I spent a long time contemplating what to write and how to phrase it. I wrote this with a lot of emotion but also tried to include hard evidence to call out what every institution is guilty of.

While I did not apply here because they don’t fit my research interests, I have been looking into the admissions statistics of schools MD-PhD programs. Schools like Duke. Earlier this year I came across their 2020 MSTP data. As I scrolled through the data I was shocked by how much transparency there was at this institution. My pleasant shock turned into horror when I looked at the application —> interview —> offer —> matriculation data. My heart sank when I saw that the percentage of URM applicants was not only incredibly small but that ZERO URMs matriculated.

When I checked on this data today, I was not able to find the same webpage on Google. I scrolled through my bookmarks to find the link I saved months prior and when I clicked on it, I was met with a “404 Page Not Found” message. I had to use an archive website to find the data once more. It never ceases to amaze me to what length institutions like this go to not only prevent URM students from reaching their programs (via systemic racism, unrealistic expectations, etc.) but also the length to which they will cover the evidence of such biases. There is no reason why an institution like Duke should matriculate zero URMs into their MSTP.

I figure that many of you will play devil’s advocate and/or not have experienced the hell that is being a URM pre-med/MD-PhD applicant. I can’t blame you. This process trains us to consider every side of the picture. Yet if we are not careful, we may overlook critical details and write it off as “coincidence” - which one can argue is part of the goal (there is an article related to this somewhere).

1. “But it’s December. So of course they’ll take down their old data to make way for the new” - while this makes sense logically it misses the point that the MD program’s data is still posted on their page.

2. “Well, they admitted URMs and they chose not to attend so that’s not their fault” - Yes, but it’s more complex than that. First, let’s do some math. Duke’s MSTP received 459 applications. Of that, 15% were URM. This means that about 68 applicants were URM (which is wild in and of itself). Of that, 65 applicants were invited to interview. 14% of them were URM —> so about 9 applicants. The data from here gets a bit murky and to be honest this data is presented in a convoluted manner. But 15% of the interviewees admitted were URM —> about 1 URM applicant. That’s all. Ultimately that student chose to attend another institution.

I also did the math by ONLY using the pie charts (starting with that raw number of 459) and it still boiled down to approximately 1 URM being admitted. The odds of this one applicant matriculating is a lot for the institution to ride on. For any MSTP to ride on. This leads me to my next point.

1. “Well…there just weren’t any other qualified URM applicants” - This is a trope that has been toted heavily in academia, medicine, and STEM. It is rooted in URMs always being perceived as “underqualified”. This is blatantly false. How do I know? I know based on me and my friends’ experiences across multiple institutions - constantly being told to drop pre-med or our STEM majors, discovering our exams were not graded fairly compared to our peers, being told to drop out of classes while our non-URM peers who perform worse academically are not given the same advice but instead encouraged and provided with resources and support from professors. It is the microaggressions from peers, professors, Deans, premed advisors, PIs, etc. It is being overlooked for programs or sabotaged by premed committees. It is us being held to a different standard than our peers. Speaking of which…

2. “The Unicorn Effect” - we are held to different standards than many believe. To receive consideration from most schools (especially T20s) we must be the epitome of a unicorn: unimaginable adversity and trauma, high stats, ECs that no one in the world has, etc. If we don’t fit this mold, then we are not worthy of becoming physicians or physician-scientists. This is why schools like Duke will admit only one or two URMs. We must be extraordinary. The problem is that every school wants the unicorns. So when the unicorn goes to a higher ranked/more prestigious school (School A), School B (ie Duke) matriculated no URMs.

In conclusion, URMs in medicine and research have known about this occurring for decades. It explains why the overall percentage of Black male physicians has not changed in the last 40 years and the small number of URMs in MD-PhD programs. Until we have an admissions process void of systemic racism, these numbers will persist and may even become exacerbated.

This is not an exhaustive list of what occurs behind the ADCOMS doors but it partially explains why I, a Black male matriculating to an MSTP next year, will most likely be the only URM in my cohort. May we all strive to do better as future physicians and physician-scientists.