Affirmative Action in Medicine: Improving Health Care for Everyone

Our nation is grappling with the Institute of Medicine's report on health care disparities (1), which demonstrates clearly that persons from minority groups suffer from unequal health care. The question of how to develop our physician workforce takes on central importance. We struggle with questions of how to bring representative numbers of minority physicians into medicine. For example, if minority medical students who have poorer grades and poorer test scores are admitted, will they have poorer school performance? What kinds of doctors will they become? Perhaps we are comfortable with affirmative action for the most economically disadvantaged medical students. But should minority students who are more advantaged be recipients of affirmative action as well?

It is precisely these types of probing and practical questions that Affirmative Action in Medicine: Improving Health Care for Everyone strives to address. The book's centerpiece is an impressive 30-year longitudinal cohort study designed to examine the impact that doctors who were admitted through affirmative action have had on the medical landscape.

The book's author, James L. Curtis, M.D., was previously the associate dean of Cornell University Medical College and the architect of Cornell's affirmative action program. In this book, he strives to produce the data needed to design and implement effective affirmative action programs. For the medical students in the longitudinal study, he traces the impact that their ethnicity, economic status, medical school, and gender had on eventual practice patterns—for example, communities served and specialty choice. Curtis produces data to address many of the controversies and debates in affirmative action. In addition, he includes well-organized comparative charts and summaries of affirmative action efforts by region and even by school. The book ends with a section containing suggestions for affirmative action in the future.

The author includes a well-summarized chapter, "Civil Rights in Health Care," in which he succinctly expands our understanding of the context that makes affirmative action in medicine necessary. This chapter in and of itself is worth reading. Curtis shares the infrequently told story of desegregation in health care. He traces the health of African Americans from slavery (when, interestingly, there were no significant health disparities) to the present day. The chapter provides the historical development of the systemic factors that buttress and perpetuate health care disparities.

Affirmative Action in Medicine is a comprehensive and highly detailed account. However, the book's rich data, particularly the cohort study data, are presented in a format that is difficult to assimilate, and on the whole the book is only lightly indexed. There is no quick way to tap into the depth of information, and the book does not lend itself to selective reading. Yet this text does contain an unparalleled level of detail about affirmative action. For anyone who is seriously interested in the development, recruitment, and retention of minority physicians, this book must be read. It is illuminating and important reading for minority physicians. It frames, contextualizes, and clarifies the minority physician experience in medicine.

Dr. McQuery is an APA/SAMSHA minority fellow and an adult psychiatry resident at Cambridge Hospital in Cambridge, Massachusetts.