Publications

California's 1996 Proposition 209 prohibits the use of affirmative action – the practice of considering an individuals’ race, sex, color, ethnicity or national origin – in public education, employment and contracting. This brief expands on previous studies that analyzed the impact of Proposition 209 on the racial/ethnic diversity of applicants and matriculants to California medical schools. While there has some been some recovery of losses in Latinx and Black/African American matriculants over the last 30 years, progress has been limited. The authors offer several recommendations from the California Future Health Workforce Commission for key investments to increase racial/ethnic diversity in California medical schools, which will yield a greater number of physicians who represent the state’s diverse population and will enable California to achieve greater health equity for all. Key findings from this brief:

• The absolute number of Latinx medical student matriculants to California medical schools decreased from 113 (1990) to a low of 92 (1997) immediately following the enactment of Proposition 209 and then increased over time to 200 (2019). UC medical schools accounted for the majority of growth in Latinx matriculants. 
• The proportion of Latinx matriculants in California’s medical schools increased from 11% (1990) to 14% (2019) with a peak of 17% in 2016. This overall increase was preceded by a low of 9%, following the enactment of Proposition 209. 
• Because the Latinx population of California grew tremendously during these 30 years, from 26% (1990) to 39% (2019) of the population, the number of Latinx medical students has fallen further behind the numbers needed to provide ethnically concordant care.
• Matriculation patterns for Black/African American students are similar to those of Latinx students: a growth in absolute number of medical students, from 63 (1990) to 121 (2019), yet only a modest change in the proportion of medical school matriculants overall, moving from 6% (1990) to 8% (2019), with a post-Proposition 209 high of 9% from 2014 through 2016. 
• Black/African American matriculation increased primarily in the UC medical schools. In California’s private medical schools, the proportion of Black/African American students matriculating fell over the 30-year period, from 6% (1990) to 5% (2019). 
• Overall, our analyses indicate that over the last 30 years, there has been insufficient progress in achieving the required level of diversity within California’s medical schools to meet the needs of California’s diverse population (Figure 1).

Figure 1. Growth in California Population and Medical School Matriculants, 1990 – 2019