As future physicians, first-year medical students are well positioned to work on the long-term creation of a more equitable healthcare system. But how prepared are first-year medical students to begin the work of dismantling structural racism in the US healthcare system? In this study, we analyzed a sample of 75 medical-student reflective responses to a book focused on the legacy of racism in medicine. Our findings indicate that students enter medical school in a range of states of critical consciousness that are visible in their "stances" toward addressing racial inequality in the healthcare system. The stances described in our findings extend the critical consciousness framework, providing a more nuanced understanding of students' starting orientations to health justice. Because students arrive in different stances toward confronting the systemic inequalities inherent to the US healthcare system, understanding these stances may help medical educators tailor learning experiences to medical students' needs more effectively.