Dreams Deferred Woodrow Myers, M.D. Stanford, California
Much as the saga of the black American family in Roots, the history of the black American in medical education has been marked by a long and difficult struggle. But unlike Hailey's saga in which progress was slowly made, progress for minorities in medical education is being eroded with increasing velocity. On February 22, 1977, the Supreme Court of the United States accepted for consideration a case which, if decided for the plaintiff, would have the effect of reversing recent gains by cutting off the supply of black and other minority physicians. A white engineer, unsuccessful in his attempts to gain admission to medical school, claims that he would have been admitted had there not been a special committee dealing with the admission of minority students, whom he argues were less qualified than he to enter the practice of medicine. The Supreme Court of the State of California called this form of admissions unconstitu-
Request for reprints should be addressed to Dr. Woodrow Myers, P0 Box 9342, Stan-
ford, Calif 94305.
tional, but the Court did not order the medical school to admit him. This decision was appealed to, and accepted by, the Supreme Court, whose verdict will gain immediate attention and perhaps action by the admissions committees and legal counsel for American schools of medicine, law, and other graduate and professional programs. In 1967, the year before the assassination of the Reverend Dr. Martin Luther King, Jr., most of the black students enrolled in medical schools in the United States were at Howard University in Washington, D. C. and Meharry Medical College in Nashville, Tenn. At that time, few black medical students were being educated at predominantly white schools. With Dr. King's assassination came a change in the exclusionary policies that in effect maintained a "quota" on the number of minorities admitted to medical school. Admissions criteria were broadened to include factors that indicated a desire to deliver medical services to people who lacked access to physicians, factors that would indicate a student's capacity for compassion, and his or her ability to effectively interact with patients of all races and nationalities. These factors were added to, not exchanged for, high levels of achievement on standardized tests and grades in premedical academic courses.
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 69, NO. 7, 1977
The fact is that many white students who would not have been admitted under rigid, strictly numerical, academic criteria were now gaining admission to medical school to study the science and to learn the art of medicine. Many schools such as those at Stanford and Harvard, after much prodding, took an active interest in the recruitment and retention of minority medical students. Both of these institutions now have a minimum goal of parity between the percentage of minority medical students and the percentage of minority people in the population. One of the mechanisms directed toward this goal has been minority admissions subcommittees to medical school admissions committees. On such subcommittees sit faculty members and medical students who are both cognizant of and sensitive to the differences that exist between races and economic classes. They evaluate the application of minority students according to the one set of criteria used for admission and in light of the differences that exist between minority and majority students. Similar approaches to admission have been used across the country, resulting in an increase in the number of minority medical students in the 519
United States to 4,324 in 1974 from 1,723 in 1970, fully ten percent of the total number of medical students. In 1975, for the first time since King's assassination, the number of first-year minority group students fell to 1,391 (9.1 percent). Throughout the 1976 academic year it remained approximately the same. This decrease coincided with the Marco Defunis case, the first nationally publicized "reverse discrimination" suit brought against a university. In this suit, a white law student sued the University of Washington for admission to law school on grounds similar to those in the present case before the Supreme Court. The Supreme Court declared the Defunis case moot, because the plaintiff had already been admitted, thus no court action was necessary. This has, in effect, delayed the decision in the case presently facing the U.S. Supreme Court. It seems odd that after the urban riots and assassinations of the late sixties, when centuries-locked doors to professional education at predominantly white universities began to crack open, that the same argument used to open them is now being actively used to close them. Article XIV, Section I of the Constitution of the United States states that no State shall "deny to any person within its jurisdiction equal protection of the laws." Indeed, to bring black slaves into the mainstream of society when it was ratified in 1868, the Fourteenth Amendment is now being misused as justification for retrenchment of the programs long fought for in the Congress, in the Courts, in the backs of buses, and in Alabama church basements. The false argument of "reverse discrimination" is now the tactic of choice in dismembering educational affirmative action. The essence of this argument is that affirmative action programs which seek to recruit and admit minority students are "unfair" in that they exclude white students. The claim is that this is the same method formerly used to exclude minorities; in this argument, the facts are
clearly ignored. When predominantly white schools began to admit minority students, they did not do so by denying admissions opportunities to white students, they did so by increasing the class size. The absolute number of white students attending medical school has 520
increased every year since the affirmative-action push began. While the number of first-year black medical students dropped by 70 from 1974 to 1975, the number of white students increased by 609. How can "reverse discrimination" exist when those who are claiming to be adversely affected by the process are gaining entrance into medical school in an ever increasing absolute number and percentage? How can one individual who has been adversely affected by the process of admission claim that the process is invalid for an entire group of people of which he is not a part, when his own group has had ever increasing success with that process? It has not been nor will it ever be unusual for a school to establish criteria for admission. These goals are by no means limited to racial or economic classifications. Schools such as Loma Linda attract and admit many students of one particular religion. The University of Illinois has recently experimented with giving preference in admissions to medical school to students from rural backgrounds who have demonstrated an interest in returning to rural areas to practice medicine. Several state legislatures have mandated that their state schools of medicine restrict admissions to a great extent to residents of those states in hopes of maximizing the number of future practitioners within those states. The federal government has gone into the business of specifying what students medical schools must accept. Public Law 94-484 (Health Professionals Educational Assistance Act of 1976), signed into law on October 12, 1976, states that in order to qualify for capitation grants, schools must accept an "equitable percentage" of American students studying in foreign medical schools who pass Part I of the National Medical Board examination. Although many schools are resisting this "intrusion" on the admissions process, others plan to comply. It has long been one prerogative of professional schools to admit applicants who happen to be the offspring of alumni or faculty members. It has not been necessary to advertise this area of admission, in that those who benefit are already aware. This practice is hardly a recent development. The Hippocratic Oath which physicians have taken for centuries says that
"I will impart a knowledge of the Art to my own sons and to those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to no others." For the few of us who have gained access to medical education it has meant the difference between ascending to the fullest potential of our talents and having that potential wasted in positions far beneath the capacity of our present and future contributions. The most important aspect of this writer's medical education has been learning to accept the unwritten responsibility of success within the black community. Not only must one seek excellence in the practice of medicine, but one must also prop open the closing door to others who wish to seek that same excellence. While this same concern is felt by individuals within the majority, it is not perceived as a responsibility. This concern is the driving force which a.llows one to remain rational, compassionate, and altruistic in an irrational, egotistical, and often malevolent system. Fulfilment of this responsibility is not attained rapidly or easily. A rational person realizes that the battlefront is no longer in the Congress and in the state legislatures, it is in that section of the cerebrum that defines and effects morality. The Civil Rights Act has been passed and we have been told that "A mind is a terrible thing to waste." Is it not absurd that this country imports 20 percent of its physician population to care for these wasting minds? One of Jimmy Carter's campaign statements after his faux pas in defending the purity of Polish neighborhoods was "There is too much ethnic purity in medicine." He made the statement before several thousand minority medical students at the National Conference of the Student National Medical Association. He has yet to make one move to correct the problem that he then found advantageous to enunciate. This fall, the Supreme Court will decide whether the University of California at Davis violated the Constitution of the United States by facilitating the admission of well-qualified minority students into medical school. Even if our left foot is cut off in addition to the right, this struggle will continue. It must.
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 69, NO. 7, 1977
Much as the saga of the black American family in Roots, the history of the black American in medical education has been marked by a long and difficult struggle. But unlike Hailey's saga in which progress was slowly made, progress for minorities in medical education is being eroded with increasing velocity. On February 22, 1977, the Supreme Court of the United States accepted for consideration a case which, if decided for the plaintiff, would have the effect of reversing recent gains by cutting off the supply of black and other minority physicians. A white engineer, unsuccessful in his attempts to gain admission to medical school, claims that he would have been admitted had there not been a special committee dealing with the admission of minority students, whom he argues were less qualified than he to enter the practice of medicine. The Supreme Court of the State of California called this form of admissions unconstitu-
Request for reprints should be addressed to Dr. Woodrow Myers, P0 Box 9342, Stan-
ford, Calif 94305.
tional, but the Court did not order the medical school to admit him. This decision was appealed to, and accepted by, the Supreme Court, whose verdict will gain immediate attention and perhaps action by the admissions committees and legal counsel for American schools of medicine, law, and other graduate and professional programs. In 1967, the year before the assassination of the Reverend Dr. Martin Luther King, Jr., most of the black students enrolled in medical schools in the United States were at Howard University in Washington, D. C. and Meharry Medical College in Nashville, Tenn. At that time, few black medical students were being educated at predominantly white schools. With Dr. King's assassination came a change in the exclusionary policies that in effect maintained a "quota" on the number of minorities admitted to medical school. Admissions criteria were broadened to include factors that indicated a desire to deliver medical services to people who lacked access to physicians, factors that would indicate a student's capacity for compassion, and his or her ability to effectively interact with patients of all races and nationalities. These factors were added to, not exchanged for, high levels of achievement on standardized tests and grades in premedical academic courses.
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 69, NO. 7, 1977
The fact is that many white students who would not have been admitted under rigid, strictly numerical, academic criteria were now gaining admission to medical school to study the science and to learn the art of medicine. Many schools such as those at Stanford and Harvard, after much prodding, took an active interest in the recruitment and retention of minority medical students. Both of these institutions now have a minimum goal of parity between the percentage of minority medical students and the percentage of minority people in the population. One of the mechanisms directed toward this goal has been minority admissions subcommittees to medical school admissions committees. On such subcommittees sit faculty members and medical students who are both cognizant of and sensitive to the differences that exist between races and economic classes. They evaluate the application of minority students according to the one set of criteria used for admission and in light of the differences that exist between minority and majority students. Similar approaches to admission have been used across the country, resulting in an increase in the number of minority medical students in the 519
United States to 4,324 in 1974 from 1,723 in 1970, fully ten percent of the total number of medical students. In 1975, for the first time since King's assassination, the number of first-year minority group students fell to 1,391 (9.1 percent). Throughout the 1976 academic year it remained approximately the same. This decrease coincided with the Marco Defunis case, the first nationally publicized "reverse discrimination" suit brought against a university. In this suit, a white law student sued the University of Washington for admission to law school on grounds similar to those in the present case before the Supreme Court. The Supreme Court declared the Defunis case moot, because the plaintiff had already been admitted, thus no court action was necessary. This has, in effect, delayed the decision in the case presently facing the U.S. Supreme Court. It seems odd that after the urban riots and assassinations of the late sixties, when centuries-locked doors to professional education at predominantly white universities began to crack open, that the same argument used to open them is now being actively used to close them. Article XIV, Section I of the Constitution of the United States states that no State shall "deny to any person within its jurisdiction equal protection of the laws." Indeed, to bring black slaves into the mainstream of society when it was ratified in 1868, the Fourteenth Amendment is now being misused as justification for retrenchment of the programs long fought for in the Congress, in the Courts, in the backs of buses, and in Alabama church basements. The false argument of "reverse discrimination" is now the tactic of choice in dismembering educational affirmative action. The essence of this argument is that affirmative action programs which seek to recruit and admit minority students are "unfair" in that they exclude white students. The claim is that this is the same method formerly used to exclude minorities; in this argument, the facts are
clearly ignored. When predominantly white schools began to admit minority students, they did not do so by denying admissions opportunities to white students, they did so by increasing the class size. The absolute number of white students attending medical school has 520
increased every year since the affirmative-action push began. While the number of first-year black medical students dropped by 70 from 1974 to 1975, the number of white students increased by 609. How can "reverse discrimination" exist when those who are claiming to be adversely affected by the process are gaining entrance into medical school in an ever increasing absolute number and percentage? How can one individual who has been adversely affected by the process of admission claim that the process is invalid for an entire group of people of which he is not a part, when his own group has had ever increasing success with that process? It has not been nor will it ever be unusual for a school to establish criteria for admission. These goals are by no means limited to racial or economic classifications. Schools such as Loma Linda attract and admit many students of one particular religion. The University of Illinois has recently experimented with giving preference in admissions to medical school to students from rural backgrounds who have demonstrated an interest in returning to rural areas to practice medicine. Several state legislatures have mandated that their state schools of medicine restrict admissions to a great extent to residents of those states in hopes of maximizing the number of future practitioners within those states. The federal government has gone into the business of specifying what students medical schools must accept. Public Law 94-484 (Health Professionals Educational Assistance Act of 1976), signed into law on October 12, 1976, states that in order to qualify for capitation grants, schools must accept an "equitable percentage" of American students studying in foreign medical schools who pass Part I of the National Medical Board examination. Although many schools are resisting this "intrusion" on the admissions process, others plan to comply. It has long been one prerogative of professional schools to admit applicants who happen to be the offspring of alumni or faculty members. It has not been necessary to advertise this area of admission, in that those who benefit are already aware. This practice is hardly a recent development. The Hippocratic Oath which physicians have taken for centuries says that
"I will impart a knowledge of the Art to my own sons and to those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to no others." For the few of us who have gained access to medical education it has meant the difference between ascending to the fullest potential of our talents and having that potential wasted in positions far beneath the capacity of our present and future contributions. The most important aspect of this writer's medical education has been learning to accept the unwritten responsibility of success within the black community. Not only must one seek excellence in the practice of medicine, but one must also prop open the closing door to others who wish to seek that same excellence. While this same concern is felt by individuals within the majority, it is not perceived as a responsibility. This concern is the driving force which a.llows one to remain rational, compassionate, and altruistic in an irrational, egotistical, and often malevolent system. Fulfilment of this responsibility is not attained rapidly or easily. A rational person realizes that the battlefront is no longer in the Congress and in the state legislatures, it is in that section of the cerebrum that defines and effects morality. The Civil Rights Act has been passed and we have been told that "A mind is a terrible thing to waste." Is it not absurd that this country imports 20 percent of its physician population to care for these wasting minds? One of Jimmy Carter's campaign statements after his faux pas in defending the purity of Polish neighborhoods was "There is too much ethnic purity in medicine." He made the statement before several thousand minority medical students at the National Conference of the Student National Medical Association. He has yet to make one move to correct the problem that he then found advantageous to enunciate. This fall, the Supreme Court will decide whether the University of California at Davis violated the Constitution of the United States by facilitating the admission of well-qualified minority students into medical school. Even if our left foot is cut off in addition to the right, this struggle will continue. It must.
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 69, NO. 7, 1977
