Summary: This extensive report card about 26 medical schools found widespread deficiencies in the pursuit of racial justice in training, clinical care, policing, worker relations, and research. Despite increasing recognition of these problems, attempts to address them remain far short of vigorous.
Racial Justice Report Card, 2020-2021, White Coats for Black Lives, September 1, 2021
The Report Card consists of metrics that evaluate institutions’ curriculum and climate, student and faculty diversity, policing, racial integration of clinical care sites, treatment of workers, and research protocols. Ultimately, WC4BL hopes that the Racial Justice Report Card will highlight best practices and encourage academic medical centers to direct their considerable power and resources toward addressing the needs of our patients and colleagues of color.
Recruitment and Admissions: URM (Under-Represented Minority) physicians are so sparse in the United States that medical schools would have to admit only URM students for almost ten years for physician racial demographics to match that of the general population. For this reason, the RJRC requires each school to have an overrepresentation of URM students with relation to the current demographics to start to correct intentionally produced inequities. None of the 26 medical schools graded met the metric set for this year’s report card with regards to student representation.
Anti-Racist Curriculum Development: While the majority of schools evaluated had some form of education on social determinants of health, schools did not uniformly provide instruction on the sociopolitical (non-biological) nature of race. Only ten of the twenty-five medical schools evaluated were reported to teach race as a social construct.
Clinical Education and Patient Protection: Twenty out of the twenty-five medical schools assessed allowed preclinical (first- and second-year) medical students to provide patient care in the setting of student-run clinics for uninsured patients. This is not the standard of care in academic medical centers, where preclinical students are generally restricted to observation and shadowing. Students at several institutions reported being provided more autonomy when caring for marginalized patients in public hospitals or student-run free clinics than they were afforded when caring for patients in the primary teaching hospital.
Equal Access for All Patients: The majority of medical schools evaluated had some system of segregated care based on insurance status. Because of the link between racism and capitalism in the United States, segregation based on insurance status generates de facto racial segregation.
Medical School and Hospital Relationship to the Carceral State: Most of the hospitals reported that patients who are experiencing incarceration were not interviewed or examined apart from an officer and that there were no clear policies that protect the privacy or information of these patients.
Treatment of Workers: Nearly all of the evaluated academic medical centers paid at least some of their workers less than the living wage for the local area.
Research: Some medical centers’ institutional review boards (IRBs) listed racial and ethnic minorities as “vulnerable subjects.” However, few schools required researchers to define race or how researchers planned to use race in their research prior to approval.
By David Himmelstein, M.D. and Steffie Woolhandler, M.D., M.P.H.
These excerpts offer a glimpse of White Coats for Black Lives’ extensive findings documenting the racism that continues to permeate our nation’s leading medical institutions. The carefully researched 411 page report was produced by medical students and house officers at each of the institutions evaluated (disclosure: one of our daughters participated in this effort). All of the schools received mostly failing grades.
While the medical establishment has, in recent years, begun to pay lip service to anti-racism, actions would speak much louder.