“DEI initiatives are crucial in promoting a more inclusive and equitable healthcare system, ultimately leading to improved health outcomes for all individuals. Medical education must reflect the diverse backgrounds and experiences of patients and train healthcare professionals to provide more just and equitable care.”

I wrote this article after an impromptu hallway conversation at the SGIM 2024 Annual Meeting with our beloved past-president, Thomas Inui. He encouraged me to embed stories and narratives into my presidential columns to introduce myself and my ideas to SGIM members. This column has deep significance for my life and career, so it seemed appropriate to try this narrative approach.

I often share with learners how my childhood experiences in a rural Georgia town, where a railroad track served as both a physical and metaphorical divide between races, provided the passion that drives much of my work. A legacy of structural racism meant my grandparents only received a grade school education—the highest possible education in this racially segregated town. They went on to die too soon from preventable social and health conditions. It is this legacy, impacting these conditions, that has driven much of my work—from providing clinical care in safety net settings to implementing research, educational, and professional interventions designed to promote broad changes to improve care for diverse populations. I have held positions and implemented many of the very programs that are now at risk from current efforts to dismantle diversity, equity, and inclusion.

In parallel with my own journey, over the past two decades, medical schools and residency programs have increasingly implemented diversity, equity, and inclusion (DEI) initiatives and curricula. DEI describes values and practices used by institutions to address historic inequities and support healthcare workforce representation that meets the needs of our increasingly diverse society. Many of these efforts followed the landmark 2003 Institute of Medicine “Unequal Treatment” report documenting widespread bias and racism contributing to disparate health outcomes for certain populations.1 Efforts further intensified in the racial reckoning that followed the murder of George Floyd in 2020. By 2022, an Association of American Medical Colleges (AAMC) survey found that 96% of US and Canadian medical schools reported some integration of DEI into their curricula.2

Threats to Diversity, Equity, and Inclusion (DEI)

As new roles, programs, and investments in DEI were emerging, so were the threats to undermine these efforts. On June 29, 2023, the U.S. Supreme Court ruled that race-conscious admissions violated the Equal Protection Clause of the 14th Amendment.3 Several schools with fledgling and established programs cited this ruling as reason to halt or dismantle DEI efforts, often with stronger restrictions than called for by the ruling. Several states have gone even further to ban DEI efforts in higher education by limiting funding that necessitates state-funded universities to close their DEI offices.3 As of May 2024, there are more than 30 bills across the country targeting DEI initiatives. A more recent bill targets medical education specifically. On March 19, 2024, Rep. Greg Murphy, MD, introduced the Embracing Anti-Discrimination, Unbiased Curriculum, and Advancing Truth in Education (EDUCATE) Act.3 If passed, this bill would stop medical schools that adopt certain DEI policies and practices from receiving federal funding, including federal student loans.

Impact

These attacks on DEI efforts have already had tangible negative results. Many DEI faculty have lost their jobs, were compelled to shift their careers, or move their families for additional opportunities. In addition, many faculty with DEI focused academic careers have been faced with limited ability to present their work and engage at academic conferences as their institutions no longer fund DEI related travel and scholarship. Importantly, DEI leaders have faced increasing scrutiny along with threats, harassment, and intimidation. Beyond DEI leaders, these consequential decisions will harm our country’s health for generations—widening the ongoing diversity gap among physicians. Physicians may avoid training and work in states with these limitations, further restricting healthcare access.

Case for Supporting Diversity, Equity, and Inclusion (DEI)

In the face of these threats, the case for DEI remains strong. Academic general internal medicine physicians have the unique privilege of preparing physicians, researchers, and other healthcare professionals to provide high-quality care in a diverse society. Engaging diverse perspectives and backgrounds in classroom, clinical, laboratory, research, and community settings, enriches the educational and work experiences of our learners and colleagues. Diverse learning and clinical environments are important to provide future physician leaders with skills needed to interact, engage, and lead change across complex health systems.

To be clear, DEI efforts are not only about historically marginalized groups—a growing body of research demonstrates the benefits of DEI efforts in maximizing organizational performance. Diversity cultivates creativity and discovery and enhances financial performance.4,5 Diverse scientist teams have also been associated with better patient outcomes and higher impact of scientific findings.4 For learners, increased student diversity strengthens skills needed to care for diverse patient populations, and stronger endorsements for equitable access.5

Ultimately, legislators and politicians cannot tell us how to be clinicians or define what is important in our profession. Accrediting bodies like the Accreditation Council for Graduate Medical Education (ACGME) and Liaison Committee on Medical Education (LCME) should “override” this legislation. Healthcare professionals and medical schools are in the best position to determine how to prepare our learners to meet societal healthcare needs. DEI initiatives are crucial in promoting a more inclusive and equitable healthcare system, ultimately leading to improved health outcomes for all individuals. Medical education must reflect the diverse backgrounds and experiences of patients and train healthcare professionals to provide more just and equitable care.

The Role of SGIM

SGIM is well-positioned to lead on this issue. At my first SGIM meeting more than two decades ago, SGIM’s commitment to health equity for patients and diversity and inclusion among our learners and colleagues was evident. Our organization and its members prioritized and led innovations in DEI well before it became a popular trend or the product of mounting scrutiny. DEI has been a long-term core value, and that will not change.

Even with these national and statewide challenges, SGIM is committed to diversifying our physician work force. We have started by publicly reaffirming our support for DEI in medical education. SGIM signed on to a joint letter to Senator Murphy along with several other societies in strong opposition to any efforts to ban DEI programs in medical education. We further endorsed a resolution introduced by Rep. Joyce Beatty and Congresswoman Kathy Castor recognizing the importance of DEI in medical education and pushing back against efforts to restrict federal funding for medical schools with DEI programs.

As SGIM looks for a way forward, a focus on these threats and SGIM’s response will be a key component of our summer Council retreat and a priority for SGIM this year. In addition to reviewing our own programs, advocacy, and education efforts, there may also be opportunities to support research documenting the impacts of anti-DEI legislation on the education and careers of students, trainees, and faculty. DEI is not only important but also essential in health care to ensure equitable access to care, address inequities, create inclusive environments, and drive innovation in the delivery of healthcare services. SGIM can play a vital role to drive positive change in the healthcare landscape by advancing diversity, equity, and inclusion for patients, faculty, staff, and learners.

References

  1. Institute of Medicine (US) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Smedley BD, Stith AY, Nelson AR, eds. Washington (DC): National Academies Press (US); 2003. PMID: 25032386.
  2. The power of collective action: Assessing and advancing diversity, equity, and inclusion efforts at AAMC medical schools. AAMC. https://www.aamc.org/data-reports/report/assessing-and-advancing-dei-efforts-aamc-medical-schools. Published November 2022. Accessed June 15, 2024.
  3. Weber S. Proposed bill could end student aid for US med schools with DEI programs. Medscape. https://www.medscape.com/viewarticle/proposed-bill-could-end-student-aid-us-med-schools-dei-2024a100059t?form=fpf. Published March 21, 2024. Accessed June 15, 2024.
  4. AlShebli BK, Rahwan T, Woon WL. The preeminence of ethnic diversity in scientific collaboration. Nat Commun. 2018 Dec 4;9(1):5163. doi:10.1038/s41467-018-07634-8.
  5. Saha S, Guiton G, Wimmers PF, et al. Student body racial and ethnic composition and diversity-related outcomes in US medical schools. JAMA. 2008 Sep 10;300(10):1135-45. doi:10.1001/jama.300.10.1135.

Issue

Topic

Health Equity, SGIM

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