First, allow me to affirm my complete agreement with Dr. Martin Luther King: children from now and forever should be judged by the content of their character, not by the color of their skin.
Second, let me acknowledge that Blacks and other colored folk have been denied membership in labor unions, in apprentice programs, even the opportunity to be fighter pilots when, in fact, experience has shown (viz Tuskegee airmen) they perform every bit as well as whites when given the opportunity in these realms.
Having said all that, I have to believe two things:
1. There are some jobs where all that counts is competence: I don't care about the color of the skin (or the gender) of the pilot when I step on my airplane, nor do I care about the color of who made my HVAC, who wired my house--all I care about is they did their job well.
2. While there have been longstanding wrongs regarding making a wide range of economic opportunities available to people of all races, it is not the job of the medical profession to right these wrongs. The job of the medical profession is to provide the very best medical care to all citizens, which of course begins by choosing, as best it can, the best people to be trained to deliver that care.
The New England Journal of Medicine published a "Perspective" piece on March 9, 2023 "Diversifying the Physician Workforce," in which Dr. Quinn Capers argued:
1. Diversity (i.e. having more physicians and scientists of color) in the physician workforce would improve the quality of care, at least for colored patients, but likely for everyone.
2. It is the responsibility of the medical profession, namely the admission committees at medical schools, the faculty at residency training programs to be sure much larger proportions of Black and colored candidates are placed into medical schools and internships and residencies, and that failing in this effort, deans, chairmen of departments should be fired if they do not achieve demonstrable goals.
3. The idea of a "meritocracy" should include the idea that being Black is, in and of itself, a form of "merit," where admission to medical schools are concerned.
"Any selection committee hires or admits candidates on the basis of 'merit,' which should be defined in keeping with the stated mission. For medical schools seeking students who want to serve underserved populations, for example, applicants can be stratified according to their relative past activities and potential for continuing such service in the future."
What he is referring to here is the problem of getting physicians to open up practices in poor, often inner city areas where medical care is scarce, and the idea that Black men and women are more likely to do that. Of course, what he is struggling with here is there is no evidence this actually happens: Black medical students, who have debt, or who simply have worked hard to rise above modest economic origins, have no intention of simply returning to the ghetto's once they have their MD degrees.
Then there is the sticky wicket of what is "merit."
Dr. Capers says, "Despite compelling evidence that workforce diversity in medicine adds value to decision making, scientific inquiry and care."
But of course, there are no convincing studies any of this is true. It would be lovely to think that simply adding Black doctors to the workforce would mean well trained Black doctors returning the the land of their forebears and practicing high quality medicine or going out into the nation at large, in all levels of affluence and poverty, and "making a difference." There is no actual unbiased evidence this happens.
Capers does address, head on, the old "Bell Curve" argument that Blacks simply test worse on standardized tests, which he says predicts only the likelihood of high scoring students to test well on future standardized tests. This is the old problem of cultural bias of many of the MCAT (Medical College Aptitude Test), and all the series of tests given medical students throughout their years of training. I would be the last to argue or standardized "board exams" or any of the exams I was subjected to are meaningful or well conceived, but that doesn't mean I agree that if Blacks were judged on the basis if "clinical excellence, collegiality, leadership skills [whatever that might mean in medicine] and problem solving skills, academic curiosity," this would result in more Blacks being selected for medical school, residency or fellowship programs.
Another quality Dr. Capers thinks should be weighed in choosing future doctors is "diversity competency" by which he means "potential for advocating for health equity in the field."
So now we have a sort of political test for doctors, which sounds vaguely familiar, as Soviet doctors who did not advocate for "the workers" or who were deemed insufficiently enthusiastic for advocating for the rights of the proletariat were relieved of their jobs and sent to Siberia.
The official bureaucracy Dr. Capers advocates, when brought down to the specifics sounds increasingly like something out of "Darkness at Noon:"
"Best practices for successful bias-mitigations trainings, advising that session be voluntary and recurrent, provide actionable tasks for participants, be framed with positive messaging ('it is human to be biased but we can overcome biases to treat everyone fairly' rather than 'you are racist') and be situated within an institutional framework for mitigating bias and enhancing diversity and inclusion. For medical school admission committees, these training could occur annually; faculty-selection committees could undergo training before nominating and rating candidates," says Dr. Capers.
Presumably, the short summary of this is: You better admit a lot more Black folks here or you're out!
So, the New England Journal of Medicine has lined up to advocate this brand of righteousness, and one can only imagine why.
But this is exactly the sort of advocacy which hands Tucker Carlson and Ron DeSantis their most cherished weapons: Look, now they are trying to put pilots into the cockpit who will crash your plane; they are trying to put surgeons into operating rooms because they are Black, not because they are good; they want your family doctor to be Black to fill some government quota!
Oh, you can imagine it all, and none of it is good.
One past chairman, who is White, of a department at Duke University Medical School, tells a story which illuminates the complexities, subtleties and difficulties of figuring out what "the Right Stuff" is in doctors and being able to identify it. He operated on his own private, unscientific theory of learning and character, but it strikes me, for all the amateur nature of his approach, it seemed to work.
One year he chose a candidate for his program who had been a tight end on an SEC football team. He was a big Black man, who was overlooked by other residency programs, perhaps because he had gone to a state medical school or perhaps because he was simply physically intimidating, or perhaps because he was Black. His standardized tests scores were not stellar. There were 90 applicants who scored better. But the chairman gave this guy one of the spots for which 100 other candidates from Harvard, Stanford, Hopkins and other elite medical schools had competed. The Chairman "took a chance."
He did this in part because he had a vague sense of dissatisfaction with the products of top medical schools he had selected previous years: these were men and women who had never had less than an A since elementary school, who had aced all their standardized exams, who had been at the top of their medical school classes. But, the chairman had noted, they were fragile when it came to being corrected.
"They'd never got anything wrong in their whole lives. Never dealt with failure, and they'd just fall apart when you'd point out if they had missed something."
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| Not the doc in this story, different guy |
"But this guy, this former football player, was used to being coached, to getting something wrong, getting corrected and the next time, he did not make that mistake again. So he starts off, first year maybe in the bottom third of his class here in the program. But I sit with him and show him stuff he's missed on this chest film, and he says, 'Oh, right! Yeah.' And he never misses that again. And by the second year, he's in the top 25% of his class and by the end of his third year, I'd say he was the best resident in our program by a country mile. He was just so 'coachable.' He'd made all the mistakes you can make, and you corrected them and he did not make them again, and, in fact, he got creative about seeing mistakes coming down the road and so you didn't even have to coach him about that. He was, more than once, mistaken by faculty members as a janitor, sitting there a big Black guy in scrubs, but he never took it personally. He'd sometimes just get up and empty a trash can, and shrug it off and go back to work. I'd take a dozen more like him, if I could find them."
Now THAT is affirmative action.
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