Medical School Admissions After the Supreme Court's 2023 Affirmative Action Ruling.

IMPORTANCE

The 2023 Supreme Court of the United States (SCOTUS) Students for Fair Admissions, Inc. v President and Fellows of Harvard College ruling to restrict race-based affirmative action is a landmark decision with potentially far-reaching consequences.

OBJECTIVE

To examine application, acceptance, and matriculation rates into doctor of medicine (MD)-granting programs before and after the 2023 SCOTUS decision.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study used deidentified data from the Association of American Medical Colleges on applicants and matriculants to US MD-granting medical schools 5 years before (2019-2023) and 1 year after (2024) the SCOTUS ruling.

MAIN OUTCOMES AND MEASURES

Application, acceptance, and matriculation into MD-granting programs.

RESULTS

The study sample included 291 764 applicants to MD programs between 2019 and 2024 (162 211 identifying as female [55.59%]; 4576 American Indian, Alaska Native, Native Hawaiian, or Pacific Islander [1.57%], 84 122 Asian [28.83%], 34 256 Black [11.74%], 35 707 Hispanic [12.24%], and 154 621 White [53.00%]). Compared with mean acceptance rates in 2019 to 2023, acceptance rates in 2024 were higher for White (40.37% vs 47.47%; difference, 7.10 percentage points [95% CI, 6.21 to 7.98 percentage points]; P < .001) and Asian (38.26% vs 45.19%; difference, 6.93 percentage points [95% CI, 5.78 to 8.07 percentage points]; P < .001) applicants and lower for Black applicants (36.06% vs 33.08%; difference, -2.98 percentage points [95% CI, -4.74 to -1.21 percentage points]; P < .001) and underrepresented in medicine (URiM) applicants overall (39.68% vs 38.33%; difference, -1.35 percentage points [95% CI, -2.60 to -0.09 percentage points]; P = .02). No racial or ethnic difference in acceptance rates were observed in 2019 to 2023, but in 2024, URiM applicants had significantly lower acceptance rates than White (difference, -9.14 percentage points; P < .001) and Asian (difference, -6.86 percentage points; P < .001) applicants. Comparing the mean of 18 304 matriculants in 2019 to 2023 with 19 018 matriculants in 2024, White student representation decreased from 10 132 matriculants (55.35%) to 10 158 matriculants (53.41%) for a decrease of 1.94 percentage points (95% CI, -3.31 to -0.56 percentage points; P = .009), Asian student representation increased from 5102 matriculants (27.87%) to 6288 matriculants (33.06%) for an increase of by 5.19 percentages points (95% CI, 3.49 to 6.88 percentage points; P < .001), and URiM student representation decreased from 4466 matriculants (24.39%) to 3963 matriculants (20.83%) for a decrease of 3.56 percentage points (95% CI, -5.34 to -1.77 percentage points; P < .001), equating to 503 fewer URiM matriculants in 2024. Post-SCOTUS decision declines in URiM representation were concentrated in schools located in states without prior state-level affirmative action bans (mean [SD] change, -6.14 [8.93] percentage points vs 0.10 [8.11] percentage points; P < .001).

CONCLUSIONS AND RELEVANCE

In this study, URiM student matriculation into US medical schools declined after the 2023 SCOTUS ruling, with an emergent disparity in acceptance rates of URiM applicants relative to Asian and White students. The decline in URiM student matriculation was concentrated in states without a preexisting state-level affirmative action ban, suggesting that there may be an association between the SCOTUS ruling and demographic changes in matriculation.