Affirmative Action in Medicine: Improving Health Care for Everyone
http://www.100md.com
《新英格兰医药杂志》
This unique and superbly accomplished contribution to the understanding of race, ethnic background, class, and opportunity in medicine was written before the Supreme Court's landmark decision in June 2003 preserving affirmative action at the University of Michigan Law School (and, by implication, at all institutions of graduate professional education). But this book presents a far bolder, broader, and more powerful argument for the defense of this still fiercely debated policy than that expressed in Justice Sandra Day O'Connor's majority opinion, which rested almost entirely on the educationally and socially enriching benefits of diversity in the student body. Instead, James L. Curtis maintains that affirmative action is needed not merely to remedy the legacy of racial segregation and exclusion from professional training, and not merely for the good of minorities, but that it is an essential part of the effort to create a more equitable American society and (as the subtitle declares) to improve the health care of everyone. "Affirmative action," Curtis asserts,
represents a recent attempt to overcome the enduring system of color caste that continues to blight the lives of all Americans. . . . [It] is a deliberate race-conscious recruitment goal designed to equalize access within a set time frame to . . . professions such as medicine from which Blacks have been unfairly excluded for many generations. . . . Affirmative action admission programs may represent the best available social policy to achieve a greater degree of fairness and justice within a racially segregated society . . . [and] provide the best means of educating future physicians to care for patients without regard to ethnicity.
Affirmative Action in Medicine, then, rests on two premises. The first is that such programs must always be considered in the context of ongoing and persistent — not merely historical — racial and class inequities. The second is that admission to medical school and other institutions of postgraduate training is a social good — not just a prized award to individuals but a response to public need.
Identifying these principles, which are the moral core of the book, should not suggest, however, that the book is just another rhetorical exercise. This is arguably the best book that has ever been written on this complex problem. It is a candid, thoughtful, and balanced assessment of the progress of (and assaults on) affirmative-action programs over the past 30 years, following up on Curtis's 1971 review of the same issues. It combines the personal experience, knowledge, and historical perspective of a pioneer who has been directly involved in these struggles for more than 50 years with a meticulously researched and hugely informative presentation of the relevant data. The book includes an important new contribution, which is a study of the medical careers of some 2109 medical school graduates who were members of minority groups and a randomly sampled, approximately equal number of non–minority-group graduates. Curtis includes such data as their family origins, medical schools, residency and specialty choices, practice locations, and characteristics several decades later, in 1994, as well as some of the factors that influenced these variables, not least among them, residential segregation.
In 1947, there were only 588 black students in U.S. medical schools — 2.7 percent of the total — and only 16 percent of them were in predominantly white schools. Medical education was effectively segregated. By 1997, there were 5303, or almost 8 percent of the total (though this was still short of population-based representation), and 87 percent of them were enrolled in such schools. Curtis explores the successes and failures of these decades and explains the current burden of inferior (and still often segregated) elementary and high-school education available to members of minority groups. In a remarkably candid description of what really goes on in the admissions process, he describes his own successful efforts to create an effective affirmative-action program at one mainstream medical school. His analysis of the two graduating cohorts documents once again the enormous importance of physicians who are members of minorities to the public's health. Readers who seek further relevant data can consult the Institute of Medicine's recent publication The Right Thing to Do, the Smart Thing to Do: Enhancing Diversity in the Health Professions (2001). What makes Affirmative Action in Medicine uniquely useful, for proponents and critics alike, is its combination of historical sweep, personal perspective, rich documentation, and unflinching advocacy.
H. Jack Geiger, M.D.
City University of New York Medical School
New York, NY 10031
jgeiger@igc.org(By James L. Curtis. 237 p)
represents a recent attempt to overcome the enduring system of color caste that continues to blight the lives of all Americans. . . . [It] is a deliberate race-conscious recruitment goal designed to equalize access within a set time frame to . . . professions such as medicine from which Blacks have been unfairly excluded for many generations. . . . Affirmative action admission programs may represent the best available social policy to achieve a greater degree of fairness and justice within a racially segregated society . . . [and] provide the best means of educating future physicians to care for patients without regard to ethnicity.
Affirmative Action in Medicine, then, rests on two premises. The first is that such programs must always be considered in the context of ongoing and persistent — not merely historical — racial and class inequities. The second is that admission to medical school and other institutions of postgraduate training is a social good — not just a prized award to individuals but a response to public need.
Identifying these principles, which are the moral core of the book, should not suggest, however, that the book is just another rhetorical exercise. This is arguably the best book that has ever been written on this complex problem. It is a candid, thoughtful, and balanced assessment of the progress of (and assaults on) affirmative-action programs over the past 30 years, following up on Curtis's 1971 review of the same issues. It combines the personal experience, knowledge, and historical perspective of a pioneer who has been directly involved in these struggles for more than 50 years with a meticulously researched and hugely informative presentation of the relevant data. The book includes an important new contribution, which is a study of the medical careers of some 2109 medical school graduates who were members of minority groups and a randomly sampled, approximately equal number of non–minority-group graduates. Curtis includes such data as their family origins, medical schools, residency and specialty choices, practice locations, and characteristics several decades later, in 1994, as well as some of the factors that influenced these variables, not least among them, residential segregation.
In 1947, there were only 588 black students in U.S. medical schools — 2.7 percent of the total — and only 16 percent of them were in predominantly white schools. Medical education was effectively segregated. By 1997, there were 5303, or almost 8 percent of the total (though this was still short of population-based representation), and 87 percent of them were enrolled in such schools. Curtis explores the successes and failures of these decades and explains the current burden of inferior (and still often segregated) elementary and high-school education available to members of minority groups. In a remarkably candid description of what really goes on in the admissions process, he describes his own successful efforts to create an effective affirmative-action program at one mainstream medical school. His analysis of the two graduating cohorts documents once again the enormous importance of physicians who are members of minorities to the public's health. Readers who seek further relevant data can consult the Institute of Medicine's recent publication The Right Thing to Do, the Smart Thing to Do: Enhancing Diversity in the Health Professions (2001). What makes Affirmative Action in Medicine uniquely useful, for proponents and critics alike, is its combination of historical sweep, personal perspective, rich documentation, and unflinching advocacy.
H. Jack Geiger, M.D.
City University of New York Medical School
New York, NY 10031
jgeiger@igc.org(By James L. Curtis. 237 p)