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

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

As a surgeon-educator, I’ve served in leadership roles for every stage of medical education and knowing that a doctor introduced this bill is disturbing. As a former congressional staffer, I applaud whomever created the Orwellian title to obscure the impact of prohibiting “graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion.” Cloaked in meritocratic doublespeak, it ignores the history of systemic racism in medical education and its destructive legacy on trainees, patients and public health.

Race-based admissions have been foundational in medical education since the 1910 Flexner Report decimated opportunities for Black students. The landmark study, commissioned by the Carnegie Foundation and American Medical Association, did provide much needed standardization for medical education. However, its author had Black medical schools in his crosshairs concluding that Black medical students should train in “hygiene not surgery.” The result? Five of the seven Black medical schools closed and Black trainees were barred from segregated medical schools for the next 50 years. The impact on Black student enrollment and patient outcomes continues to this day. Of note, Howard, the historic HBCU which remained open, was the first integrated medical school in the country from the moment of its founding in 1868.

Nearly a century after the Flexner Report, in 2003 the Institute of Medicine, now the National Academy of Medicine, published its own landmark report, Unequal Treatment: Confronting Racial And Ethnic Disparities In Healthcare. It was the first systematic review of racial and ethnic health care disparities in the United States. Even after correcting for socioeconomic factors, health care systems and providers contribute to disparities in the quality of health care based on race and ethnicity. The report concluded that to fix the persistent racial disparities in health outcomes we must increase the number of underrepresented minorities in medicine. The EDUCATE Act will do the opposite and worsen an already dire situation.

In the four decades from 1978 to 2021, the number of Black medical school graduates decreased. With over two decades training and teaching at academic medical centers, I know firsthand the importance of diversity in medical schools. Lack of racial and ethnic representation is not only a problem for trainees 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 outcomes are a few. Although Black patients suffer at greater rates, it affects us all regardless of race and ethnicity.

Poor U.S. health outcomes are not the fault of mythical, underqualified, Black doctors. Perverse financial incentives that place profits over patients drive our health care industry. The U.S. accounts for 5 percent of the world’s population, consumes 50 percent of its health care resources, and still ranks near the bottom for most objective measures of health. Amongst high wealth nations the U.S. has higher infant mortality, lower life expectancy and higher health care expenditures. To reverse this trend, shutting the door on Black medical students is not the answer. 

The EDUCATE Act is a distraction from what we must really do to create a nation of health equity—address the social determinants of health, invest in universal affordable and accessible health care and bolster a diverse health care workforce. Discriminatory policy like the EDUCATE Act has no place in 21st-century medicine. 

Dr. Brian Williams is a Harvard-trained trauma surgeon, DEI expert, former congressional health policy advisor, and served as a 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 on X: BHWilliamsMD