A portrait of two women medical students, one Black, and one Brown, wearing blue scrubs. They face the camera with arms crossed and serious looks on their faces.
Image credit: PeopleImages on iStock

The EDUCATE Act, a bill recently introduced to Congress, would effectively ban diversity, equity, and inclusion (DEI) efforts in medical schools by restricting federal funding.

Drawing upon an extreme version of color-blind politics, the bill would bar graduate medical schools from “distinguishing students by race, color, or ethnicity,” or from using race, color, or ethnicity to establish privileges or benefits for students. The bill also effectively bans courses for students based on race, color, or ethnicity and instruction “about unique medical needs or conditions that may be related to an individual’s gender, race, or other characteristics.”

The bill cuts funding for any DEI office that serves a graduate medical school which could lead to the closure of DEI offices at institutions of higher education all over the country. The bill would also require government agencies and associations to demonstrate “the agency or association does not require an institution or program to adopt any [DEI] policies or other requirements.”

The bill goes so far as to also ban DEI efforts within research operations at medical schools, student organizations’ operations, and the invitation of lecturers and other guest speakers.

A growing body of scientific evidence “indicates clear benefits of adding diverse perspectives and seeing each patient as who they are, formed by their individual experiences. This is important not only for marginalized populations but for all patients.”

The EDUCATE Act was proposed by Rep. Greg Murphy of North Carolina, who co-authored an article in the Wall Street Journal, “Ban DEI Quackery in Medical Schools.” In the article, Murphy and co-author Stanley Goldfarb argue that “the ideology of ‘diversity, equity and inclusion’ is dangerous everywhere, but especially in medical education.” The article reads as a preamble to the bill which equates efforts to diversify medical schools or promote culturally competent care as “political activism” that essentially wastes time better spent on “rigorous coursework and preparation for medical practice.”

The article, which promotes the main points addressed in the bill, takes issue with medical school courses on health equity and health justice, systemic racism, and colonialism. According to Murphy and Goldfarb, “medical schools teach about ‘intersectionality,’ ‘colonization’ and ‘white supremacy’ while promoting the idea that people are either ‘oppressors’ or ‘oppressed.’” They also point to affinity groups based on race and loyalty oaths with DEI statements as part of “a dangerous and contagious philosophy.”

In a letter to the Wall Street Journal, several scholars and medical practitioners responded and refuted Murphy and Goldfarb’s claims that DEI programming and instruction on racism and discrimination in medical settings worsens the quality of medical education. David J. Skorton, president and CEO of the Association of American Medical Colleges, and Alison J. Whelan, AAMC’s chief academic officer, wrote that “teaching related to DEI, health equity and the care of our diverse population supplements, but in no way replaces, a strong focus on the latest science and evidence on human health and disease.”

Color-blind policies like the EDUCATE Act operate on the assumption that fairness and equity already exist and that any programs that target a specific group are therefore inherently racist or unjust.

They go on to assert that a growing body of scientific evidence “indicates clear benefits of adding diverse perspectives and seeing each patient as who they are, formed by their individual experiences. This is important not only for marginalized populations but for all patients.” 

Hurting Vulnerable Communities

If enacted, the bill would threaten the quality and accessibility of healthcare for vulnerable communities. The diversity of the physician workforce impacts patient care in several ways. Diversifying the physician workforce increases the number of physicians and other healthcare providers for those who live in medical deserts.

Since people from vulnerable communities are more satisfied with their care and more likely to receive preventative care when they have access to doctors who share their lived experiences, the diversity of the physician workforce also impacts the quality of care these communities receive.

Color-blind policies like those reflected in the EDUCATE Act operate on the assumption that fairness and equity already exist and that any programs that target a specific group are, therefore, inherently racist or unjust. However, such a view neglects the long history of discrimination and systemic racism in the United States, as well as in the professionalization of medicine and medical education.

As medicine became institutionalized and professionalized, medical schools and medical associations, for instance, refused entry to African Americans and other groups. The very history of medicine and health policy is deeply rooted in racist and exploitive use of Black bodies to further the discipline at the expense of Black people. And the history of the eugenics movement in the United States has been a centuries-long tool for the formation and the reification of scientific racism. This history has culminated in a lack of diverse healthcare providers and poor health outcomes among vulnerable groups.

The issue of racism in medicine reaches into the present day. Clinical guidelines, for example, include race adjustments that make Black patients less likely to receive needed interventions than White patients. As clinical guidelines are automated through AI systems used widely by hospitals and health systems, this form of discrimination has become exacerbated.

Though doctors are supposed to “do no harm,” and bedside manner is an important part of delivering high-quality healthcare, there are documented instances of medical professionals’ overt racism toward patients and, sometimes, other medical professionals. Discriminatory practices are often the result of more covert forms of racism such as unconscious bias and institutionalized racism, which can embed unequal and unjust practices within the everyday functioning of care settings. Programs, courses, and loyalty oaths, which Murphy and Goldfarb denounce in their Wall Street Journal article, are meant to help combat the insidious nature of racism and the ways it shows up in medical practice.

Currently, the medical student body is predominantly male and White, and the faculty at medical schools skew heavily toward White men. While there has been some progress in diversifying medical schools’ student populations in recent years, the anti-DEI backlash within medicine is likely to stymie progress in creating a more diverse workforce of healthcare professionals to serve an increasingly diverse nation.

The EDUCATE Act essentially argues that there is no need to adapt policies and procedures to provide better care for vulnerable communities that have a centuries long history of exclusion and discrimination in the healthcare system.

The Bigger Picture

The EDUCATE Act comes on the heels of several anti-DEI efforts within the nonprofit and for-profit landscape. The Supreme Court decisions in Students for Fair Admissions, Inc. v. President & Fellows of Harvard College and Students for Fair Admissions, Inc. v. University of North Carolina to end race-conscious admissions had already threatened the diversity of the medical student body as well as of programs in all other disciplines. According to Axios, the anti-DEI backlash has been ramping up at the state level before the Harvard and UNC cases were decided; since 2021, 21 states proposed bills to dismantle DEI programs on college campuses.

The US House Office of Diversity and Inclusion was disbanded by a government spending bill. And the Fearless Fund’s protracted legal battle on the validity of its Fearless Strivers grant contest, which provides grants up to $20,000 to Black woman-owned small businesses, is yet another instance of the growingly contested ground of DEI initiatives, race-conscious policies, and justice-centered programming.

The EDUCATE Act essentially argues that there is no need to adapt policies and procedures to provide better care for vulnerable communities that have a centuries-long history of exclusion and discrimination in the healthcare system. Though anti-DEI efforts only attack people of color and the instruction and programming meant to draw critical attention to their unique healthcare experiences, as David J. Skorton and Alison J. Whelan point out, many DEI policies benefit all patients. Therefore, it is all of America that stands to suffer the consequences of efforts to abolish DEI in medical schools.