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The possibility of a ban on race-conscious college admissions appears increasingly likely following oral arguments at the Supreme Court this week, and a decision in the case could have ripple effects on medical schools and ultimately on patient care, argued organizations like the Association of American Medical Colleges (AAMC) and the American Medical Association (AMA).

On Monday, the Supreme Court heard oral arguments in two cases focused on the right of institutions of higher education to apply a race-conscious approach to the admissions process: Students for Fair Admissions v. President and Fellows of Harvard College (Harvard Corporation) and Students for Fair Admissions v. University of North Carolina.

The petitioners, Students for Fair Admissions (SFFA), pointed to Brown v. the Board of Education, the landmark 1954 Supreme Court decision that found segregation unconstitutional, to argue that racial classification of any kind is wrong and should play no role in determining educational opportunities.

SFFA further sought to overrule , another Supreme Court decision that in 2003 determined that the educational benefits of having a diverse student body justifies the use of race as one factor in the admissions process, saying the decision "contradicts the 14th amendment's guarantee of equal treatment," as Patrick Strawbridge, JD, the attorney representing SFFA, argued.

The respondents also argued that such policies give racial preference to African American, Hispanic American, and American Indian applicants, but disadvantage Asian Americans.

The high court's ultimate decision has the potential to impact colleges and universities around the country, as well as medical and other health professional schools. And with a supermajority of conservatives, the possibility of a ban on race-conscious admissions now than ever before.

In an , the AAMC and 45 other health organizations, including the AMA, urged the high court not to do anything that would "disrupt" the current admission processes of health professional schools.

And the AAMC and its counterparts further argue that when it comes to educating physicians and other healthcare professionals, diversity is a "medical imperative" that "literally saves lives."

The brief cited the examples of whose likelihood of dying is halved when Black physicians are responsible for their care, and of Black physicians' ability to more accurately assess a Black patient's tolerance for pain and therefore .

AMA President Jack Resneck Jr., MD, said an "accumulating and substantial amount" of medical research indicates that having a diverse workforce benefits patients.

That does not mean the AMA believes that every healthcare visit should have "racial concordance," he stressed, but rather that residency or medical school training is enriched when those students and residents represent a diversity of people with a diversity of life experiences that closer reflects the population of the country.

The brief also states that it's unrealistic to think that every minority patient could or should be seen by a minority healthcare professional, and that the reason that medical outcomes improve isn't only because minority professionals are more willing to serve in minority communities, but also "because all physicians become better practitioners overall as a result of a diverse working and learning environment."

Being part of a diverse care team helps clinicians avoid the kinds of mistakes that might occur in a more "culturally homogeneous environment," where a practice of "respectful inquiry" and "challenged assumptions" is not routine, the brief noted.

That the Supreme Court is even hearing a case with years of precedence that have benefited the profession and the quality of education so dramatically, and that that precedent could be overturned is "incredibly disheartening," Resneck told MedPage Today.

"This is absolutely, positively, not about letting people who are not qualified into medical school or into residency training programs," he said.

It's not about meeting quotas or setting a minimum number or a maximum number of applicants from one group or another, he added.

"This is really, again, about race-conscious admissions processes that allow [race] to be taken into account along with ... performance in college, volunteer experiences, leadership experiences, test scores," Resneck said. "To all of a sudden say, here's one factor that you're legally not allowed to consider when you're looking at all of the things that are necessary to build a class that can learn together and take great care of patients in the future, seems like an arbitrary exclusion."

Heather Alarcon, JD, AAMC's senior director of Legal Services, who helped write the brief, agreed, saying that any notion that medical schools would accept an unqualified applicant to a class as a means of "reparation" or atoning for decades of discrimination in the field is misguided and "a luxury that medical schools cannot afford."

"Medical schools' admissions officers are doctors. They have a duty of care. Part of that duty of care is selecting physicians who they think can get the job done," she said.

The AAMC hopes that, at the very least, the high court will offer a "safe harbor" to allow for race and ethnicity to be considered in personal essays and letters of reference, Alarcon said.

In that same vein, she offered two examples: an applicant who's had childhood leukemia who writes in her essay that she wants to become an oncologist, and an applicant who attributes a parent's death from COVID to racial disparities and now feels a call to medicine.

"Both of those applicants' personal history is relevant, and to silence one of them because it relates at all to race is absolutely unfair to that applicant," Alarcon said.

As to the argument that the current processes discriminate against Asian-American applicants, Alarcon noted that in the Harvard case, the district court did not find any evidence of discrimination against Asian Americans.

However, excluding an applicant based on their race is "unethical," and "currently unlawful ... You don't have to overrule Grutter for that to be true," she said.

Moreover, she added, overruling Grutter and imposing a ban on race-conscious admissions processes would actually risk hurting Asian-American applicants by limiting their ability to share their own personal history or aspirations that may have been shaped by their racial and ethnic backgrounds.

Approximately 15% of medical school applicants with the highest GPA and MCAT scores were rejected from every medical school to which they applied, Alarcon noted, underscoring the importance of subjective qualifications gleaned through interviews, essays, and recommendations.

As of 2019, approximately 7.3% of advanced practice registered nurses (APRNs), 5.2% of physicians, and 4.4% of dentists identify as Black, while Black individuals account for 12.1% of the working-age population, according to the amicus brief. Similarly, Hispanic individuals account for 5.5% of APRNs, 6.9% of physicians, and 5.7% of dentists, while accounting for 18.2% of the working-age population.

Resneck noted that there has been "substantial progress" in the last few years, with the from 2020 to 2021 and the number of first-year .

He credits the increase to the fact that more medical schools are using a holistic admission process, and to a growing awareness in historically marginalized communities that medical school is a possibility.

However, the physician and medical student populations still do not reflect the diversity of patients they serve, and that's why retaining the ability to use a holistic review process matters, said Resneck.

"We really want to preserve medical schools' and residency programs' ability to build a class of highly qualified, talented individuals who are best for each other, best for the school, best for the physician workforce, and really best for the future health of the nation," he said.

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