Why attacks on DEI in medical education will harm patients
And a friendly reminder: We're all patients
Hi! I hope you all are doing okay. Seeing the fresh horrors inflicted each day by the Trump Administration is, well, awful. My family has been personally affected by Trump policies, and I fear it is only the tip of the iceberg. I’m so grateful for my communities — online and IRL — in this wild time. Sending love to all of you.
If you’d like a break and want to listen to something fun and (kinda) uplifting, I’ve been on a couple of podcasts recently:
“You Just Have To Keep Buying:” Money With Katie podcast, January 2025 (Editor’s note: is hilarious!)
“What Does Healthy Even Mean?” Busy Body podcast, January 2025 (Editor’s note: Can’t wait to have a Q&A with in Chief Complaint in the coming weeks!)
On February 14, the Department of Education sent out a letter to all educational institutions in the U.S. that started, “Dear Colleague.”
Nothing good ever starts this way.
This letter, which I learned about from coworkers and then read more about online, is vague, confusing, and frankly, pretty amateur.
But its intention is clear. It is threatening to withhold federal funding from educational institutions — including medical schools — that do diversity, equity, and inclusion work.
Here’s what it says:
Educational institutions have toxically indoctrinated students with the false premise that the United States is built upon “systemic and structural racism” and advanced discriminatory policies and practices. Proponents of these discriminatory practices have attempted to further justify them—particularly during the last four years—under the banner of “diversity, equity, and inclusion” (“DEI”), smuggling racial stereotypes and explicit race-consciousness into everyday training, programming, and discipline.
Of course, no educational institutions can function without federal funding. Medical schools depend on government dollars from a huge number of sources: research grants from National Institutes of Health, Centers for Disease Control, and other public health agencies; federal student financial aid; Medicare funding for residency training programs — the list goes on.
So the letter is really just a threat. Stop talking about race and racism, or cease to exist.
As a medical educator, I was chilled when I saw this letter. I’ve worked with students my entire career, and I love it. They ask me smart questions and keep me honest. They force me to stay up-to-date on medical research. They’re enthusiastic and excited about the possibilities of medicine. They have taught me that I can wear pants other than skinny jeans.
This letter represents an existential threat to all of that curiosity and optimism. And it’s particularly chilling because its implications are vague. This is not a healthy debate about, say, how to use race in predicting risk of cardiovascular disease. This is not even about the use of race in admissions decisions, which, to my dismay, the Supreme Court blocked in 2022, actively making our health care workforce less diverse.
This is an attempt to silence any discussion about racism and inequality in institutions that depend on free intellectual inquiry to exist.
What’s especially disturbing is that many medical schools are rushing to comply with these unclear mandates. My alma mater wasted no time in dismantling much of its diversity, equity, and inclusion work.
Yet it’s not even clear if the mandate is legal. Multiple groups are suing the Department of Education, arguing that it’s impossible to comply with an order that has been so poorly defined.
A judge blocked much of the executive order’s reach — yet institutions continue to shutter DEI programs and scrub websites of language that points to equity work. Quietly, around the country, medical schools are taking words like “equity” and “diversity” off of their websites, putting DEI programs on the back-burner. They don’t want targets on their backs. They want to fly under the radar.
I fear this will cause lasting harm to our system of medical education, and more importantly, to our system of health care.
Why, you might ask, when there are so many hateful policies being enacted — detention centers opening, non-White people being rounded up by ICE, to share just two examples going on near my home in Philadelphia — should we care about whether or not fancy medical schools have websites about their diversity policies? Aren’t there bigger issues to grapple with?
There’s a lot of work to be done to fight against the hate coming from the White House. But today, because medical education is an area I know a lot about, I wanted to share some of my thoughts about how this might affect medical students, medical educators, and ultimately, our patients.
(And of course, we are all patients. So really, this is about how attacks on DEI might harm all of our ability to access health care.)
Health equity is health. I met a patient for the first time the other day who was in her 60s and had never had a mammogram. (The U.S. Preventive Services Task Force — which hopefully will not get shut down like other government public health resources — recommends most women start mammograms to check for breast cancer at age 40.) Like many women of color, this patient had experienced major gaps in her access to primary care. She worked as a home health aide and made too much money to qualify for Medicaid but, as a contract worker, wasn’t eligible for health insurance through her job. Over the years, a mammogram simply wasn’t her top priority, and finally, a few weeks ago, we got to talking about why. There are well-documented disparities between White women and women of color when it comes to breast cancer screening. As a primary care doctor, it’s my job to understand those disparities — and work to address them. It’s bad medicine not to. Our students deserve to learn about these issues, and researchers need to study them. There’s no separating the study of medicine from the study of access to medicine. And access to medicine, of course, is about racism, misogyny, and poverty.
Health care will be a less desirable field to work in. I’m often asked if I’d encourage my nieces and other young people that I know to go into medicine — and the answer is a hard maybe. The pros and cons are complex, and I’d be happy to talk your ear off about them over a cup of coffee sometime. But I very much fear that attacking diversity work will make medicine a less desirable field for smart and idealistic young people. Our field is increasingly dominated by women, but men in still outearn us. Medical training and hospitals are known for being hostile environments for students and doctors of color. Racist and sexist workplaces are not fun places to be, period, and will especially harm our ability to recruit and retain new doctors of color. This will likely have dramatic trickle-down effects on the way patients experience health care.
The fear and paralysis of a surveillance state. The “Dear colleagues” letter ended on an especially ominous note: It had a link to a form where anyone could “report” supposed violations of the Department’s policies. (The link takes you to a reporting form that appears to have existed for years to lodge complaints with the Office of Civil Rights. Still, it’s obvious that people are now being encouraged to use this for reporting “diversity work.”) Is a student affinity group considered “toxic indoctrination” that should be reported? What about reporting sexual harassment or racist incidents? What about a lecture for students about transgender health care or contraception? Encouraging educators and students to turn each other in is terrifying. It will undoubtedly limit the types of topics we feel comfortable openly discussing, which in turn will affect what our doctors-in-training learn about.
Research will suffer. American medical schools are some of the most impressive sources of scientific research in the world. But all of that groundbreaking science requires money, much of which comes from the federal government. STAT News reported that federal grantmaking agencies like the NIH and National Science Foundation are flagging grants that use words like “transgender,” “diversity,” and even “women.” This will stifle the ability for researchers to conduct excellent science, which in turn will make it harder for all of us to access new medical tests, treatments, and cures.
We all pay when everyone gets sicker. It’s obvious where all of this is headed. Worsening disparities, worsening access to health care, worsening outcomes. And even if you’re some kind of psychopath who doesn’t care about babies dying from preventable diseases (just happened in Texas; brought tears to my eyes reading about it), your health insurance premiums will.
It’s morally wrong to not fight against racism and misogyny. Full stop.
How are you standing up for what’s right in your communities? Take care of yourselves and your loved ones.
Oh, and in case it isn’t obvious, I speak for no institution and only for myself. <3
Thanks Mara, I'm right there with you on all of this.