Ending Affirmative Action Will Impact Workforce and Outcomes, Cardiologists Say

The US Supreme Court’s decision to end affirmative action will reverberate through the cardiology workforce for years to come, say cardiologists and organizations that advocate for physicians and their patients.

Striking down the social justice policy effectively disavows colleges and universities from using race as a factor in admissions decisions aimed at diversifying learning environments and student bodies. Shortly after the announcement, the American Medical Association (AMA) said the move reverses gains made in the battle against health inequities.

“This ruling restricts medical schools from considering race and ethnicity among the multiple factors in admissions policies and will translate into a less diverse physician workforce. Diversity is vital to health care, and this court ruling deals a serious blow to our goal of increasing medical career opportunities for historically marginalized and minoritized people,” AMA President Jesse M. Ehrenfeld, MD, MPH, said in a statement. 

To TCTMD, Marlon E. Everett, MD (Advocate Trinity Hospital, Chicago, IL), communications committee co-chair of the Association of Black Cardiologists (ABC), said the decision undermines decades of work.

“It's really a step backwards in the progression that we've had and, more importantly, the success that we've had to improve equity within the cardiology workforce as well as the medical workforce itself. The reason why these mandates were implemented years ago was because of the lack of diversity,” he said. “In the next generation, there is a high chance that there won't be the same equity that we've had. To be clear, we're still inequitable. But, we were making strides in the right direction and now we're going backwards.”

Everett added that further reducing the already minor percentages of physicians of color can only harm patient care.

“It's very clear that patients, from a trust standpoint, from a confidence standpoint, and an outcomes standpoint, seem to do better with physicians and/or healthcare workers of their same race,” he said. “So there is a high chance that if we don't have that equity in the workforce, it’s going to change outcomes in the future as well.”

Forward-thinking efforts should also be focused on increasing funding to and supporting historically Black colleges and universities (HBCUs) as well as predominantly Black medical schools, Everett continued.

“College is the backbone, and we recognize that the backbone has been broken,” he said. “So we have to mend that in some way . . . and focus on how we can increase the number of physicians of color, the number of nurses of color, the number of advanced practitioners of color, and other healthcare providers of color.”

“It won't solve all the problems and it would not be fair for the majority of medical schools and really for the rest of the world to put that burden just on the shoulders of the HBCU, but I believe if we're talking about a multipronged solution, that will be one of many things we can do,” Quinn Capers IV, MD (University of Texas Southwestern Medical Center, Dallas), told TCTMD.

More Societies React

The Association of American Medical Colleges (AAMC) noted that they had previously filed an amicus brief “urging the court to refrain from a broad prohibition on awareness of an applicant’s race, which for many applicants is a significant part of their personal story.”

The American College of Physicians (ACP) also expressed disappointment. “Evidence has shown diverse populations in educational and medical training settings improves learning outcomes by increasing active thinking and intellectual engagement skills and increases understanding of and empathy for diverse cultures,” read a statement from ACP President Omar T. Atiq, MD, (University of Arkansas for Medical Sciences, Little Rock).

The American Heart Association (AHA), in their statement, said the decision is misaligned with their strategic efforts to ensure a diverse healthcare workforce and eliminate health disparities.

“We are expanding diversity-research opportunities for underrepresented racial and ethnic groups in science and medicine; leveraging our clinical registry programs to capture data and create new scientific knowledge on the health effects of social determinants of health and disparities in health outcomes among racial and ethnic groups; and creating digital learning opportunities for clinicians, health professionals, and scientists to reverse structural racism and improve health outcomes for all,” the AHA added.

In a joint statement issued today, the ABC, ACC, AHA, American Society of Nuclear Cardiology (ASNC), American Association of Heart Failure Nurses (AAHFN), Heart Failure Society of America (HFSA), Heart Rhythm Society (HRS), Society for Cardiovascular Angiography and Interventions (SCAI), Society of Cardiovascular Computed Tomography (SCCT), Society of Cardiovascular Magnetic Resonance (SCMR), and the Society for Vascular Medicine (SVM) said they “remain more committed than ever” to continuing and expanding efforts to support diversity, equity, and inclusion (DEI).

“Together, we will build upon our efforts to provide implicit bias training, develop mentoring and professional development programs for young scholars and medical school attendees, and support young investigators with dedicated research awards and funding,” the statement reads.

“Cardiology is a wonderful, wonderful field, but it lacks diversity, severely,” Capers noted.

As chair of the American College of Cardiology’s diversity and inclusion committee, he said, “we've been spending the last couple of years reaching out to internal medicine residents who come from diverse backgrounds. We have a cohort of women who are very underrepresented in cardiology, a cohort of Black internal medicine residents, a cohort of Hispanic internal medicine residents, and this year we added a cohort of residents who consider themselves to be members of the LGBTQ+ community. Those are the four groups that are the most underrepresented in cardiology, as far as we can tell.”

Part of the work the ACC is doing with those individuals includes a one-on-one mentor, access to ACC meetings, and webinars, all of which is aimed at “making them the most competitive applicant they can be when they apply for cardiology.”

Improving the Inflow

However, the ability to even have diverse internal medicine residents to mentor as future cardiologists is dependent upon having a diverse group of medical students, which in turn is dependent on having diversity among college students, Capers added.  “I’m concerned that we will see a drop in the diversity of students at the inflow [college], which will have a significant impact on our ability to grow the physician workforce, although our commitment to doing that remains strong,”

With only 5% to 6% of all cardiologists being people of color, losing even a small percentage in the inflow stage can end up having a big impact, agreed Saima Karim, DO (Case Western Reserve University, Cleveland, OH).

“There are quite a few hurdles that you have to overcome to become a cardiologist. It's a marathon, it's not a sprint, and the problem is that we lose people in each relay for a variety of reasons,” she said. “So if you have fewer people to begin with starting out in that race in the future, the workforce and the patient care is going to look very different than it does now.”

Although the downstream effects of the SCOTUS decision on the field of cardiology remain to be determined, Karim said outreach by the community and the societies that support it will be more important than ever.

“I think one thing we can do is clarify the path that’s needed to get to the point of becoming a cardiologist and to do that we have to start early and we have to have people who are willing mentors,” Karim said.

Mentorship and support is a commitment that stretches people’s already short bandwidth, but larger strides could be made if it was shared at hospital or community levels through cardiologists going into high schools to talk about their careers, and making research opportunities and shadowing programs available to minority students with an interest in medicine, she added.

“Unfortunately it seems like if the currency now is going to be simply who scored the highest on a test, then we've got to redouble our efforts to make sure that that all people are scoring high on the test. That's a problem because of inequities in K-12 education,” Capers said. “But we do need to be focusing on the school system to get a more equitable, capable education so that we do have people who are well prepared.”

“The other thing that I think is important at this point in time is that any organization that's saying that they have made DEI a priority should certainly think about a very enforceable way to ensure that they're looking at all applicants and they're doing that early community outreach so they have the most impact possible,” Karim said.  “What are you doing to ensure that you are helping balance the number of minorities that are coming into medicine? The problem is going to be that without affirmative action, there's going to be no holding people's feet to the fire.”