A new UCLA Health has found that Black, Hispanic, and Native American students taking the Medical College Admission Test (MCAT) prior to applying to medical school have more financial and educational barriers, and face greater discouragement from important advisors compared to their white counterparts. The study also found that Black and Hispanic students taking the MCAT were less likely to apply to and attend medical school.
These findings, published in JAMA Health Forum, come amidst an impending Supreme Court ruling in June that will potentially ban affirmative action, a practice that takes race as one of many factors into consideration when reviewing applications.
While there are studies describing how barriers and discrimination contribute to the lack of diversity among medical students, residents, and the physician workforce, the researchers focused on barriers that students from underrepresented racial and ethnic groups in medicine face earlier in the career pathway.
“The research is unique because it goes one step back and looks at students who are interested enough in medical school to take the MCAT—an intense, rigorous, and expensive test—but have not applied yet,” said Dr. Jessica Faiz, first author, emergency medicine physician, and National Clinician Scholars Program fellow at UCLA.
To conduct the study, the researchers analyzed survey data from 81,755 people who took the MCAT from 2015-2018. They focused on Asian, Black, Hispanic, Native American, and white populations, and analyzed parental educational background, financial hardships, extracurricular educational opportunities, and discouragement from advisors that may reflect discrimination, along with whether they ultimately applied to and attended medical school.
The study found that Black, Hispanic, and Native American students were more likely to face challenging barriers, which include having parents without a college degree, attending a low-resourced college, having difficulty affording MCAT preparatory materials, and having more pre-medical school debt. All of these barriers decreased their likelihood of applying to and attending medical school. The study also found that Asian, Black, Hispanic and Native American students were more likely than white students to have an advisor negatively impact their choice to pursue a career in medicine.
Given the study results, Dr. Faiz says there are undoubtedly interested students from underrepresented backgrounds who are getting deterred from the profession even before taking the test. “If we see that these barriers exist in those who are already taking the MCAT, we can only imagine how many students are really falling off before that, and we know that that's due to systemic factors.”
To ensure that medical schools diversify their student bodies and ultimately promote health equity, Dr. Faiz says race-conscious admissions must be preserved. Additionally, eliminating economic barriers to applying to medical school, educating members of admissions committees on how the enduring effects of structural racism lead to barriers in the pursuit of a career in medicine, and employing rubrics that highlight the value that applicants’ diverse experiences bring are critical. Lastly, innovative medical school curricular options, structured mentoring programs, and accelerated pathways should be explored to increase the diversity of the physician workforce.
The study’s other authors are Dr. Utibe Essien, Dr. Donna Washington, and Dr. Dan Ly of UCLA and the Greater Los Angeles Veterans Affairs Healthcare System.
: Racial and Ethnic Differences in Barriers Faced by Medical College Admission Test Examinees and Their Association With Medical School Application and Matriculation. JAMA Health Forum. 2023;4(4):e230498. doi:10.1001/jamahealthforum.2023.049
