOJ is not interested in promoting the highest quality health care for a just society, which depends vitally on having well-educated physicians who reflect the patient population of our nation. Given the data reviewed previously that there are relatively few Black and Hispanic physicians in the U.S., does the DOJ want to diminish the number even further? Such an outcome is not in the best interest of a just and equal society. If that is the intent, this action is not only counterintuitive, but also diabolical.

Although the assistant attorney general stated that her priority is a concern about racial discrimination in medical school admissions, the justification for this investigation is lacking. Moreover, the rationale for the selection of these three medical schools as targets is not immediately clear. Nor is the burdensome demand for seven years of detailed, often private, data on their medical school applicants, such as Medical College Admission Test scores, personal essays, and applicant ZIP codes, race and ethnicity. The DOJ’s demand for sensitive, personal information also raises invasion of privacy concerns and unnecessarily threatens the privacy of both applicants and current medical students. The production requests may also include institutional items including internal institutional communications and diversity, equity, and inclusion initiatives related to admissions. These medical schools, already facing funding challenges from this political administration, will face significant burdens on faculty and staff to respond to the production demand. This unwarranted and intrusive action is likely to have a chilling effect on the admissions policies and practices of all the nation’s 156 M.D. programs. 

In the opening sentence of his 1971 classic, A Theory of Justice, the political philosopher John Rawls wrote, “Justice is the first virtue of social institutions, as truth is of systems of thought.” If Rawls is correct, as we believe he is, for the benefit of the health of a just society, medical school deans, admissions officers, and other leaders throughout the health care community will need to unite and counter the imprudent policies of the current political administration. Time and action are of the essence as these challenges for the nation’s physician workforce threaten optimal health care for our increasingly diverse society.