For the head of admissions at a medical school, Dr. Mark Henderson is quite forthright when evaluating the profession.
« Mostly rich kids can go to medical school, » he said.
In his role at the University of California, Davis medical school, Dr. Henderson sought to change that by developing an unorthodox tool for evaluating applicants: the Socioeconomic Disadvantage Scale, or SED
The scale rates each applicant from zero to 99, taking into account life circumstances, such as family income and parental education. Admissions decisions are based on that score, combined with the usual portfolio of grades, test scores, recommendations, essays, and interviews.
The scale of disadvantages has helped transform UC Davis into one of the most diverse medical schools in the country, notable in a state that voted in 1996 to ban affirmative action.
With last week’s Supreme Court ruling against racist admissions, the medical school offers a glimpse into how selective schools across the country could overhaul their admissions policies, as they look for alternative ways to achieve diversity without coming into conflict with the new law.
Last week, President Biden called adversity scores a « new standard » for achieving diversity.
Word got around about the UC Davis scale. Dr Henderson said around 20 schools have recently requested more information. And there are other socioeconomic metrics, including Landscape, released in 2019 by the College Board, the nonprofit that administers the SATs. This tool allows university student admissions offices to assess the socio-economic background of individual students.
But skeptics question whether such rankings — or any kind of socioeconomic affirmative action — will be enough to replace race-conscious affirmative action. And schools that use adversity scales may also find themselves wandering into legal swamps, with conservative groups promising to fight programs that are simply substitutes for race.
Over the years, medical schools have made some progress in diversifying their student bodies, with numbers on the rise. But just like undergraduate admissions, wealth and connections continue to play a big part in who gets accepted. More than half of medical students come from families in the top 20%, while only 4% come from those in the bottom 20%, according to data by the American Association of Medical Faculties.
There’s also a family dynamic. Doctors’ children are 24 times more likely to become doctors than their peers, according to the American Medical Association. It’s hard to know why the profession is handed down from generation to generation, but statistics have prompted the association to do so to adopt a policy that opposes inherited preferences in admissions.
« This is a staggering economic gap between medical students and the general public, » said Dr. Henderson, who comes from a working-class upbringing and now serves as associate dean of admissions.
As a result, the number of black doctors remains stubbornly low: About 6 percent of practicing physicians in the United States are black, compared to 13.6% of American population who identify as black.
With the Supreme Court decision, « that number is likely to go down, » said Dr. James EK Hildreth, president of Meharry Medical College, founded in 1876 in Nashville to train black health care workers.
Medicine leaders say training more Black and Hispanic doctors could help bridge the vast divides in American health care. Research shows that physicians from underrepresented racial and ethnic groups are more likely to work in primary care or in places where physicians are in short supply.
And patients fare better when treated by doctors with similar backgrounds, said Dr. Jesse M. Ehrenfeld, president of the American Medical Association.
The UC Davis scale has attracted attention for its ability to engage diverse students using what schools term « race-neutral » socioeconomic models.
In its most recent enter the classroom out of 133 students, 14% were black and 30% Hispanic. Nationwide, 10 percent of medical students they were black and 12 percent were Hispanic. The vast majority of the UC Davis class – 84% – come from disadvantaged backgrounds and 42% are the first in their families to go to college.
The overall acceptance rate was less than 2%.
In the Davis Scale, first used in 2012, eight categories establish an adversity score for each candidate. Factors include family income, whether the applicants are from an underserved area, whether they help support their nuclear families, and whether their parents went to college.
The higher a candidate’s rate on the disadvantage scale, the greater the push.
There is no set formula for how to balance scale with academic record, Dr. Henderson said, but a simulation of the system revealed that students from underrepresented groups grew from 10.7% to 15.3%. And the share of economically disadvantaged students tripled, from 4.6 percent to 14.5 percent of the class.
At the same time, scores on the MCAT, the standardized test for medical school applications, have declined only marginally.
Still, it’s not easy to get medical schools to raise admissions standards, especially anything that undermines the value of test scores and grades. Dr Henderson said he has received pushback from his own colleagues.
« Doctors say their kids got into medical school elsewhere, and they didn’t get into here, » she said.
As children of doctors, he said, those applicants scored zero SEDs.
A number of scholars, including Richard D. Kahlenberg, have promoted the use of class preferences, which they argue could address racial inequities in education without fostering the resentment often provoked by plans for racial diversity.
And President Biden said Thursday his administration would develop a « new standard for colleges by taking into account the adversity a student has overcome. »
« The kid who faced tougher challenges showed more grit, more determination, » Biden told reporters at the White House, « and that should be a factor colleges should consider in their admissions. »
He could be talking about someone like Eleanor Adams, a member of the Choctaw Nation, who said she didn’t think medical school was an option for her.
« I didn’t grow up with a lot of money, » she said.
But she found mentors who encouraged her, and today she is in her third year of medical school at UC Davis, located in Sacramento. She plans to become an Indian Health Service physician in Oklahoma, fulfilling one of the school’s goals, Dr. Henderson said, which is to train doctors who will return to their communities.
At schools in other states without affirmative action, such as the University of Michigan, admissions officials have complained that enrolling more socioeconomically disadvantaged students has not significantly increased the share of Black, Hispanic, and Native American students.
« These tools certainly have utility, but they fail to accomplish what a breed-conscious admissions practice does, » said Dr. Ehrenfeld of the American Medical Association.
Socioeconomic rankings could also be legally challenged. Chief Justice John G. Roberts Jr., in his majority opinion on affirmative action, wrote that colleges could consider how race has affected a candidate’s life. But he also warned against using proxies for race.
The Pacific Legal Foundation, a group of libertarian activists, has already sued a selective school, Thomas Jefferson High School for Science and Technology in Alexandria, Virginia, for using economic factors as substitutes for race in admissions.
Joshua P. Thompson, an attorney for the foundation, said the legal issues surrounding these disadvantage indices were complex.
« I think the devil will be in the details, » Mr. Thompson said. « The Supreme Court has been quite clear that what cannot be done directly cannot be done indirectly. »
If so, Dr. Henderson said his school’s scale of disadvantages would be defensible in court.
« I’m worried? Yes,” Dr. Henderson said of a lawsuit. “Will it stop me? NO.”