This story is from The Pulse, a weekly health and science podcast.
In 1989, sociologist Tim Ready was perusing the Washington Post, when he came across a job ad that would change his life. It was from the Association of American Medical Colleges, or AAMC — a hugely influential group in the world of academic medicine that represents the interests of medical schools and facilitates the application process to both med schools and residencies.
AAMC was looking for someone to help with a project to increase diversity in med schools. Ready didn’t have a background in medicine, but he did have experience researching race-related disparities and effective educational programs serving diverse and economically disadvantaged students.
“Most of my work had had to do with diversity and social justice, social determinants of health, and looking at issues of discrimination and injustice and how that affects stressors,” he said.
Ready had spent the previous few years studying the impact of injustice and discrimination on the health of high school kids of color in South Texas.
“I saw, despite the aspirations of the Mexican American kids, wanting to go to college and essentially wanting the same American dream, there were lots of barriers getting in the way and schools seem to be sorting out who gets opportunity and who doesn’t, rather than giving opportunity.”
Ready had been raised on the civil rights movement, including President Lyndon Johnson’s Great Society programs of the 1960s, which placed education at the center of a campaign to eliminate poverty and racial injustice.
“Schools were supposed to be the great equalizer, and they weren’t working that way,” Ready said.
It was a cause Ready was hungry to work on, so when he spotted AAMC’s classified ad, he jumped on it — and was promptly hired.
“Little did I know that it would lead to me having the opportunity to design and direct the national diversity campaign for the 126 medical schools in the country during the 1990s,” he said.
Ready was hired by Herbert Nickens, who directed all of the AAMC’s diversity programming, and with whom Ready worked closely.
The push for progress
The job was part of an initiative launched by the AAMC’s president at the time, Robert Petersdorf — who, according to Ready, had decided that med schools had to do something once and for all about how few students of color they were training.
Ready recalls Petersdorf, who died in 2006, saying, “‘This can’t go on. We need to change this trajectory of worsening under-representation.'”
The problem had deep roots. Prior to 1968, Ready said, medicine in the U.S. was a mostly white affair, with the majority of Black doctors training at historically Black medical schools.
“We didn’t use the word at the time, but it was something pretty close to apartheid in medical education.”
Then came the civil rights movement, and in 1968 the assassination of Dr. Martin Luther King Jr.
“That’s really when medical schools got serious about promoting diversity,” Ready said. “There was this big spurt of activity and improvement.”
The focus, especially in academic circles, was on “underrepresented minorities” — defined as students who were Black, Mexican American, mainland Puerto Rican, or Native American (though in later years, the term would come to include other groups as well.)
Across the country, medical schools established offices of minority affairs, started summer programs for students who were interested in medicine, and started using affirmative action as part of their admissions process. Pretty quickly, they saw a jump in the number of enrolled “underrepresented minorities” from 2% of the medical school population to 9%.
“It was a pretty significant gain, but there was still very significant under-representation of those groups relative to the size of the population,” Ready said.
Forging pipeline programs
As America grew more diverse, medical schools didn’t. By the 1970s, their progress had flatlined — so much so, that in 1978, another task force at the AAMC wrote a report on it.
The report’s conclusion: that medical schools couldn’t solve this problem alone. Instead, they needed to join forces with local colleges and school districts, to forge an academic pipeline that would help shepherd more Black and brown students into medicine.
“That was a great report,” Ready said. “Unfortunately, it wasn’t implemented.”
By the 1990s, progress on increasing diversity had completely stalled. But for Ready, the report played an important role — it told him that if a solution existed, it needed to start early.
“We strongly believe that there was just no way in the world that we were going to reach our goal of parity in actual medical students without doing work to build the pipeline,” Ready said.
The goal wasn’t just improvement, it was parity — which at that time meant enrolling 3,000 Black and brown medical students every year. But that would be a tall order: In 1989, fewer than 3,000 Black and brown students had even applied for medical school.
Ready had his work cut out for him. He ended up spending almost a year doing research to figure out which strategies would work, and which wouldn’t. He traveled around the country visiting the medical schools that had the most students of color, to see what it was they were doing right.
What he found were budding programs — early education initiatives that reached back to high school or earlier. There was Gateway to Higher Education and Bridge to Medicine — science-focused magnet schools in low-income areas that had partnered with medical schools to basically serve as feeder programs.
Once they had all the research, Ready and his colleagues carved it into an ambitious 10-year plan called “3000 by 2000.” The name was a reference to the project’s ultimate goal: to enroll a class containing at least 3,000 students of color by the year 2000.
The name was emblematic of the project’s pragmatic, data-centered approach.
“It was very kind of no-nonsense,” Ready said. “Let’s really measure this and accomplish it, and just not make this happy talk or vague conversations about, ‘Diversity is great.’ Let’s do specific stuff to make it happen. And that’s the plan that we tried to lay out.”
Ready even wrote up instruction manuals for medical schools, complete with local data that they could use to develop their own pipeline programs.
Launching 3000 by 2000
AAMC president Petersdorf announced the project in 1991, in four meetings with medical school deans from across the country.
“I mean, this was a pretty gutsy thing,” Ready said. “He said, ‘Deans’ — these incredibly powerful people who run these massive institutions — ‘show up at this meeting, and we’re going to talk to you about diversity,’ and by God, they came.”
The next few years were a whirlwind of activity. Medical schools succeeded in helping to set up magnet schools and other early education programs across the country. They also started using articulation agreements — promises between med schools, colleges, and high schools that students who reached a certain academic level would be guaranteed admission.
And almost right away, they saw a jump in the number of Black and brown matriculants, from fewer than 1,500 students in 1990 to more than 2,000 in 1995.
“At its peak, we increased the number of underrepresented students entering medical school by 37% from our starting point,” Ready said.
Then, in the mid-1990s, something happened that stopped that progress in its tracks: legal challenges to affirmative action.
Back in 1978, the U.S. Supreme Court had upheld the use of race as a factor in admissions. Colleges, law schools, med schools — they could all take race into consideration, though the ruling barred the use of explicit quotas.
More challenges erupted in the mid-’90s — in particular, a federal court case called Hopwood v. Texas, in which four white law students challenged the University of Texas Law School’s use of affirmative action and won. This time, the U.S. Supreme Court declined to hear the case, which meant that the ruling became law in Texas, Louisiana, and Mississippi. California, meanwhile, passed a referendum outlawing the use of affirmative action by state governmental institutions.
The reverberations went farther than those four states — the attacks on affirmative action had a chilling effect on schools in the rest of the country. Basically, no one wanted to get sued.
A devastating blow
The political shift had a disastrous effect on 3000 by 2000, said Jordan Cohen, who was president of the AAMC from 1994 to 2006.
“We were right on track to make that goal of 3,000 matriculants by the year 2000,” Cohen said. “As soon as that anti-affirmative action movement took root and began to be very successful in limiting, legally, the ability to use this tool, our progress towards that goal of 3000 by 2000 was abruptly aborted.”
Ready said the shift was especially harmful to the project’s data-centered, results-driven approach.
“One unfortunate effect of the attacks on affirmative action is that institutions seemed to become less willing to quantify their progress and activities for fear that it would be interpreted as being driven by quotas,” Ready said.
Many did remain committed to their early education programs and partnerships, Ready said, even incorporating early educational outreach programming as criteria for medical school accreditation in 2000.
“But, in my opinion, they drifted away from the sharp focus on producing results,” Ready said. “It seemed to me that as time went on, doing it became more important than doing it to produce positive results with regard to URM [underrepresented minority] applicants and matriculants.”
The result was that the project never reached its full potential. After a quick increase in Black and brown students, from 1,486 in 1990 to 2,047 in 1995 according to Ready’s data, the numbers crept back down. When the project finished in 2000, it fell roughly 700 students short of its goal, according to numbers provided by the AAMC.
“It was a great disappointment that we were unable to make the goal that was set out,” Cohen said. “If anything — at least in my mind — it reinforced the urgency of finding ways in which we could influence this in the future.”
The problem, Cohen said, goes beyond medical schools — and so should the solution.
The project ended without much fanfare, and Ready’s proposal for a follow-up project was rejected. So he ended up leaving the AAMC.
“I felt sad, but I thought that it was time for somebody else to carry the ball,” Ready said. “And maybe they have better ideas, maybe they don’t. But I think my ideas and my time had kind of run its course.
The legacy of 3000 by 2000
But that doesn’t mean 3000 by 2000 didn’t leave its mark.
Norma Poll-Hunter, the senior director leading workforce diversity at AAMC, said the project did a lot: It helped spark pipeline programs and articulation agreements; maybe most important, it raised awareness in a major way.
“It galvanized the national community to really double down and address this issue of underrepresentation,” Poll-Hunter said.
“It was, as far as I know, the first explicit recognition that this was a major problem that was facing American medicine, and that we had an obligation to do what we could to try to solve it,” Cohen said.
For Ready, the legacy is a living one — one that has popped up again and again, especially recently.
“You know, looking at all the health news on television these days, and COVID, and you see African American physicians and scientists speaking up,” Ready said. “The system wasn’t working in a way that enabled a lot of those people from those underrepresented groups to be able to do that before. And I think we at least played some small role in changing the playing field so that it was a little bit more level.”