As the first African-American dean of a majority-white medical school, Dr. Donald E. Wilson of the University of Maryland was pleased to see the number of minority students at his school bound upward during his first seven years in office.

But over the past four years, Wilson has been disturbed to watch the number of minorities in his entering classes decline by almost half - from 21 of 141 in the fall of 1998 to 11 of 147 last fall. He and other medical school officials across the country say they see an unhealthy pattern.

At the same time that a growing number of researchers are concluding that educating more black doctors is an important antidote to racial disparity in patient care, medical schools across the country are admitting fewer minority students.

The reasons are complex and numerous. Some schools are quietly tiptoeing away from efforts to admit more minority students because they've been battered by lawsuits claiming reverse discrimination. Others are backing off because they've concluded some of their affirmative- action programs were admitting too many minority students who weren't prepared.

The problem is likely to get worse. While some universities have stepped up recruiting of minority undergraduate applicants, many medical schools have cut outreach programs because federal funding has been slashed in the past two years by the Bush administration.

Fewer students of all races are applying to medical school, in part because they're turned off by rising numbers of malpractice lawsuits and the bureaucracy of managed care, admissions officials say.

And public university officials say they are at a disadvantage in competing for the shrinking number of qualified minority applicants because they are often outbid by better-funded private schools that don't have to follow the same court decisions as the public schools.

"Anti-affirmative-action efforts have had a chilling effect nationally as schools feel more limited in what they can do to increase their numbers of minority students," said Dr. Jordan Cohen, president of the Association of American Medical Colleges. "There has been a retreat from more aggressive affirmative-action efforts."

The retreat began in 1996, the year that a federal appeals court outlawed the use of racial preferences at the University of Texas and that California voters passed Proposition 209 with the same intent. Over the next five years, the number of blacks in medical schools nationally dropped by about 11 percent, according to the Association of American Medical Colleges.

Some of the best private medical schools - such as Johns Hopkins and Harvard - have not suffered declines in minority student enrollment. That is because they offer scholarships and large stipends to attract the best minority applicants in a shrinking field, according to admissions officials.

The possibility of a national decline in the number of black doctors is troubling to many because it could mean fewer physicians attuned to the needs of black patients.

"People feel more comfortable and less intimidated around people who are like them - and that makes the doctor-patient relationship easier," said Kiana Hebron, an African-American medical student who recently finished her first year at the University of Maryland.

It's not simply a matter of communication between doctors and patients, but of disparity in health care and shorter life expectancies for minority patients, according to a panel of 15 experts at the Institute of Medicine who studied the issue at the request of Congress.

The panel released a report in March that concluded that minority patients receive inferior medical care, even when they have the same insurance as white patients.

For example, whites in the United States are nearly four times more likely than blacks to receive coronary bypass surgery when they need it, according to the report, titled "Unequal Treatment."

One of the best cures for negative racial stereotypes by doctors, according to the report, is to educate more black and Hispanic doctors, who today comprise less than 4 percent of U.S. physicians. That's roughly the same proportion as in 1968.

"There is no question that disparities in medical care exist, and we need to address that," Maryland's Wilson said.

The University of Maryland and other schools outside Texas, Louisiana and Mississippi were not directly affected by the 1996 federal appeals court decision barring the consideration of race in admissions.

But the University of Maryland was sued in 1998 by a rejected white medical school applicant, Robert Farmer Jr., who claimed that he had better test scores than some black candidates. The U.S. District Court in Baltimore threw out the case in August 2001 after the university showed evidence that Farmer's application was hurt by a mediocre letter of recommendation, not his race.

But the case is being appealed. And Wilson believes that his 17-member admissions committee - which he says he does not control - has become increasingly "gun-shy" about affirmative action because it is afraid of lawsuits.

Although the committee admitted 3.5 percent of 503 black and Hispanic applicants two years ago, it admitted only about 2 percent of 481 minority candidates last fall, according to university estimates.

"I don't see [the litigation] as a serious threat, but I'm not sure the people on the admissions committee don't see it as a threat," Wilson said.

Although minority applicants sometimes have lower Medical College Admissions Test (MCAT) scores than white candidates, Wilson said, he would rather de-emphasize those scores and consider the character of students from poor and often uneducated families who show they can overcome adversity.

"The anti-affirmative-action stuff ... really is destructive," Wilson said. "Because it goes on the presumption that if your MCAT score is 35 you're going to be a better doctor than if it's 30. That's nonsense.

"What we need is a population of doctors that can provide excellent care to an increasingly diverse population."

Maryland is not the only medical school experiencing a decline in minority students.

At the University of Virginia, the number of black and Hispanic first-year medical students has dropped by half, from 21 of 136 in 1996 to 10 of 139 in 2001, university officials said.

The University of Illinois at Chicago College of Medicine has seen a smaller drop in black students, from 158 of 1,252 in 1996 to 126 of 1,272 in 2001.

Illinois worked hard to admit as many minority students as possible in the early and mid-1990s. But administrators decided to be more selective with black applicants after 1996 -they concluded too many were dropping out because they weren't ready for medical school in the first place, said Jorge Girotti, director of admissions at the school.

The University of Virginia School of Medicine canceled a program in 1996 that guaranteed admission to about 10 minority students a year if they performed well in a series of undergraduate science classes, said Beth Bailey, director of admissions at the school.

"Many in the program struggled in medical school and were unable to graduate in four years or pass their national boards, so we decided it was the wrong way to achieve parity," Bailey said.

The Bush administration for the past two years has been cutting back on funding for programs designed to recruit African-Americans and Hispanics for careers in health care.

Next fiscal year, President Bush is proposing to eliminate all funding for the $32 million Centers for Excellence program, which reaches out to minority students while they are in college to try to encourage them to apply to medical school, said Laura Griffin, spokeswoman for the federal Health Resources and Services Administration.

"Important programs have been zeroed out by the Bush administration," said Dr. Fernando Mendoza, associate dean for minority programs at Stanford Medical School. "And that's a shame because we really need a diversified medical work force."