The anti-DEI EDUCA Act has no place in 21st century medicine

To find racism disguised as federal policy, I direct you to the Embracing Anti-Discrimination, Fairness, and Advancing Truth in Education (EDUCATE) Act. Recently introduced in the House of Representatives, HR 7725 will nationalize the anti-DEI movement storming through state legislatures, deprive qualified students of medical school admission, and ensure that America continues to move toward to the bottom for health outcomes.

As a surgeon-educator, I have served in leadership roles for all stages of medical education, and to learn that a physician introduced this bill is disturbing. As a former member of Congress, I applaud whoever created the Orwellian title to obscure the impact of prohibiting “graduate medical schools from receiving federal financial aid if those schools adopt certain policies and requirements related to diversity, equity and inclusion”. Surrounded by meritocratic doublespeak, it ignores the history of systemic racism in medical education and its destructive legacy on students, patients, and public health.

Race-based admissions have been central to medical education since the 1910 Flexner Report decimated opportunities for black students. The landmark study, commissioned by the Carnegie Foundation and the American Medical Association, provided much-needed standardization for medical education. However, its author had black medical schools in his sights and concluded that black medical students should be trained in “hygiene and not surgery.” The result? Five of the seven black medical schools were closed, and black students were barred from segregated medical schools for the next 50 years. The impact on black student enrollment and patient outcomes continues to this day. Notably, Howard, the historic HBCU that remained open, was the nation’s first integrated medical school since its founding in 1868.

Nearly a century after the Flexner Report, in 2003 the Institute of Medicine, now the National Academy of Medicine, released its own landmark report, Unequal Treatment: Confronting Racial and Ethnic Disparities in the ‘health care It was the first systematic review of racial and ethnic disparities in health care in the United States. Even after correcting for socioeconomic factors, health systems and providers contribute to disparities in the quality of health care based on race and ethnicity. The report concluded that persistent racial disparities in health outcomes need to be addressed to increase the number of underrepresented minorities in medicine. The EDUCAR Law will do the opposite and worsen an already scary if serious situation.

In the four decades from 1978 to 2021, the number of black medical school graduates declined. With more than two decades of training and teaching in academic medical centers, I know firsthand the importance of diversity in medical schools. The lack of racial and ethnic representation is not only a problem for students and institutions, it harms patients. The cost to black patients, regardless of socioeconomic status, is well documented. Higher infant mortality, maternal mortality, lower life expectancy and worse surgical results are some. Although black patients suffer at a greater rate, it affects us all regardless of race and ethnicity.

America’s poor health outcomes are not the fault of mythical, underqualified black doctors. Perverse financial incentives that place profits over patients drive our healthcare industry. The United States accounts for 5 percent of the world’s population, consumes 50 percent of its health care resources, and still ranks at the bottom of most objective measures of health. Among high-wealth nations, the US has the highest infant mortality, lowest life expectancy, and highest health care spending. To reverse this trend, closing the door to black medical students is not the answer.

The EDUCATE Act is a distraction from what we really need to do to create a nation of health equity: address the social determinants of health, invest in affordable and accessible universal health care, and strengthen a diverse health care workforce. Discriminatory politics like the EDUCA Law have no place in 21st century medicine.

Dr. Brian Williams is a Harvard-educated trauma surgeon, IED expert, former congressional health policy advisor, and served as the Robert Wood Johnson Health Policy Fellow at the National Academy of Medicine. His book, “The Bodies Keep Coming: Dispatches from a Black Trauma Surgeon on Racism, Violence, and How We Heal,” is a call to action to create safe and healthy communities by dismantling structural racism. Follow X: BHWilliamsMD