The inclusion of diversity, equity, and inclusion (DEI) principles in undergraduate medical education is considered crucial for creating a just and fair health care system. Though DEI education, including critical race theory and its derivatives, is still a topic of public debate, many industry specialists and educators believe that it forms the foundation of high quality health care practices and the achievement of health equity. The introduction of a bill in March by North Carolina Congressman Greg Murphy, MD, reignited the debate on the role of DEI in medical education. The bill, known as the Embracing Anti-Discrimination, Unbiased Curricula, and Advancing Truth in Education (EDUCATE), aims to limit federal financial support for educational institutions with DEI policies, leading to concerns that the act may hinder efforts toward health equality.12 Recent legal developments, such as the Supreme Court‘s ruling on affirmative action programs at Harvard and the University of North Carolina, have further fueled the debate on DEI in education.6,10 Additionally, several states have recently proposed bills to regulate DEI initiatives in public schools and universities, highlighting the issue’s controversial nature. While many of these legislative efforts are ongoing, the implications for DEI programs in medical education remain a significant concern. Furthermore, the importance of DEI in medical education goes beyond academic discussions.
Explore This Issue
ACEP Now: Vol 43 – No 08 – August 2024Rep. Murphy’s proposed EDUCATE Act aims to change the Higher Education Act of 1965 to prevent medical schools from mandating or providing incentives for students, faculty, or staff to express specific views on diversity. This includes limiting conversations about how systemic factors influence racial inequalities and avoiding terms like “oppressor” and “oppressed” when referring to racial or ethnic groups. Furthermore, the bill restricts diversity initiatives in medical schools by prohibiting diversity statements, diversity offices, race-based courses, and consideration of diversity factors in accreditation. Rep. Murphy states in the press release introducing the bill, “Medicine is about serving others and doing the best job possible in every circumstance. We cannot afford to sacrifice the excellence and quality of medical education at the hands of prejudice and divisive ideology.”9
However, Rep. Murphy is short-sighted in that the impetus behind his bill needs to consider the reality that DEI goes beyond mere symbolism: Diversity, equity, and inclusion directly benefit patients. Studies consistently show that having a diverse physician workforce leads to improved patient outcomes, lower mortality, reduced morbidity rates, and, ultimately, a more robust health care system.2 Diversity fosters better understanding and trust between patients and physicians.4,5 When patients feel respected and valued by their health care professionals, they are more likely to seek medical care and adhere to treatment plans. While there has been progress in promoting diversity in health care, the under-representation of minority groups, particularly in the physician workforce, remains a significant concern. Statistics reveal a notable disparity between the demographics of physicians and the general population, with a particularly noticeable lack of racial diversity among African American physicians.4 Therefore, it is crucial to prioritize comprehensive diversity, equity, and inclusion (DEI) education to establish a health care system that is fair and meaningful for all individuals.
Beyond Inclusion: How Diverse Health Care Teams Improve Patient Care
Diversity within the health care workforce plays a crucial role in addressing the unique needs of various patient populations. While Hispanic physicians represent 6.9 percent of practicing physicians, the representation of other ethnic groups, such as American Indian, Alaska Native, Native Hawaiian, or Pacific Islander, remains significantly lower.12 This lack of diversity emphasizes the importance of fostering a health care environment that is inclusive and representative of the communities it serves.2,4
With cultural competency, health care workers from diverse backgrounds possess unique perspectives that enable them to navigate cultural nuances, implicit biases, and communication styles. Literature has demonstrated that when patients seek treatment from individuals of their own race or ethnicity, they are more likely to take their prescriptions and engage in prevention services.13,14 A study conducted in New York City on patients with hypertension and cardiovascular symptomatology demonstrated that when treated by doctors of a concordant race, patients were more likely to adhere to medication compliance guidelines.11
A study at Stanford University School of Medicine further underscored the impact of cultural competency on patient engagement. Involving over 1,300 Black men in Oakland, Calif., the study revealed that patients assigned to Black doctors were more inclined to openly discuss health concerns and participate in screenings for conditions like diabetes and cholesterol.1 The connection between culture, diversity, and care is fundamental in promoting positive patient outcomes and restoring a positive perception of health care.14
The infusion of DEI in medical school curricula and admissions processes is crucial to ensuring that the workforce reflects the patient population. When institutions of higher learning commit to training and recruiting a diverse cohort of medical students, they prepare a qualified workforce poised to deliver quality and equitable care to patients of all backgrounds. Educating all health professionals on culture and bias elimination is also essential in promoting a care environment that offers high quality care to all patients.3,7,8 As a result, actively supporting DEI in medical education and practice is not just a matter of ethics; DEI is a viable tactic for improving the quality of health care delivered to all members of the public. The active implementation of measures aimed at diversifying discourses and making them more compassionate allows for the development of a fairer and more comparable health care system that will address patients’ individual needs and create a healthier environment for generations to come.
Dr. Kendall is the chief of clinician engagement at US Acute Care Solutions and has 15 years of emergency department leadership experience. She is the chair of the USACS diversity, equity, and inclusion committee, the social issues and equity in medicine committee co-chair, and leads physician leadership development for USACS.
References
- Alsan M, Garrick O, Graziani G. Does diversity matter for health? Experimental evidence from Oakland. Am Econ Rev. 2019;109(12):4071-4111.
- Boyle P. Do Black patients fare better with Black doctors? American Association of Medical Colleges. Published June 6, 2023. Accessed July 15, 2024.
- Cooper LA, Saha S, van Ryn M. Mandated implicit bias training for health professionals—a step toward equity in health care. JAMA Health Forum. 2022;3(8):e223250.
- Godoy M. Diversity in medicine can save lives. Here’s why there aren’t more doctors of color. National Public Radio. Published April 20, 2023. Accessed July 15, 2024.
- Gomez LE, Bernet P. Diversity improves performance and outcomes. J Natl Med Assoc. 2019;111(4):383-392.
- Hurley L. Supreme Court strikes down college affirmative action programs. NBC News. Published June 29, 2023. Accessed July 15, 2024.
- Like RC. Educating clinicians about cultural competence and disparities in health and health care. J Contin Educ Health Prof. 2011;31(3):196-206.
- McGregor B, Belton A, Henry TL, et al. Improving behavioral health equity through cultural competence training of health care providers. Ethn Dis. 2019;29(Supp2), 359-364.
- Press Release: Office of Gregory F. Murphy, MD. Murphy introduces bill to ban DEI in medicine. Office of Gregory F. Murphy, MD. Published March 25, 2024. Accessed July 15, 2024.
- National Council of the Churches of Christ in the USA. NCC legislative update July 1, 2023. Published July 1, 2023. Accessed July 15, 2024.
- Nguyen, A, Siman, N, Barry, M, Cleland, C, et al. Patient–physician race/ethnicity concordance improves adherence to cardiovascular disease guidelines. Health Serv Res. 2020;55(Suppl 1):51.
- Palmer K. Bill seeks funding ban for medical schools with DEI programs. Inside Higher Ed. Published March 22, 2024. Accessed July 15, 2024.
- Shen MJ, Peterson EB, Costas-Muñiz R, et al. The effects of race and racial concordance on patient–physician communication: a systematic review of the literature. J Racial Ethn Health Disparities. 2017;5(1):117-140.
- Spevick J. The case for racial concordance between patients and physicians. AMA J Ethics. 2003;5(6):215-218.
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3 Responses to “Why Diversity, Equity, and Inclusion Matter in Medical Education”
August 18, 2024
Mark CollinsACEP,
There are in fact very good reasons to consider defunding government sponsored DEI initiatives. I would submit to you that DEI actually has the very real potential to diminish the quality of care received by diminishing the quality of physicians that are admitted into programs with DEI initiatives enacted.
The argument is made that if we don’t have enough physicians of a certain skin tone or a certain gender identity, taking care of those of a similar skin tone or gender identity their care won’t be as good. This is a frankly racist and foolish argument! Yes cultural nuance is a thing but at what price? You are frankly pushing for segregation here. Is that what you want to go back too.
Would you have us to believe that a black physician cannot reasonably care for a white patient? Would you make that argument? Would you argue that a lesbian can’t provide reasonable medical care for a heterosexual woman?
DEI initiatives actually foster racism, segregation, division and degradation of diversity in this way.
Let’s have brown people take care of brown people because it’s “proven” they’ll have “better outcomes” if we take care of them in more culturally sensitive or appropriate way. Besides being segregationist, I think the “proof” of this concept is extremely sketchy and very unlikely to be of true tangible value in regards to actual care delivered and outcomes. My blood pressure is better managed by someone who actually knows how to manage it medically than someone who is sensitive to my cultural needs or my racial background. Your data on these topics is on very shaky ground.
I don’t believe that pairing people up with a physician based on their race, ethnicity, gender preference or whatever DEI category claimed is actually beneficial or will cause these individuals to get better medical care. This is especially true if the person providing care is actually less qualified to do the job because they were admitted based on DEI initiatives in order to meet a quota! This is frankly foolish and these policies foster a segregationist mentality.
If you are truly being honest with yourself you will admit that you don’t care if your airplane pilot is lesbian, black, white, or any other DEI category you can name. The only thing you care about is how qualified they are to actually fly the plane in your in.
Another example: You could also care less about whether your Secret Service agent is trans, female, black or white. What you care more about is whether they are THE best person to do the job of a Secret Service agent and protect you from being assassinated.
By the same logic, I could care less about what background my doctor comes from, I want the best physician for the job. I want the best person for the job. I don’t care what their race, ethnicity, etc is, I want them to be the best at what they do!
Tell me honestly if you would pick your brain surgeon based on DEI criteria?
I didn’t think so.
The problem with these DEI policies is that the best person for the job is not always selected and in fact they are actually discriminated against because they may not match a DEI inclusion criteria.
I want the best person for the job whoever that person may be and regardless of what their skin color is, their gender is, their ethnicity, their race, or their social background.
This is what every person seeking care actually cares about!
Are they getting a good doctor?
In this country everyone can succeed if they try. There is not the supposed need that the left (ACEP?) seems so fixated on to “lift” people out of their social position and give them more opportunities. The opportunity is truly there for everyone in the USA and question is WHY do some groups, Asians for instance, take advantage of it while others, do not. The reasons here have nothing to do with lack of opportunity but more to do with lack of motivation, family structure and numerous other factors that government intervention is NOT capable of remedying. Prior policies which lower the bar, such as affirmative action, have resulted in discrimination against those with superior qualifications in favor of quotas which actually degrades the quality of product medical schools produce and helps no one get a better doctor.
DEI initiatives do not improve the quality of doctors patients get.
They actually do the opposite.
If we lower the standard just to include people of different categories we’re actually NOT increasing our quality of physician, we are diminishing it.
While all of us, myself included, would love to see a more diverse physician workforce, that is not achieved by simply pushing affirmative action/DEI quotas and initiatives which actually lower the bar and foster division and racism! I do not want a more diverse physician workforce at the expense of physician quality and I don’t want more qualified candidates being actively discriminated against because they don’t meet a DEI category. That is what is happening and the reason for the bill discussed. DEI literally is discrimination!
If you have a more qualified candidate that candidate should get the position based on merit alone, not some discriminatory DEI initiative.
Again, DEI = discrimination.
Discrimination is something that I would assume ACEP would NOT support??
Mark Collins MD FACEP
August 18, 2024
Dr. David WoodRep. Murphy is on the right track. It is NOT up to medical schools to re-balance the social delivery of health care based on a small group of minority activists. My ACEP dues should not be going to support this misguided focus on healthcare.
August 19, 2024
Mark CollinsACEP, There are in fact very good reasons to consider defunding government sponsored DEI initiatives. I would submit to you that DEI actually has the very real potential to diminish the quality of care received by diminishing the quality of physicians that are admitted into programs with DEI initiatives enacted. The argument is made that if we don’t have enough physicians of a certain skin tone or a certain gender identity, taking care of those of a similar skin tone or gender identity their care won’t be as good. This is a frankly racist and foolish argument! Yes cultural nuance is a thing but at what price? You are frankly pushing for segregation here. Is that what you want to go back too. Would you have us to believe that a black physician cannot reasonably care for a white patient? Would you make that argument? Would you argue that a lesbian can’t provide reasonable medical care for a heterosexual woman? DEI initiatives actually foster racism, segregation, division and degradation of diversity in this way. Let’s have brown people take care of brown people because it’s “proven” they’ll have “better outcomes” if we take care of them in more culturally sensitive or appropriate way. Besides being segregationist, I think the “proof” of this concept is extremely sketchy and very unlikely to be of true tangible value in regards to actual care delivered and outcomes. My blood pressure is better managed by someone who actually knows how to manage it medically than someone who is sensitive to my cultural needs or my racial background. Your data on these topics is on very shaky ground. I don’t believe that pairing people up with a physician based on their race, ethnicity, gender preference or whatever DEI category claimed is actually beneficial or will cause these individuals to get better medical care. This is especially true if the person providing care is actually less qualified to do the job because they were admitted based on DEI initiatives in order to meet a quota! This is frankly foolish and these policies foster a segregationist mentality.
If you are truly being honest with yourself you will admit that you don’t care if your airplane pilot is lesbian, black, white, or any other DEI category you can name. The only thing you care about is how qualified they are to actually fly the plane you are in. Another example: You could also care less about whether your Secret Service agent is trans, female, black or white. What you care more about is whether they are THE best person to do the job of a Secret Service agent and protect you from being assassinated. By the same logic, I could care less about what background my doctor comes from, I want the best physician for the job. I want the best person for the job. I don’t care what their race, ethnicity, etc is, I want them to be the best at what they do! Tell me honestly if you would pick your brain surgeon based on DEI criteria? I didn’t think so. The problem with these DEI policies is that the best person for the job is not always selected and in fact they are actually discriminated against because they may not match a DEI inclusion criteria. I want the best person for the job whoever that person may be and regardless of what their skin color is, their gender is, their ethnicity, their race, or their social background. This is what every person seeking care actually cares about! Are they getting a good doctor? In this country everyone can succeed if they try. There is not the supposed need that the left (ACEP?) seems so fixated on to “lift” people out of their social position and give them more opportunities. The opportunity is truly there for everyone in the USA and question is WHY do some groups, Asians for instance, take advantage of it while others, do not. The reasons here have nothing to do with lack of opportunity but more to do with lack of motivation, family structure and numerous other factors that government intervention is NOT capable of remedying. Prior policies which lower the bar, such as affirmative action, have resulted in discrimination against those with superior qualifications in favor of quotas which actually degrades the quality of product medical schools produce and helps no one get a better doctor. DEI initiatives do not improve the quality of doctors patients get. They actually do the opposite. If we lower the standard just to include people of different categories we’re actually NOT increasing our quality of physician, we are diminishing it.
While all of us, myself included, would love to see a more diverse physician workforce, that is not achieved by simply pushing affirmative action/DEI quotas and initiatives which actually lower the bar and foster division and racism! I do not want a more diverse physician workforce at the expense of physician quality and I don’t want more qualified candidates being actively discriminated against because they don’t meet a DEI category. That is what is happening and the reason for the bill discussed. DEI literally is discrimination! If you have a more qualified candidate, that candidate should get the position based on merit alone, not some discriminatory DEI initiative. Again, DEI = discrimination. Discrimination is something that I would assume ACEP would NOT support??
Mark Collins MD