Patients need doctors who look like them. Can medicine diversify without affirmative action?

DETROIT — Dr. Starling Tolliver knew she wanted to become a doctor. Yet, as a Black girl growing up in Akron, Ohio, it was a dream that felt out of reach.

She rarely saw doctors who looked like her. As a child, she experienced severe hair loss, and struggled to find a dermatologist who could help.

Tolliver made a pact with two childhood best friends to become doctors who would care for Black and underserved communities like their own. Now 30, she is in her final year of dermatology residency at Wayne State University.

She plans to spend her career caring for the body’s largest organ, where differences in melanin give humans the skin colors underpinning the construct of race. In dermatology, only 3% of U.S. doctors are Black.

Despite her success, the girls’ pact remains unfulfilled. While her friend Charmaine became a nurse, Maria, who wanted to become a pediatrician, was killed in their hometown at the age of 19.

Her friend’s death only strengthened her resolve.

“I’m going to continue to go on this path of medicine,” Tolliver said. “Not only for myself, but for Maria, and to potentially help others in the future from similar backgrounds as mine know that they can do it as well.”

But more than two months after the Supreme Court struck down affirmative action in college admissions, concerns have arisen that a path into medicine may become much harder for students of color. Heightening the alarm: the medical field’s reckoning with longstanding health inequities.

Black Americans represent 13% of the U.S. population, yet just 6% of U.S. physicians are Black. Increasing representation among doctors is one solution experts believe could help disrupt health inequities.

The disparities stretch from birth to death, often beginning before Black babies take their first breath, a recent Associated Press series showed. Over and over, patients said their concerns were brushed aside or ignored, in part because of unchecked bias and racism within the medical system and a lack of representative care.

A UCLA study found the percentage of Black doctors had increased just 4% from 1900 to 2018.

But the affirmative action ruling dealt a “serious blow” to the medical field’s goals of improving that figure, the American Medical Association said, by prohibiting medical schools from considering race among many factors in admissions. The ruling, the AMA said, “will reverse gains made in the battle against health inequities.”

The consequences could affect Black health for generations to come, said Dr. Uché Blackstock, a New York emergency room physician and author of “LEGACY: A Black Physician Reckons with Racism in Medicine.”

“It’s really about holding these larger organizations, institutions accountable and saying: ‘Right now, we’re in a crisis — a crisis of humanity,’” Blackstock said.

With affirmative action off the table at predominantly white institutions, historically Black colleges and universities may see an increase in applications, said Dr. Valerie Montgomery Rice, president and CEO of Morehouse School of Medicine in Atlanta.

The college, which typically has 115 openings for new medical students, receives between 7,000 and 9,000 applications per year, a number Rice said she believes will increase in light of the Supreme Court ruling. HBCUs have long served as a direct pipeline of Black doctors.

Experts say diversity is especially needed within specialty medicine. In dermatology, just 65 of the 796 applicants for residencies in 2020 were Black, data from the Association of American Medical Colleges shows. Only 39 were Latino.

For a field focusing on the skin, the unequal access among patients of color is stark: Patients of color are half as likely as white patients to see a dermatologist for the same conditions.

The consequences can be devastating.

Without affirmative action as a tool, career programs focused on engaging people of color could grow in importance.

For instance, the Pathways initiative engages students from Black, Latino and Indigenous communities from high school through medical school.

The program starts with building interest in dermatology as a career and continues to scholarships, workshops and mentorship programs. The goal: Increase the number of underrepresented dermatology residents from about 100 in 2022 to 250 by 2027, and grow the share of dermatology faculty who are members of color by 2%.