To the Editor:
We congratulate Poole and colleagues for their thought-provoking Perspective on the challenges of diversity initiatives in medicine. The authors present two arguments to justify adequate representation of African Americans in medical school admissions: a social justice argument supported by affirmative action policies1 and a patient outcomes–based argument focused on racial or ethnically concordant care.2 Their first argument is sufficiently justified on its own. However, by conflating it with their second argument, the authors weaken their stance.
Poole and colleagues suggest that improved clinical outcomes due to race concordance may justify affirmative action policies that recruit African Americans preferentially over non–African American Blacks. However, there is no evidence to support this notion. In fact, a prior study2 demonstrated that racial—and not ethnically—concordant care may be associated with improved clinical outcomes and better patient experience. Furthermore, there is no evidence in support of a difference between the proportion of African American versus non–African American Blacks practicing in underserved communities.3 In our experiences as first- and second-generation Nigerian American immigrant physicians practicing in different geographic regions of the United States, Black patients rarely inquire about the ethnicity of their Black clinicians as a prerequisite for seeking care. Nor does ethnicity appear to influence treatment adherence.
If our objective is to improve clinical outcomes for underserved patients, an effective strategy is to increase the pool of qualified Black medical school applicants using holistic admissions processes. However, the application of genealogical assessments to identify suitable medical school candidates is divisive. With growing rates of immigration to the United States, interethnic and interracial mixing, how do medical school admissions committees quantify the appropriate level of “African Americanness”? Narrow definitions of race, ethnicity, and cultural experience come at the expense of inclusion and validation of all underrepresented Blacks in medicine.
There is a critical need to improve diversity in the health care workforce. Strategies implemented early in the educational pipeline to increase exposure of African American students to the health sciences are lacking. Proposed solutions should not create more challenges for underrepresented Blacks and should focus on promoting unity.
Uchenna Ikediobi, MD, MPH
Assistant professor, Departments of Medicine and Infectious Disease, Yale University School of Medicine, New Haven, Connecticut; [email protected]
Nneka Comfere, MD
Professor, Departments of Dermatology, and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; [email protected]; ORCID: https://orcid.org/0000-0002-8001-2639.
Ogechi Ikediobi, MD, PharmD, PhD
Dermatology resident, University of California, San Diego, San Diego, California; [email protected]
1. Poole KG Jr, Jordan BL, Bostwick JM. Mission drift: Are medical school admissions committees missing the mark on diversity? Acad Med. 2020; 95:357–360
2. Gobatenko-Roth K, Prose N, Kundu RV, Patterson S. Assessment of black patients’ perception of their dermatology care. JAMA Dermatol. 2019; 155:1129–1134
3. Capers Q 4th, Gray DM 2nd, McDougle L. Why we should not distinguish between African American and African immigrant applicants in medical school admissions. Acad Med. 2019; 94:154