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Affirmative Action in Medicine: Improving Health Care for Everyone (review)

It is hard to think of a more contentious social and political issue of the late decades of the twentieth century than affirmative action, whose history in the United States is long and intense. Dr. James Curtis now updates his 1971 book Blacks, Medical Schools, and Society by describing thirty years of progress and problems in the nation’s medical schools. Curtis is especially well qualified to write about this subject: now a psychiatrist, he was the lone black student in his class in the 1940s at the University of Michigan Medical School. He was recruited by Cornell University in 1968 to run a program for minority students, a position he held until 1980. As an observer of American medical school admissions for more than three decades, but more importantly, as a direct participant, he is in an ideal position to chronicle the history of minority admissions during these eventful decades. The main subject of this important book is the unsuccessful effort of the Association of American Medical Colleges to raise the number of minority medical students in American medical schools. The Association’s first goal was to have minorities make up 12 percent of all medical students by 1975. In 1990, it set another goal, of admitting three thousand minority students to medical school each year starting in the year 2000. Curtis discusses both the failure of the AAMC to achieve these goals and the progress it made in reaching toward them. The first part of the book includes a detailed discussion of the history of affirmative action in American medical schools. In the second part, Curtis compares two thousand minority students who graduated from medical schools between 1973 and 1977 with an equal number of randomly selected nonminority students in these years. Here he discusses graduate medical education and specialty choices. With a few major exceptions, such as the Universities of California, Michigan, and Wisconsin, more progress could be seen in the private universities, as well as in the large city hospitals with historic missions to serve the poor, than in the public or state universities. Finally, Curtis follows his cohort out thirty years, and he is guardedly optimistic about the future. With this extensive study, and with the publication of Thomas Ward’s Black Physicians in the Jim Crow South,1 we now have a clearer picture of what is happening to one of the key social issues that affect both doctors and patients in the United States.