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Overturning decades of precedent, the U.S. Supreme Court on Thursday struck down the use of affirmative action, ruling that it is unconstitutional for colleges, universities — and professional schools for law, medicine, and nursing — to consider race as one factor in deciding who they will admit.

The decision comes as a blow to many in the field of medicine, which has been unable to appreciably increase the numbers of Black, Hispanic, and Indigenous doctors in recent decades. Many medical schools have turned to using race as one factor among many in admissions decisions to try to boost the numbers of students from underrepresented groups and help overcome obstacles to entry like MCAT testing that favor students from wealthier backgrounds.

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The justices ruled on two cases brought by an anti-affirmative action group: Students for Fair Admissions v. President and Fellows of Harvard, and Students for Fair Admissions v. University of North Carolina. The court ruled that the admissions policies used by the schools violate the equal protection clause of the 14th Amendment. The decision was written by Chief Justice John Roberts with justices breaking along ideological lines with Clarence Thomas, Samuel Alito, Neil Gorsuch, Brett Kavanaugh, and Amy Coney Barrett agreeing and Justices Sonia Sotomayor, Ketanji Brown Jackson, and Elena Kagen dissenting. (Jackson recused herself from the Harvard case because she had served on the school’s board of overseers.)

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