The Evolution of Medical School Admissions: Standardized Metrics, the End of Affirmative Action, and Impacts on Physician Workforce Diversity

Human Rights Research Center
Jul 2
7 min read

July 2, 2026

Brief Summary

Medical school admissions assess a multitude of skills and aptitudes required for successful matriculation. However, concerns about the diversity of the student body and racial/ethnic admissions violations led to legal precedents that significantly decreased the number of matriculants from underrepresented groups in medicine within the United States. University medical school investigations are ongoing by the Department of Justice to determine any potential racial discrimination in their admissions processes. Eliminating race-conscious admissions hinders medical schools' ability to cultivate a representative physician workforce, stalling progress toward health equity.

Historical Context of Medical School Admissions

Medical school admissions have consistently been competitive, relying on student assessments to gauge medical aptitude. Developed in the 1920s, the Medical College Admission Test (MCAT) standardized the evaluation of prospective medical students. Over time, it has undergone multiple structural and scoring revisions to assess skills ranging from scientific terminology to biological and physical science problem-solving.¹

Admissions committees traditionally rely on the MCAT and undergraduate grade point averages (UGPAs) to determine applicants' suitability and potential for success, although analyses of these metrics' effectiveness are mixed. A prior study examined the predictive validity of MCAT scores and UGPAs on the Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) Level 1 and Level 2-CE (Cognitive Evaluation). Administered by the National Board of Osteopathic Medical Examiners (NBOME), these exams showed comparable predictive values across sex, race, ethnicity, and socioeconomic status (SES) for Doctor of Osteopathic Medicine (DO) students.² Similar results were found for Doctor of Medicine (MD) students;³ however, neither study accounted for factors such as educational opportunity or the influence of structural racism on the academic achievements of underrepresented students.⁴ Furthermore, the predictive value of the MCAT did not extend to assessments based on direct clinical observation or performance during Postgraduate Year 1 (PGY-1), the initial year of residency that bridges the gap between medical education and independent practice.⁵

The Shift to Holistic Review

Although quantitative metrics like the MCAT are important for predicting medical school success, admissions processes shifted toward a holistic review framework in the early 2000s to cultivate a more diverse student body. This approach emphasized balancing academic metrics with lived experiences, personal attributes, and extracurricular activities.⁶ Prior studies indicate that this holistic approach increased the number of underrepresented medical trainees interviewed and selected,⁷ resulting in a higher percentage of matriculating residents who are underrepresented in medicine (URM).⁸ While not a perfect solution for increasing diversity in medical schools, holistic review has made a measurable impact.⁹

Legal Challenges and the End of Affirmative Action

In June 2023, the U.S. Supreme Court’s decision in Students for Fair Admissions, Inc. v. President & Fellows of Harvard College struck down affirmative action, raising significant concerns about future diversity in both medical school admissions and the broader physician workforce. In this case, and the related Students for Fair Admissions, Inc. v. University of North Carolina, the Court ruled that considering race in admissions violated the Equal Protection Clause of the Fourteenth Amendment.^10,11,12

This decision revisited the 2003 Supreme Court ruling in Grutter v. Bollinger, which had held that the Equal Protection Clause permitted the limited consideration of race in higher-education admissions.^10,13 The Grutter decision originally supported efforts to build a diverse student body and increase the enrollment of underrepresented minority students. Under legal precedents, however, universities must evaluate applicants as individuals; they cannot establish quotas for members of specific racial or ethnic groups or place them on separate admissions tracks.¹³

Impact on Underrepresented Applicants

The effects of the 2023 Supreme Court decision have been statistically significant for groups underrepresented in medicine (URIM). The Association of American Medical Colleges (AAMC) defines URIM as individuals identifying with one or more of the following racial or ethnic categories: American Indian or Alaska Native, Black or African American, Hispanic or Latino, or Native Hawaiian or Pacific Islander.¹⁴ In 2024, Doctor of Medicine (MD) matriculants increased by almost 6% for Asian students, but decreased by almost 5% for URIM student representation, especially in states without a preexisting state-level affirmative action ban.¹⁵ Using data from the AAMC and American Association of Colleges of Osteopathic Medicine (AACOM), the matriculants in the 2023-2024 and 2024-2025 academic years had a significant MD decline of 11.6% for Black students and 10.8% for Hispanic students. In Doctor of Osteopathic Medicine (DO) programs, White individuals had significantly higher matriculation rates, with increases in applicants to White and Hispanic individuals.¹⁶ In addition, data from the AAMC on the diversity of applicants and enrollees in 2024-2025, Black or African American (2.8%), and Hispanic, Latino, or of Spanish Origin (up 2.2%) applicants increased, while American Indian or Alaska Native applicants had a substantial decrease of 15.4%.¹⁷ Further, matriculants greatly decreased in all groups, including Black or African American matriculants (11.6%), Hispanic, Latino, or of Spanish Origin (10.8%), American Indian or Alaska Native (22.1%), and Native Hawaiian or Other Pacific Islander (4.3%).¹⁷

Ongoing Investigations and Implications

In the wake of the Supreme Court decision and subsequent shifts in applicant and matriculant data, efforts have continued to investigate 15 colleges for alleged racial discrimination in their admissions practices.^18,19 In June 2026, the Department of Justice (DOJ) announced that the University of California, Los Angeles, and Yale University had illegally considered race in their admissions. Both medical schools, however, remain adamant that their admissions are merit-based, selecting students who demonstrate excellent academic achievement, individual commitment, and public service.²⁰ Earlier, in March 2026, the DOJ also launched investigations into the medical school admissions practices at Stanford University, Ohio State University, and the University of California, San Diego.²⁰

Although holistic reviews of medical school applicants encourage diversity, they are ultimately insufficient given the persistent racial and systemic inequities within the physician workforce; merely seeking diversity is inadequate.²¹ Current constitutional law on affirmative action hinders medical schools' ability to cultivate a representative physician workforce. Downstream, this actively harms minority patient health and stalls progress toward health equity.

Abbreviations

AACOM: American Association of Colleges of Osteopathic Medicine
AAMC: Association of American Medical Colleges
CE: Cognitive Evaluation
COMLEX-USA: Comprehensive Osteopathic Medical Licensing Examination of the United States
DO: Doctor of Osteopathic Medicine
DOJ: Department of Justice
MCAT: Medical College Admission Test
MD: Doctor of Medicine
NBOME: National Board of Osteopathic Medical Examiners
PGY-1: Postgraduate Year 1
SES: Socioeconomic Status
UGPA: Undergraduate Grade Point Average
URIM/URM: Underrepresented in Medicine

Glossary

Affirmative Action: The use of policies, legislation, programs, and procedures to improve the educational or employment opportunities of members of certain demographic groups (such as minority groups, women, and older people) as a remedy to the effects of long-standing discrimination against such groups.
Applicant: A person who formally requests something, especially a job, or to study at a college or university.
Diversity: The state or practice of including people of different races, cultures, etc., in a group or organization.
Equity: Freedom from disparities in the way people of different races, genders, etc., are treated.
Ethnicity: Of or relating to large groups of people classed according to common racial, national, tribal, religious, linguistic, or cultural origin or background.
Holisitic: Concerned with the whole person as opposed to a specific part or aspect.
Matriculant: To be enrolled at a college or university.
Minority: A part of a population thought of as differing from the rest of the population in some characteristics, and often subjected to differential treatment.
Quota: The share or proportion assigned to each in a division or to each member of a body.
Race: Any one of the groups that humans are often divided into based on physical traits regarded as common among people of shared ancestry.
Sex: The state of being male or female.
Socioeconomic Status: Socioeconomic status is the social standing or class of an individual or group. It is often measured as a combination of education, income, and occupation.
Underrepresented: To give inadequate representation to; representation in numbers that are disproportionately low.

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