- [Mark] I started the University of Washington School of Medicine in 1986.

And because it was a state school I made the assumption that it would be diverse.

One of the things I was sort of looking forward to was being in a place where there would be more African-Americans, more minority students.

The very first day of class we're all in the class and there must be 170 of us.

And there were no African-Americans at all.

And I actually remember going to what was then a minority affairs office for the school and I actually asked, "Am I really the only African-American in the EAD six class?"

The person there so that, got this chagrined look on her face and looked down and says, "Yes, you are."

I said, "Oh, okay.

Now, I know.

I'll deal with it."

But I was, I was shocked.

(upbeat music) - [Narrator] It's been over 30 years since Mark Snowden graduated from medical school.

And a lot has changed since then.

(camera clicks) But a lot hasn't.

Our medical schools are still struggling to enroll a diverse class of students.

In nearly four decades, the needle has only budged a few percentage points.

David Acosta leads diversity efforts at the Association of American Medical Colleges.

They analyze the demographics of med school applicants from 1980 to 2016.

- [David] We saw pretty large disparities and gaps with regards to certain population groups considered to be historically excluded and underrepresented in medicine.

When you start looking at African-Americans or black students, percentage wise, they made up 7% of the total applicants to medical school in 1980 and only 8.2% in 2016 - [Narrator] We've added in the latest year for comparison.

Latinos also had just over a 1% increase while numbers for American Indian and Alaska natives actually got worse.

- [David] There was only a 156 applications to medical school in 1980.

And in 2016, they actually went down to only 127.

- [Narrator] And in 2020, the latest year we have data from 73 applications.

Our medical schools have become more diverse, but much more slowly than the nation as a whole.

Underrepresented communities in the US grew from about 20% of the population in 1980 to 32% in 2020.

But during that same time, the number of underrepresented students entering medical school, lagged far behind.

So what's happened in the past 40 years that's held up progress?

- We'd like you to join in our discussion on education Mr. Caller from Raytown, Missouri.

- [Caller] Hello.

I was wanting to talk about affirmative action.

- [Narrator] In the late 1990s and 2000s, many States passed anti-affirmative action laws modeled after California's Prop 209.

It prohibited state government institutions from considering race, sex, ethnicity, or national origin when it came to employment and public education.

Washington voters passed I-200 in 1998.

- [Mark] Initiative 200 really said that you could not show preferential consideration for the admission of students of color.

You could do things to increase the applicants but when it came to deciding who got into the school and who did not, you couldn't use race and ethnicity as one of those deciding factors.

It made it really hard.

I mean, there were other places in the country where minority students can go and get scholarships specifically designed for minority students.

You couldn't really do that here.

- [Leslie] It was devastating to diversity.

I know people who actually went to school here in the 80's and they come back to reunion and say that it's less diverse now.

- [Narrator] Advocates say affirmative action policies are important to level the playing field.

Black and Hispanic households often have much lower incomes than white or Asian households, which means that an expensive medical school education is often out of reach.

Affirmative action also takes into account that not everyone has access to the support systems and preparation needed to be academically competitive from test prep to AP classes.

- It's hard to make up gaps that exist.

The kinds of gaps that students can have.

And it's not for lack of talent or ability, it's for lack of opportunity.

The problem that we face is structural.

We sit at the very tippy top end of higher education and we rely on all the different levels of the educational system to provide us with a prepared and diverse student pool.

It starts way before med school, depending on your school district, the zip code where you live, you are going to have access to higher or lower quality education.

What we need is a much larger pool of prepared students who are coming from currently underserved and underrepresented communities.

And that means strengthening K through 12, and even pre-K. That means supporting families.

It means providing better education better teachers, better resources.

- [Narrator] Many places try to make up the difference by creating enrichment programs to make med school more accessible.

These efforts help, but it's a long-term strategy.

- [Leslie] People say let's work on a pipeline but you have to work on the people that are coming through now too.

Programs are fine and you'll find that there are 20 people here that get to move ahead or this person hired three more African-Americans but that's not really what diversity is and inclusion is.

We've got to go beyond programs and change the game.

You know, change the rules.

- [Mark] We've got to look at what do we do in admissions.

- [Layla] Traditionally, in medical school admissions the metrics can carry greater weight than looking at an applicant characteristics or their life experiences.

- [Narrator] Layla Harrison is a Dean of admissions at Washington State University School of Medicine.

It was founded in 2015 and graduates its first class this year.

- When we overemphasize metrics we might leave behind first-generation college graduates or students that come from low socioeconomic backgrounds or students that are in marginalized groups we're going to miss applicants who very much would have made it through your medical program, but they were overlooked.

- [Leslie] It's very ingrained to look at the tests and not so ingrained to look at, "Well, where has this person begun?"

You know, where are they coming from?

What have they done?

Maybe they had a job instead of going to work for the World Health Organization.

When you see those things layer out by race that means that they are inherently biased.

And I think education is fine but there also is a point where you just change the rules.

- [Narrator] In 2016, Leslie Walker Harding was working at Penn State Children's Hospital overseeing their residency programs for recent graduates entering the field.

- [Leslie] We changed how we ranked our residence.

Life experience came up higher.

We went from having zero percent African-Americans and underrepresented minorities to 28% in one year.

And it was sustained the next year.

We just changed completely how we looked at, how we were ranking people.

I don't believe that things take years to change.

It takes leadership, deciding that it's important and then saying the rules are changing and this is what I expect.

We just have to open the door.

If we open the door, we will see a change.

(upbeat music) - [Narrator] This series is made possible in part by the generous support of Premera Blue Cross.