Early last month, the Association of American Medical Colleges (AAMC)—the organization that oversees the Medical College Admission Test (MCAT) and cosponsors the accrediting body for all medical schools— published a story claiming that black patients fare better with black doctors, an idea that has become popular across the health-care establishment. That it was being amplified just as the Supreme Court prepared to hand down its landmark ruling on affirmative action was neither subtle nor coincidental. Woke activists are determined to sell the idea that race-based medical school admissions are noble and sensible to justify skirting bans on affirmative action. Justice Ketanji Brown Jackson even paid lip service to the purported benefits of doctor-patient race concordance in her dissent.
The notion that patients benefit from seeing doctors who share their race is dubious to the majority of us who know better than to essentialize race in our encounters with others. So is the implicit claim that lowering standards and elevating race in medical school admissions maximizes patient welfare. Indeed, the quality of the studies that AAMC cited to support these claims are as poor as one might expect.
Take, for example, a recent study published in JAMA Network Open. It observes that black life expectancy is longer in counties with higher proportions of black primary care providers (PCPs). But the researchers make no allowance for how their results are shaped by their modeling of the relationship between black representation among PCPs and life expectancy—including a curious decision to omit the roughly 50 percent of counties that don’t have any black PCPs. Data can be manipulated to reach just about any conclusion. The researchers’ failure to demonstrate that their results are robust, and not dependent on their very specific parameters, should leave readers deeply skeptical.
The study also highlights the limitations of correlational (as opposed to causal) analysis. The JAMA Network Open study reveals that blacks have the highest expected life expectancy in counties with high proportions of black doctors—and high levels of poverty. That second factor is glossed over in the study. In other words, some of the results of their analysis are so dubious that the researchers have to tiptoe around them and highlight only their preferred observations.
Another study that the AAMC cited evaluated an experiment in Oakland in which black patients were recruited to be seen by a black or non-black doctor. In the first phase of the experiment, patients were shown a photo of a doctor and asked about their willingness to undergo certain preventative screenings with that doctor. No differences were observed according to doctor race. In the second stage, however, some patients changed their mind after meeting with the doctor, such that their willingness to receive certain screenings was higher among black doctors. Trouble is, the experiment consisted of only six black and eight non-black doctors. It’s impossible to discern whether it was race that produced the more favorable results or other factors like personality, facial expressions, or demeanor. That the “experiment” lacked a control group of non-black patients and that the more properly controlled lottery (i.e., the one involving a photo of the doctor) didn’t show any difference by race amounts to remarkably weak evidence in favor of racial concordance.
“Research shows that racial concordance can improve communication, trust, and adherence to medical advice,” the AAMC says in its recent post. The word can is doing some Herculean lifting there. The studies that the AAMC cites—flaws and all—are carefully cherry-picked from a larger body of evidence that tells a different story. Recent systematic reviews of the evidence base on racial concordance in medicine have found “no relationship” or “mixed results” between race/ethnicity and quality of communication and “inconclusive” evidence for patient outcomes. Further, “no clear pattern” emerges when it comes to health-care utilization, satisfaction, or perception of respect.
A strong likelihood exists that these systematic reviews are in fact understating the extent to which research has failed to demonstrate a link between doctor-patient racial concordance and improved health outcomes. File-drawer bias—in which researchers are more likely to try to publish studies that find significant results—is a well-documented phenomenon. Many more studies have likely been conducted that found no relationship between doctor-patient racial concordance and health-care outcomes but never made it to publication.
The AAMC says that its mission “focuses on transforming health care in four primary mission areas: medical education, patient care, medical research, and diversity, inclusion and equity in health care.” It’s clear that the organization’s obsession with that last priority trumps everything else.