American universities have long treated racial underrepresentation in academic programs as a problem to be solved at the point of admission. Race-conscious selection, whether explicit or concealed, rests on the assumption that disparities in outcomes reflect systemic exclusion and can be corrected by relaxing formal thresholds based on merit. With medicine as the focus, this essay challenges that assumption by shifting attention to earlier in the pipeline, where preparation and performance are first measured at scale. Advanced Placement (AP) exam participation and performance—such as in AP Chemistry—are early meritocratic filters, and we document persistent gaps in both. We trace these disparities along the “success sequence” to medicine and demonstrate how conclusions about underrepresentation depend entirely on the denominator chosen. Relative to the general population, Blacks are underrepresented among medical school graduates; relative to AP examinees, they are neither under nor overrepresented among medical school graduates; relative to top AP performers, they are strongly overrepresented among medical school graduates. The same data tell three different stories, only one of which respects the structure of a meritorious pipeline. We argue that treating disparity as prima facie evidence of discrimination obscures the real problem: unequal preparation. A post-progressive research agenda should abandon the reflex to equate disparity with racism and instead confront the upstream factors that shape academic readiness. If the aim is durable representation in medicine and other selective professions, lowering standards at the end mistakes symptoms for causes.
Bleske-Rechek et al. (Tue,) studied this question.