Med Schools, Major Accrediting Body Cling to Diversity Efforts Despite Supreme Court Affirmative-Action Ruling By Ari Blaff
https://www.nationalreview.com/news/1539869/
Just weeks before the Supreme Court struck down race-conscious admission policies in late June, an influential professional body known as the Accreditation Council for Graduate Medical Education (ACGME) was busy reassuring its members that medical schools across the country would remain committed to diversity, regardless of the case’s outcome.
The organization’s president, Thomas Nasca, released a note to the “Medical Education Community,” explaining that existing ACGME requirements ensuring medical schools “engage in ongoing, mission-driven, systematic recruitment and retention of a diverse and inclusive workforce,” still stood. Nasca explained that “nothing in the ACGME’s standards is intended to require programs or institutions to violate the law.”
“While political and legal decisions may create uncertainty regarding the ‘how’ we accomplish our responsibility, there is no doubt about the ‘why,’” he signed off the June 13 public letter.
Exactly how ACGME can maintain its efforts to promote diversity without running afoul of the Supreme Court’s decision is unclear. Diversity efforts are now baked into all aspects of medical-school evaluation, according to a family-medicine professor at a prominent medical school who asked not to be identified for fear of professional reprisal.
“The new definition of what it means to be a family physician includes that they advocate for social justice.” Specifically, ACGME could ask prospective medical schools what “your program is doing to advance social justice.”
Do No Harm, a group of medical professionals seeking to remove “radical, divisive, and discriminatory” ideologies from health care, issued a report in August 2022 calling attention to the ways in which medical schools are trying to get around federal anti-discrimination law. One commonly used tactic involves application essays aimed at teasing out ideological commitments and possibly even the race of the applicant.
Duke University’s School of Medicine, ranked sixth in the nation by U.S. News & World Report, underscores to applicants the institution’s “commitment to equity, diversity, and inclusion.” Application essays feature questions such as: “Describe your understanding of race and its relationship to inequities in health and health care.”
A similar practice is used at the highly ranked David Geffen School of Medicine at UCLA. The college claims that its “core values of justice, equity, diversity and inclusion are inseparable from our institutional goals of excellence in all tenets of healthcare, research, education, and community engagement.” Aspiring medical-school students must explain how “inequity has impacted you or your community and how educational disparity, health disparity and/or marginalization has impacted you and your community.”
According to the Do No Harm study, many other medical schools use similar practices to make race-conscious admissions decisions. The University of Minnesota, Florida Atlantic University, Michigan State University College, SUNY Downstate Medical Center, Tulane University, and Loyola University Chicago all feature varying applications steeped in DEI, replete with references to privilege, anti-racism, implicit bias, dismantling systemic racism, social justice, health equity, and advocacy.
Even Harvard, a named defendant in the Supreme Court case, announced weeks after the landmark decision a new series of essay requirements asking prospective students to explain how their “life experiences that shape who you are today” will enable them to contribute to the university’s “diverse student body.”
Should they make it to the interview round, medical-school applicants are often pressed on what they’ve done to personally advance DEI goals, For example, applicants could be asked whether they’ve attended any women’s marches or Pride festivals, George said. “You might have an interviewer that’s asking you: ‘What have you done to advance social justice?’”
Elite medical schools are going down this road despite an explicit warning from Chief Justice John Roberts. Writing on behalf of the majority in Students for Fair Admissions v. President and Fellows of Harvard College (SFFA), Roberts explained, “despite the dissent’s assertion to the contrary, universities may not simply establish through application essays or other means the regime we hold unlawful today. (A dissenting opinion is generally not the best source of legal advice on how to comply with the majority opinion.)”
In seeking to get around the opinion, the schools seem to be taking their cue from accrediting organizations like ACGME. In January, Do No Harm revealed that ACGME sent out a “Diversity in Emergency Medicine Questionnaire” to program directors of residencies seeking to learn how administrators planned to “increase racial/ethnic and gender diversity” in forthcoming recruitment classes. The survey included demographic points based on gender (e.g. “Non-binary/gender non-conforming) as well as race/ethnicity (e.g. “LatinX” and “Bi-racial/Multiracial”).
Respondents were asked to enumerate strategies that would address inequities within their medical schools, including dedicating DEI funding in department budgets, creating residency websites “that specifically highlights Diversity, Equity, and Inclusion,” as well as holistic reviews, a catchall term used to refer to policies that can help institutions account for an applicants’ race.
ACGME did not respond to a request for comment.
The medical establishment has been at the legal forefront pioneering attempts to bypass the Supreme Court. “It is possible to adjust to this new law and continue to serve the absolutely critical goal of a diverse workforce,” Dayna Matthew, a health-care law specialist and dean of the George Washington University’s law school, told Axios immediately after the verdict. A similar sentiment was expressed by Joseph Flaherty, the president of Western Atlantic University School of Medicine: “There are other ways you might say are proxies for race and ethnicity you can use to the maximum.”
The day after the justices rendered their opinion, the Association of American Medical Colleges publicly acknowledged they were “deeply disappointed,” arguing it would exacerbate existing racial-health disparities. The group, which filed an amicus brief with the court in favor of affirmative action, released a nearly identical statement to ACGME’s, explaining that these “court cases are just one example of the many attacks at the state-, local-, and federal- level against diversity, equity, and inclusion efforts across all aspects of education.”
It took ACGME two weeks after the Supreme Court finally issued its ruling on June 29 to clarify just how the organization would accomplish its affirmative-action sidestep. Reiterating the body’s earlier commitment to “mission-driven, systematic recruitment and retention of a diverse and inclusive workforce,” Nasca affirmed that ACGME would “assist Sponsoring Institutions and programs in achievement of their mission.”
“It is important to note that the ACGME standards do not require race-based affirmative action to achieve diversity,” Nasca noted, before elaborating that the Supreme Court “decision does not require programs and institutions to change their resident selection practices.” The president pointed members to “alternative strategies” in the organization’s “Equity Practice Toolkit,” comprised of 13 modules with topics ranging from “Whiteness: Power and Privilege” to “The Intersection of Racism & Gender Oppression as Root Causes of Health Inequities.”
Nasca then issued a thinly veiled threat to universities that did not follow the body’s proposed workaround of the Supreme Court ruling. “ACGME-accredited Sponsoring Institutions and programs must equip residents and fellows with the knowledge, skills, and attitudes to recognize and address the systemic, structural, institutional, and interpersonal factors that result in inequitable health care.” In other words, race-conscious ideology and DEI would remain ingrained across American medical schools; colleges that bucked the trend could jeopardize their membership and good standing.
William McDade, the group’s chief diversity, equity, and inclusion officer, took it a step further during a panel discussion with the American Medical Association (AMA) a week earlier. Joining the chorus of other senior representatives of American medical schools, including UC Davis and the historically black college Meharry Medical College, McDade condemned the Supreme Court’s ruling and advised industry leaders that the new ruling might not even apply to them.
“As you know, everyone who trains in the United States has to train in an accredited program, and ACGME has really made it a point of the last years now to emphasize the importance of diversity within the training environment,” the equity officer said before highlighting health disparities between black and white Americans. “It is still important that we maintain diversity within our classes; the question, of course, is how to do it.”
“I think that the decision the Supreme Court had last week is going to impact the lives of those patients that we ultimately sought to try to improve,” McDade continued. “So this ultimately means we’re going to reduce that workforce that disproportionately says it will take care of disadvantaged and minoritized groups of people.”
“One of the things I think we have to keep in mind is that when we’re changing programs and processes, that we don’t do it prematurely. As we said before, that we only do what’s necessary and to point out some of the subtleties in the Supreme Court decision impacting the physician workforce.”
Dr. Stanley Goldfarb, the chairman of Do Not Harm, rejected such arguments. “I strongly disagree that there is any solid evidence that a more diverse workforce leads to better clinical outcomes. We have looked at this carefully and found no real evidence for racial concordance between patients and physicians providing better outcomes. The data claiming otherwise is scanty and contradictory,” Goldfarb told NR.
McDade advanced the radical notion that the Supreme Court’s judgment in SFFA did not directly apply to core aspects of medical education, especially hiring decisions and residency placements. According to McDade, “hiring is a Title VII process with protections with respect to the Civil Rights Act of 1964. The Supreme Court spoke only to Title VI, which is an admissions process.”
“I would argue that the hiring process of residents and selection,” he continued, is not “a one-to-one admissions process as an undergraduate medical education differs. And the Supreme Court was silent on that process.” The DEI administrator argued that American medical schools are not bound by SFFA. There was wiggle room, McDade insisted, in the Supreme Court’s decision, and ACGME should exploit it.
McDade concluded by underscoring ACGME’s intention to advance DEI throughout medical education.
Kenny Xu, a board member of SFFA and outspoken critic of Harvard’s discriminatory admissions policies, pushed back on McDade’s argument in an interview with NR. “No. The reasoning used by SCOTUS applies to all med schools for admissions, as it is an extension of the 14th Amendment, not Title VI or Title VII, to prohibit invidious racial discrimination in state-sponsored colleges and universities,” Xu said. Xu serves as president of Color Us United and, in September, announced his plan to run for a congressional seat in North Carolina.
Legal non-profits that support race-neutrality in hiring and admissions have begun threatening to sue universities and private companies for flouting the Supreme Court ruling. Medical schools and medical-education accrediting institutions could also be in legal jeopardy.
In addition to potential legal consequences, the medical-school professor who spoke to National Review predicts that trust in health-care institutions will be further harmed by their insistence on skirting the affirmative-action ruling. “If you go into the hospital and you need to have heart surgery, do you care what color your doctor is? Or, do you care about whether they are qualified to be in that room?”
“What they’re doing is they’re looking at quote underrepresented classes or races and saying: ‘This is clearly an issue we need to fix because it doesn’t represent how America looks,’” George said.
However, for patients, this will lead them to think twice.
“Is this person actually qualified to be here?” he continued. “You’re actually introducing a little bit of racism into the patient because now they’re unsure of whether you’re qualified to be there or not. As opposed to being qualified across the board.”
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