Trends in Medical School Applications and Acceptances From Historically Black Colleges and Universities, 1980-2022.

Importance: Historically Black Colleges and Universities (HBCUs) play a pivotal role in higher education and the physician career path in the US. Studies have highlighted the importance of HBCU medical schools in the training of Black physicians. However, little is known about the contributions of HBCU undergraduate institutions to the medical school pathway over the past 30 years. Objective: To describe trends in Black HBCU undergraduate students' medical school application and acceptance rates from 1980 to 2022. Design, Setting, and Participants: This descriptive cross-sectional study analyzed data from the Association of American Medical Colleges from 1980 to 2022 on medical school applicantions and acceptances, as well as National Center for Education Statistics data on Black bachelor's degree recipients (1990-2020). Data were analyzed from August to December 2023. Main Outcomes and Measures: The number and proportion of medical school applicants and accepted students were compared over time for Black students who completed their undergraduate training at HBCUs vs non-HBCUs. Results: The study population included 1 666 145 total applicants (754 580 female [45.3%]; 146 852 Black [8.8%]). Between 1990 and 2020, Black bachelor's degree recipients from HBCUs increased by 50% (from 17 930 to 26 944 recipients), while those from non-HBCUs rose 271% (from 48 445 to 179 583 recipients). Black representation among medical school applicants grew from 7.2% in 1980 (2490 of 34 369 applicants) to 11.5% (5895 of 51 385 applicants) in 2022. From 1990 to 2017, Black HBCU graduates made up a higher proportion of Black medical school applicants, but from 2018 to 2020, non-HBCU graduates contributed more to the applicant pool. Throughout the study period, Black HBCU applicants had consistently lower medical school acceptance rates than their non-HBCU counterparts. Conclusions and Relevance: This cross-sectional study found that while HBCUs consistently produced a significant portion of Black medical school applicants, Black HBCU graduates faced lower medical school acceptance rates compared with their non-HBCU peers. Underinvestment in HBCUs and potential biases within medical school admissions may contribute to these challenges, limiting the full potential of HBCU students in diversifying the physician workforce; addressing these disparities through HBCU support, partnerships, and funding could enhance pathways to medical careers for Black students and contribute to achieving greater health equity.