For the head of admissions at a medical school, Mark Henderson is pretty blunt when sizing up the profession.

“Mostly rich kids get to go to medical school,” he said.

In his role at the medical school at the University of California, Davis, Henderson has tried to change that, developing an unorthodox tool to evaluate applicants: the socioeconomic disadvantage scale, or S.E.D.

The scale rates every applicant from zero to 99, taking into account their life circumstances, such as family income and parental education. Admissions decisions are based on that score, combined with the usual portfolio of grades, test scores, recommendations, essays and interviews.

The disadvantage scale has helped turn U.C. Davis into one of the most diverse medical schools in the country — notable in a state that voted in 1996 to ban affirmative action.

With the Supreme Court’s ruling last week against race-conscious admissions, the medical school offers a glimpse of how selective schools across the country might overhaul their admissions policies, as they look for alternative ways to achieve diversity without running afoul of the new law.

Henderson said that about 20 schools had recently requested more information.

But sceptics question whether such rankings — or any kind of socioeconomic affirmative action — will be enough to replace race-conscious affirmative action. And schools that use adversity scales may also find themselves wandering into legal quagmires, with conservative groups promising to fight programmes that are simply stand-ins for race.

Over the years, medical schools have made some progress in diversifying their student bodies, with numbers ticking up. But just like undergraduate admissions, wealth and connections continue to play a determining role in who is accepted. More than half of medical students come from families in the top 20 per cent of income, while only 4 per cent come from those in the bottom 20 per cent, according to data from the American Association of Medical Colleges.

There is also a family dynamic. Children of doctors are 24 times more likely to become doctors than their peers, according to the American Medical Association.

“That’s a staggering economic gap between medical students and the general public,” said Henderson,who comes from a working-class upbringing and now serves as associate dean of admissions.

Leaders in medicine say training more Black and Hispanic doctors could help bridge the vast divides in American health care. Research shows that doctors from underrepresented racial and ethnic groups are more likely to work in primary care or in locales where doctors are scarce.

And patients have better outcomes when treated by doctors from similar backgrounds, said Jesse M. Ehrenfeld, president of the American Medical Association.

The U.C. Davis scale has drawn attention because of its ability to bring in diverse students using what the schools says are “race-neutral” socioeconomic models.

In its most recent entering class of 133 students, 14 per cent were Black and 30 per cent were Hispanic. Nationally, 10 per cent of medical school students were Black and 12 per cent were Hispanic. A vast majority of the U.C. Davis class — 84 per cent — comes from disadvantaged backgrounds, and 42 per cent are the first in their family to go to college.

In the Davis scale, first used in 2012, eight categories establish an adversity score for each candidate. Factors include family income, whether applicants come from an underserved area, whether they help support their nuclear families and whether their parents went to college.

The higher an applicant rates on the disadvantage scale, the bigger the boost.

A number of scholars have promoted using class-conscious preferences, which they say could address racial inequities in education without fostering the resentment often prompted by racially based diversity plans.

President Biden said on Thursday that his administration would develop a “new standard for colleges taking into account the adversity a student has overcome.”

“The kid who faced tougher challenges has demonstrated more grit, more determination,” Biden told reporters at the White House, “and that should be a factor that colleges should take into account in admissions.”

The socioeconomic rankings could also be legally challenged. Chief Justice John G. Roberts Jr., in his majority opinion on affirmative action, wrote that colleges could consider how race had affected an applicant’s life. But he also warned against using proxies for race.

Should it come to that, Henderson said that his school’s disadvantage scale would be defensible in court.

“Am I worried about it? Yes,” Henderson said of a lawsuit. “Is it going to stop me? No.”

New York Times News Service