access to undergraduate higher education. Outreach programs and efforts targeted at segments of the population historically underrepresented in the sciences and health professions will be jeopardized, and highly successful programs such as the Robert Wood Johnson Medical Minority Education Program would likely decrease or cease to exist. Scholarship programs to address the financial needs of minority students also could be ruled illegal.

The Small Size of the Applicant Pool

Although affirmative action policies have provided a mechanism by which higher educational institutions can—or could—pursue diversity initiatives, the small size of the minority applicant pool in the health professions is a persistent challenge. By its nature, medical education in the United States is a graduate educational program. A requirement for all applicants is completion of the necessary premedical requirements, which for most prospective applicants means earning an undergraduate college degree. A review of the output of all U.S. undergraduate institutions shows that the likelihood that a person 18 years or older will obtain a college degree is 82 percent for whites, yet only 6.9 percent for African Americans and 4.5 percent for Hispanics (U.S. Department of Education, 2000). The admissions process at the nation’s most selective colleges and universities yields a class composed of 69.8 percent white students but only 6.3 percent African Americans and 5.5 percent Hispanics (IPEDS, 1999). These long-standing disparities in educational opportunity and achievement ensure that many of the nation’s poor and minority students will disproportionately fail to achieve entrance to medical school in proportion to their representation in society.

The term “underrepresented minority” (URM) has been used by the AAMC since the early 1970s to define minority groups excluded from participation in the medical profession through societal discriminatory practices. To date, the four groups recognized as URMs include African Americans or blacks, Mexican Americans, Native Americans (American Indians, Alaskan Natives, and native Hawaiians), and mainland Puerto Ricans. Changes in the racial and ethnic demography of the United States over the past three decades have motivated the AAMC to look again at this definition. Because eligibility for participation in minority enrichment programs sponsored by the AAMC is tied to this definition, alternative guidelines have been established by the federal government that define how race and ethnicity information is collected. Concern about the admissions practices of medical schools created by recent attacks on affirmative action increases the urgency for a new definition.

DHHS recognizes underrepresented minorities as “racial and ethnic populations that are underrepresented in the health profession relative to



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