Tackling the decline of Black students entering medical schools

Nationwide, fewer Black students enrolled in medical schools this year.

Dr. James E.K. Hildreth Sr., president and CEO of Meharry Medical College, is concerned about the drop in Black students enrolling in medical schools. He says medical schools need to take new approaches to ensure qualified Black students get opportunities to pursue careers in medicine.

The number of new Black enrollees in medical schools dropped by 11.6% in the 2024-25 academic year, according to figures from the Association of American Medical Colleges. The figures offer the first snapshot of the impact of a 2023 Supreme Court ruling that prohibits the use of race in college admissions.

James E.K. Hildreth Sr., MD, president and CEO of Meharry Medical College, worries about the disturbing decline in just one year. Meharry Medical College, based in Nashville, is one of the nation’s largest historically Black medical schools.

“Once the decision was made by the Supreme Court to do away with affirmative action, we expected this drop to occur, because we have discovered or learned that without proactive steps to ensure that minorities have a chance to gain admission to medical school, that this was going to happen,” Hildreth says.

Hildreth says that while he expected fewer Black students to enroll in medical school after the Supreme Court decision, he is surprised that it occurred so quickly.

“It is worse than we might have expected,” he says. “I mean, many, many medical schools have worked really hard to ensure that they're training a diverse healthcare workforce.”

In an interview with Chief Healthcare Executive®, Hildreth talks about the need to reverse that trend and the steps medical colleges must take to attract more Black students. He says it’s imperative to develop a more diverse physician workforce to improve public health. And he talks about the impact of Michael Bloomberg’s $600 million donation to Black medical schools.

While he is dismayed by recent developments, Hildreth says he is optimistic that these hurdles can be overcome.

• Read more: Why hospital boards need more diversity

DEI programs dissolved

Hildreth makes it clear that medical school students must be admitted on the basis of merit. But he says medical colleges must make sure they’re not turning away Black students with the potential to become superb doctors.

“I take issue with a lot of individuals who assume that when a minority student gets to medical school, they are less qualified and have taken a seat away from somebody who is qualified,” Hildreth says. “I can tell you most assuredly that here at Meharry. The students we admit are just as qualified to get into other medical schools as any other student would be. They choose us because of our mission.”

Hildreth is worried about the number of colleges that have shuttered their DEI offices, and he says that’s likely going to compound the difficulties in recruiting more Black medical students.

“It’s probably going to be a challenge, because in many cases, those individuals were the ones who had as their goals to make sure that minority students stayed encouraged, stayed on the path,” Hildreth says. “The rationale for eliminating these programs, as I understand it, is to declare that racism no longer exists, and that is patently false. We know it to be false. The evidence is very clear that racism still exists.”

With the Supreme Court ruling forcing colleges and universities to change their admissions policies, Hildreth worries about the long-term ramifications.

If fewer Black students enter undergraduate schools in the future, then medical schools will have a smaller pool of Black candidates. He’s also worried about funding cuts that could disrupt summer enrichment programs aimed at students interested in science and health care, which could also impact enrollment to medical colleges.

Hildreth is also concerned that the changes in enrollment policies in the wake of the Supreme Court decision could reduce the pool of Black men in medical school.

“You can't go to medical school unless you graduate from college and you've done well enough in your science courses, etc., to be competitive. And so the pipeline is one of the issues we're trying to deal with,” he says.

The low number of Black male students in medical schools frustrates Hildreth. He says studies have shown that Black men who don’t pass medical school exams on their first attempt are less likely to try again than other groups.

Meharry runs a program to bring high school students and undergraduate students to the medical school to try and encourage them to pursue careers in medicine.

“We're hoping to identify them early on, show them that it is possible for them, and make sure that they don't give up,” he says. “Part of it is just to keep them encouraged and keep them motivated to keep trying.”

Moving forward

In light of the Supreme Court ruling upending affirmative action, medical schools have to pursue new strategies to ensure they are recruiting diverse student bodies.

He says, “We have to take race out of the conversation, and focus on factors, such as, what disadvantage have you had to overcome?”

Medical schools can look at individuals who have come from families with lower incomes, or are the first in the family to attend college.

Hildreth says the answer is not simply looking at MCAT scores and transcripts. A student who had to work 20 hours a week and managed a 3.9 GPA could show more potential than a student who has a transcript full of A’s but didn’t have to get a job.

“If that's going to be the basis for admission, then of course, there are going to be challenges, just like we've seen in times past,” he says. “But you know, medical schools and admissions teams have discovered that performance on an MCAT or other similar tests does not predict how well a person will do as a physician or dentist or the health care provider.”

Institutions can also look at factors showing resilient and well-rounded students that could make superb physicians, he says.

“By taking a more holistic approach to evaluating candidates for medical school, I think we can overcome this problem,” Hildreth says. “It's going to take some years for that to sort of kick into place and start to show results.”

“And I do know that many medical schools around the country are starting to have that mindset about how we approach this,” he adds. “And the need for it is now apparently clear.”

Historic gift

Meharry received an unprecedented gift when Michael Bloomberg donated $175 million to the medical school, part of $600 million he donated to Black medical colleges.

“None of the four schools had ever received a gift of this size before,” Hildreth says. “And you know, Mr. Bloomberg was very specific in saying that he'd like the funds to be used to promote the training of minority physicians, knowing that a diverse workforce results in better outcomes for everybody.”

Meharry is investing the funds in the endowment and will be able to provide more financial aid to students in need.

“It's going to change our conversation with a lot of students who otherwise we will not be able to bring to Meharry,” he says. “So it is quite significant. We're hoping that this gift will validate the investment in our institutions.”

Hildreth also hopes that Bloomberg’s gift will also spur others to donate to Meharry, even if those contributions aren’t quite at the same size. And he says that it’s an indication that Meharry’s programs are comparable to other institutions.

“The gift was just amazing, and it's going to have a generational impact, and that's very exciting,” he says.

Hildreth hopes Bloomberg’s gift could also spur more medical students to pursue careers as primary care physicians.

Many students saddled with heavy medical debt opt for more lucrative careers in specialty medicine, but Hildreth says that he hopes the prospect of more aid could get some more students to look at primary care.

“The country needs tens of thousands of additional primary care physicians who represent the frontline of access to health care,” Hildreth says.

Maintaining optimism

When asked how he manages to remain optimistic, Hildreth smiles and talks about his obligations to Meharry’s students.

“One of the things that I'm trying to do, I'm trying really hard to do this, is to make sure that our students and our fellows and our trainees do not lose the passion and drive they bring to us to go out and change the world,” he says. “The worst thing that could happen would be for our students to fall into a state of despair and lose hope that the dream they had of being able to go and do the work that they've come to train for is not going to be possible for them.”

Hildreth says today’s medical school students have opportunities he’d never imagined decades ago.

“There's never been a more exciting time to think about becoming a physician,” he says. “When I was in medical school in the early 80s, there were some diagnoses for which we had no possibility of even thinking about curing them. That's totally changed. The tools available, the treatments available, the diagnostic methods available, are just so amazing now that I can't think of a more exciting time to think about going into medicine.”

Hildreth says he’s excited about the students he meets, and says he’s doing his best to keep them from being disillusioned.

“I think we'll get through this,” he says. “I really do.”