Diversity and equity in medical education over the past decade: applications, matriculations, and the growing gaps.

backgroundDiversity and race-concordant relationships contribute to improved patient experiences and outcomes. In contrast, the representation of underrepresented in medicine (URiM) individuals in different medical specialties is declining. The essential pathway to improving diversity within the future workforce centers around the inclusion of a diverse cohort of medical students. We aimed to examine the diversity of medical school applications and admissions across sex, race and ethnicity over the past decade.

methodsThis study used data from the Association of American Medical Colleges from 2015 to 2024. URiM individuals refer to minority populations that are underrepresented in the medical profession, including Black, Hispanic, American Indian or Alaska Native (AIAN), and Native Hawaiian or Other Pacific Islander (NHPI). Diversity representation was measured using the representation index.

resultsThere was an increasing trend in medical school applicants among females but a decreasing trend among males. The number of Asian female applicants increased significantly (51.33%), while the numbers of Black (29.74%) and Hispanic (14.98%) female applicants also showed notable upward trends. Matriculation rates for Black females (mean: 33.64%; SD: 2.28%) and overall URiM females (mean: 35.94%; SD: 2.02%) have consistently remained below White females (mean: 44.22%; SD: 2.66%), Asian females (mean: 43.57%; SD: 2.59%), and the national average for females (mean: 40.96%; SD: 2.05%) over the past decade. The findings indicate that all racial and ethnic groups were underrepresented among both applicants and matriculants over the last decade, with the exception of Asian individuals. The representation index between matriculants and applicants among Black females (-1.46 vs. -1.19; P < 0.001) is widening, which may help explain the underrepresentation discrepancy for overall URiM females (-2.09 vs. -1.83; P < 0.001).

conclusionThis study highlights both progress and persistent challenges in achieving racial and ethnic diversity in U.S. medical education. While female and URiM applicant numbers have increased, matriculation disparities remain, especially among Black and URiM females. The widening representation gap between applicants and matriculants underscores structural barriers that continue to hinder equity in medical school admissions. A more inclusive physician workforce should begin with meaningful reform in how future doctors are recruited, supported, and selected.