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At Texas Tech University’s medical school, just 4 percent of students are black; 13 percent are Hispanic. And those numbers might soon shrink. Research has shown that’s what happens when schools stop considering race in admissions, and that’s what the school plans to do.

In late February, Texas Tech University reached an agreement with the U.S. Department of Education to end its use of race in admissions to its medical school. The resolution, first reported by The Wall Street Journal, brought to an end a 14-year federal investigation into the school’s affirmative-action practices. The complaint had been filed following the Supreme Court decisions in the Michigan affirmative-action cases Grutter v. Bollinger and Gratz v. Bollinger, where the Court decided race could be used in admissions, but only in a “narrowly tailored” way. Texas Tech had stopped using race in admissions at its pharmacy school in 2008, and at its undergraduate college in 2013, but not at its medical school. There, the school argued, it needed to use race as a factor to ensure a diverse class of future doctors, and there was no other way around it.

The law, as interpreted by the Supreme Court in affirmative-action cases over the past 40 years, requires schools to show that they have exhausted all other, race-neutral options to achieve a diverse student body before using race as an admissions criterion. Most schools are able to show that they are using race in admissions in the narrowly tailored way that the Supreme Court has said, time and again, is legal. But Texas Tech was not periodically reviewing those race-neutral alternatives, or, at least, could not show that it was. That’s why it’s hard to read too much into what this means for the future of affirmative action, Scott Schneider, a higher-education attorney with Husch Blackwell, told me; the details of the case were specific to Texas Tech.

In a letter to the Department of Education’s Office for Civil Rights, Eric Bentley, the general counsel for the Texas Tech University system, said that the school could prove that it was using race in an constitutionally accepted way, but that Texas Tech would voluntarily agree to drop the practice anyway. Still, he wrote, the medical school “strongly believes that diversity in academic medicine is not only a necessity at the [School of Medicine], but is a necessity nationally as well; therefore, we continuously strive to enhance the diversity of our student body.” But diversity in medical schools, broadly, has been difficult to achieve—especially without the use of race in admissions.

Many minority groups—particularly blacks, Hispanics, and Native Americans—are significantly underrepresented at medical schools, Liliana Garces, an associate professor at the University of Texas who has studied the effects that affirmative-action bans have had on student representation, told me. And according to a recent report from the Association of American Medical Colleges, positive increases in racial diversity are few. For example, the number of black matriculants to medical school rose by 4.6 percent last year, to 1,856, and the number of American Indian or Alaska Native matriculants rose by 6.3 percent, to 218.

These numbers could yet get smaller. Research shows that banning affirmative action—eliminating the use of race in admissions—leads to a decline in the enrollment of those underrepresented students. This is just as true at medical schools as it is at undergraduate institutions. For example, the number of black and Chicano students enrolled at University of California medical schools from 1996 to 1997 declined by 38 percent and 29 percent, respectively, following the state’s affirmative-action ban.

The lack of diversity isn’t a problem merely for young black college graduates hoping to become doctors someday, but for many of their would-be patients as well. Research has shown that health outcomes are improved when black patients have black doctors; they’re more likely to go for treatment and to be more satisfied with the care they receive. Those facts make the continuing lack of diversity in medical schools even more acute, and the potential for a decline in enrollment more threatening. “For health care and medical schools in particular to be in a situation where we might be likely to have fewer black doctors creates real implications for the type of care and treatment that black patients are likely to receive,” Adia Harvey Wingfield, a professor of sociology at Washington University in St. Louis, told me.

Wingfield’s new book, Flatlining: Race, Work, and Health Care in the New Economy, explores how changes in work affect black medical professionals. Black doctors, she finds, end up doing an extra level of work—the attentiveness to black patients, the added attention to caregiving—that is part of why black patients have better health outcomes with doctors who look like them.

With fewer black doctors, those who are already doing more work would be stretched even thinner. “If we’re talking about practitioners who are going to be servicing communities that are only going to become a larger and larger part of our society,” the goal, Wingfield says, should be to boost the ranks of those underrepresented minorities in medical professions.

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