Dear Dr. Wang,

Your article was recently  retracted by the editors of the Journal of the American Heart Association and was denounced by the AAMC and the American Heart Association. As researchers and leaders in selective admissions and medical education, and as Asian Americans, we are deeply disturbed and offended by your article’s lack of conceptual rigor and its perpetuation of racist tropes, namely that a race-conscious admissions process produces unqualified Black physicians and physicians of color.

A flawed paper

The crux of your argument seems to be that by using a set of holistic admissions criteria, medical schools admit unqualified applicants and therefore, produce an unqualified physician workforce. However, you seem to confuse winning a competition on a single scale with being qualified. Being competitive is not the same as being qualified.  24,127 runners qualified for the Boston Marathon.  Not all qualifying runners will finish at the top, or even within minutes of the most competitive athletes, but most will finish and all were qualified through a rigorous process to pursue the marathon course.  The tripartite mission of medicine – education, research and patient care – is served best with attention to equity, not competition.

Dr. Wang, you falsely defined “qualified” applicants using only MCAT scores, which are incomplete metrics of an applicant’s qualifications for medical school.  Aggregate national acceptance data from 2017-2020 shows that 18.1% of applicants to medical school with MCAT scores between 514-517 were not accepted.  For those scoring above 517 (95th percentile) 12.2 percent were rejected by every school.  Practitioners in undergraduate medical education (UME) admissions understand that assessing academic preparation and personal qualifications for medicine is complex, nuanced, and cannot be reduced to the MCAT, which has  limited capacity to predict academic success (and does not predict clinical outcomes).  We would no more assess cardiovascular health using only body weight than admit applicants to a profession based only on MCAT scores. There are many other factors that must be considered in context.  Among these factors is the experience of racism.

Your paper ignored structural racism, and claimed that centuries of colonization and racism, and their implications for contemporary society, vanished with the Civil Rights Act of 1964.  This is tantamount to claiming lead poisoning ended when the Consumer Product Safety Commission banned lead paint in 1977.  Medicine takes place within societal realities that cannot be ignored.

Racism affects different populations differently, and solutions must acknowledge these differences. As Asian Americans we face anti-Asian racism and xenophobia especially in the COVID era, but the inequalities we face are different from other forms of racism, especially anti-Black racism. Regardless of economic status, Black people must survive murderous state racism and deep structural inequalities, as they pursue educational goals. Similarly, and in different ways, Latinx, Indigenous peoples, and the diversity of Asian Americans including Southeast Asian and Filipinx Americans confront different forms of intersectional racism. Systems of oppression (e.g., racism + patriarchy + poverty) intersect to affect us in different ways. We are not all playing the same “game.” Unfortunately a uterine lottery pick predetermines resources produced by deep systems of inequalities that are heavily reproduced in access to education resources, supports, and outcomes.  It would be odd if a fair admissions process could somehow simply ignore that fact.

Intersectional racism-conscious admissions

Talent is universal, opportunity is not.  Many schools already employ advanced, holistic evaluation and selection methods for choosing the next generation of physicians.  Affirmative action, or race-conscious admissions in education, is a critical policy and practice to advance diversity, which has been deemed necessary for robust educational benefits.

Higher education can seek to achieve diversity necessary to facilitate educational benefits, through narrowly tailored practices. Race cannot be the reason that anyone is admitted or denied, nor can race be considered to reach quotas or “parity.” The narrowly tailored consideration of race as “one of many factors” through holistic review should center and acknowledge how intersectional structural racism shapes students’ educational contexts. Everyone, including white and Asian Americans, benefits from diversity resulting from affirmative action and race-conscious admissions that account for individual students’ whole stories and contexts of education. Medical admissions should value a wide array of applicant experience to foster an appreciation of the wide array of patient experiences.

We are calling for robust praxis in intersectional, racism-conscious admissions, which affirmative action law allows. Using an admissions approach that is conscious of intersectional racism, we center everyone’s unique human dignity in evaluating their qualifications, moving beyond checking off a particular racial box to understand the totality of the applicant’s experience and talents. It does not guarantee admission for anyone. It offers a fairer, more equitable evaluation process. Only highly qualified applicants are admitted.

Equity is fundamental to medicine living up to its ideals to “do no harm” and serve all people. Black Lives Matter.

Sincerely,

Dr. Nakae and Dr. Poon

Sunny Nakae, MSW, PhD, is a clinical associate professor of social medicine, population, and public health and Associate Dean for Student Affairs at the University of California-Riverside School of Medicine. She has previously held administrative positions at the University of Utah School of Medicine, Feinberg School of Medicine at Northwestern University, and Loyola University Chicago Stritch School of Medicine. She is the author of Premed Prep: Advice from a Medical School Admissions Dean (Rutgers University Press, 2020)

 

OiYan Poon, Ph.D. is an associate professor affiliate in the Department of Educational Policy Studies at the University of Illinois at Chicago. Her research focuses on how race-conscious holistic admissions works, and the racial politics of Asian Americans and affirmative action.