Black US medical-school matriculation declined 11.6 percent between the 2023-2024 and 2024-2025 academic years following the June 2023 Supreme Court decision in Students for Fair Admissions v. Harvard, with Hispanic MD matriculation declining 10.8 percent in the same window (Florescu et al., JAMA Network Open 2025; PMID 41071546). Underrepresented-in-medicine matriculants fell from 4,466 (24.39 percent of total matriculants) to 3,963 (20.83 percent), a loss of 503 URiM matriculants in 2024, and Black applicants experienced a 2.98 percentage-point acceptance-rate decline relative to pre-ruling cycles (Nguyen et al., JAMA Network Open 2025; PMID 40857005).
That is the first-cycle measurement, not a transition figure. The downstream effect compounds across the four-year medical school cycle plus the three-to-seven-year residency window. A Black student who would have matriculated in 2024-2025 graduates around 2028-2029 and enters independent practice around 2031-2035 depending on specialty and fellowship. The 11.6 percent first-cycle Black matriculation loss thus shapes the supply of Black clinicians available to a 2026 reader looking for a Black doctor or therapist or OB-GYN somewhere in the 2030 to 2035 window.
Three distinct measurements, not one
The peer-reviewed evidence base supports three separate findings about the SFFA-ruling effect. The piece carries them as separate measurements rather than collapsing them into a single number.
Matriculation count change. The Florescu 2025 study analyzed five US medical-school admissions cycles (2020 to 2025), with four pre-ruling and one post-ruling, drawing on AAMC and AACOM publicly available data. The 11.6 percent Black MD matriculation decline between 2023-2024 and 2024-2025 was the largest race-specific drop in the analysis, and was statistically significant at the strictest conventional thresholds (PMID 41071546). Hispanic MD matriculation declined 10.8 percent in the same cycle. DO programs showed broader underrepresentation across all racial groups except White and Asian.
URiM share of total matriculants. The Nguyen 2025 study analyzed 291,764 applicants across 2019 to 2024 admissions cycles. URiM students dropped from 4,466 matriculants (24.39 percent of total) to 3,963 (20.83 percent), a loss of 503 URiM matriculants in 2024 alone (PMID 40857005). Total matriculation actually grew slightly between 2023 and 2024 (18,304 mean to 19,018), so the URiM share decline reflects a redistribution of matriculation seats, not a contraction in the overall class size.
Black applicant acceptance-rate decline. The Nguyen 2025 paper also reports a 2.98 percentage-point decline in Black-applicant acceptance rates relative to pre-ruling cycles. The authors describe this as "an emergent disparity in acceptance rates of URiM applicants relative to Asian and White students." The acceptance-rate measurement is distinct from the matriculation-count measurement because applicant volume also shifted; the acceptance-rate finding isolates the admissions-decision change from any concurrent applicant-pool composition shift.
What the SFFA ruling actually held
The June 29, 2023 Supreme Court decision in Students for Fair Admissions v. Harvard held that the race-based admissions practices at Harvard College and the University of North Carolina violated the Equal Protection Clause of the Fourteenth Amendment (SCOTUS opinion 20-1199). The Court did not categorically prohibit consideration of race in admissions; it restricted the prior race-conscious-admissions framework that had been operative under Grutter v. Bollinger (2003).
The 2025 JAMA Network Open papers measure the downstream effect of that legal-policy shift on medical-school admissions specifically. Both studies are observational and cross-sectional; neither could randomize. They cannot prove the SFFA ruling caused the matriculation decline at the level of a controlled experiment. What they can do is establish the magnitude of the change in the first post-ruling cycle and put it in the context of the four prior pre-ruling cycles' baselines.
The cross-piece cascade for any Factory 3 directory reader
Every Factory 3 directory piece on this site rests on an implicit assumption about Black-physician supply. Our piece on why finding a Black doctor is harder than it should be covers the workforce numbers behind the search difficulty. Our piece on how to find a Black OB-GYN and piece on how to find a Black therapist both walk readers through directories that index a clinician supply assumed to be stable or growing.
The 11.6 percent Black MD matriculation decline alters that assumption with measurable peer-reviewed evidence. If the trend persists through subsequent cycles, the pipeline shrinkage compounds: a 503-student first-cycle loss becomes a multi-year aggregate loss; the multi-year aggregate loss becomes the Black-physician supply available to readers in the 2030 to 2035 window. The directory pieces remain useful (there are real Black clinicians in practice today and the directories index them), but the search difficulty those pieces describe is poised to deepen rather than ease.
The peer-reviewed framework on physician-patient race concordance is itself contested. Our coverage of the Greenwood-Borjas PNAS replication walks through the evidence on whether Black physicians produce different birth outcomes for Black newborns. The cross-piece point: pipeline shrinkage matters regardless of whether the contested-concordance literature ever resolves, because patient preferences for Black clinicians are well-documented in their own right and a smaller supply of Black clinicians forecloses a preference reader before any outcome question is settled.
Two named investigator voices on the post-ruling data
Dr. Mytien Nguyen, PhD, is in the Department of Immunobiology at Yale School of Medicine. She is the lead author on the Nguyen 2025 JAMA Network Open paper that reported the URiM matriculation share drop and the 2.98 percentage-point Black acceptance-rate decline.
Dr. Dowin Boatright, MD, MBA, MHS, is in the Department of Emergency Medicine at NYU Grossman School of Medicine. He is the senior author on the same Nguyen 2025 paper and a long-running investigator-voice on physician workforce diversity research.
An additional named expert at the academic-medicine-pipeline-policy level is queued for verification through Scout's research, including the long-standing public-facing role of Dr. Quinn Capers IV in admissions-diversity research across his prior appointments. The current institutional placement is pending direct-source confirmation.
What the data does not yet tell us
Three things the peer-reviewed record does not currently pin down. First, whether the 11.6 percent first-cycle Black MD matriculation decline is a one-time adjustment as schools recalibrated admissions processes, or the start of a sustained downward trajectory. Only multi-cycle data answers this; the 2025-2026 admissions data publishes through AAMC FACTS in fall 2026 and the 2026-2027 data in fall 2027.
Second, which specific admissions-policy changes at individual medical schools account for the largest portion of the matriculation effect. Florescu 2025 and Nguyen 2025 are AAMC-aggregate analyses; school-level disaggregation is the natural next-research question.
Third, whether the SFFA ruling's effect on Black-physician-pipeline cohorts will translate into measurable patient-care effects on Black-patient access in 2031 to 2035. The downstream measurement requires sustained workforce-tracking studies and patient-outcome studies in the next decade.
What you can do this week
Three concrete actions for a reader concerned about the Black-physician pipeline.
First, track the longitudinal data yourself. The Association of American Medical Colleges FACTS table publishes annual race-stratified counts of MD applicants, matriculants, and graduates. The 2025-2026 admissions cycle will publish in fall 2026; the 2026-2027 cycle in fall 2027. A reader can check whether the 11.6 percent first-cycle Black-MD decline holds, deepens, or reverses across subsequent cycles.
Second, support Black-physician-pipeline organizations. The Student National Medical Association (snma.org) runs medical-school recruitment, mentorship, and pipeline programs for Black premedical students, undergraduates, and high schoolers. Tour for Diversity in Medicine runs medical-school recruitment events at HBCUs and minority-serving institutions. Donations and time-volunteering directly affect the next admissions cycle's applicant pool.
Third, engage with state-level admissions policy. Some state legislatures and university systems have adopted admissions frameworks that the AAMC describes as "holistic review" in response to the SFFA ruling. Readers in states with public medical schools (Cal-system, UNC-system, University of Florida, University of Texas system, and others) can engage with the relevant state university system regents and state medical board appointment processes where the admissions policy is actually set.
Update plan
We will update this piece when the 2025-2026 admissions cycle data publishes through AAMC FACTS, when school-level disaggregation studies appear, when the queued named expert affiliation verifies, or when a sustained multi-cycle trajectory becomes visible. The peer-reviewed evidence base will not move on a four-week horizon; the longitudinal pipeline data will.
Citations
Florescu N, Lin A, Temucin S, Rae L. Affirmative Action Repeal and Racial and Ethnic Diversity in US Medical School Admissions. JAMA Network Open. 2025;8(10):e2535020. PMID 41071546.
Nguyen M, Hajduk AM, Fancher TL, et al. Medical School Admissions After the Supreme Court's 2023 Affirmative Action Ruling. JAMA Network Open. 2025;8(8):e2527008. PMID 40857005.
Students for Fair Admissions, Inc. v. President and Fellows of Harvard College, 600 U.S. ___ (2023). Supreme Court of the United States. supremecourt.gov.
Association of American Medical Colleges. FACTS: Applicants and Matriculants Data. aamc.org.
Malik Johnson is a senior staff writer covering Black health. Send tips to malik@blackhealth.org.
