LAUSR

In 2021, the number of matriculating Black and Hispanic medical students in the US was the highest it has ever been.1 Several contributing factors may explain this shift. Very visible health and health care inequities during the COVID-19 pandemic may have encouraged medical schools to actively recruit students underrepresented in medicine (UIM), including American Indian, Black, and Hispanic students.2 These same circumstances may have encouraged UIM students to pursue careers in medicine. Additionally, the de-emphasis of standardized testing in the medical education pathway may have made medicine more appealing to groups traditionally disadvantaged by standardized testing.3 Regardless of the reasons, this demographic shift in matriculating students is a welcome one, given evidence that racial concordance between patient and physician is associated with improved patient outcomes,4,5 studies have shown that UIM trainees are more likely to establish practice in underserved areas,6,7 and according to the Association of American Medical Colleges (AAMC), more than two-thirds of increases in physician demand over the next 15 years will be driven by racially and ethnically minoritized populations, such as American Indian, Black, and Hispanic patients.8 However, in their qualitative study of the experiences of premedical students during the COVID-19 pandemic at Historically Black Colleges and Universities (HBCUs), Weiss et al9 raise important concerns regarding ongoing threats to pathways programming. Prehealth advisors at these institutions perceived 3 types of COVID-19–related difficulties faced by HBCU students that could negatively influence students’ academic progress: balancing academic responsibilities with family needs associated with the pandemic; distraction, disruption, and isolation in the virtual learning environment; and the uncertain and evolving requirements of the medical school application process. Weiss et al9 point out that these difficulties have disproportionately affected HBCU students due to racial disparities in COVID-19–related morbidity and mortality in the Black community10 and exacerbation of what students have perceived to be a prepandemic lack of mentorship opportunities, institutional support, and shadowing opportunities at HBCUs.11 As an individual investigation, the study by Weiss et al9 is significant because HCBUs produce 25% of all Black graduates earning degrees in science, technology, engineering, and medicine.12 In addition, their study joins other important studies contributing to an evolving understanding of the role of COVID-19 in the pathways continuum and the growing need for workforce diversity efforts. This understanding has grown more robust over the last year and now warrants action. First, the pandemic has exacerbated health and health care disparities. Nationwide, Asian, Black, and Hispanic patients have experienced all-cause excess mortality that is as much as 4-fold that experienced by White patients.13 Furthermore, changes in life expectancy have been significant in many parts of the country. In Chicago, Illinois, Latinx residents have lost 7 years in their life expectancy since 2012.14 The life expectancy gap between Black and White residents in Chicago has increased by 10 years since 2012, with life expectancy among Black residents now less than 70 years for the first time in decades.15 COVID-19 has served to amplify the impact of long-established disparities in access to and quality of health care among US racially and ethnically minoritized groups. Second, the pandemic has adversely affected efforts to sustain pathways designed to improve physician workforce diversity. Support for pathways programs (formerly known as pipeline programs) that recruit and support UIM trainees have stalled during the pandemic due to public health precautions and institutional financial strains.16 + Related article