Racialized Health Disparities Will Worsen as Med School Accreditor Drops Diversity Standard

An accreditation committee sponsored by the Association of American Medical Colleges and the American Medical Association is dropping its diversity standard, Inside Higher Ed reported Tuesday. That is likely to be a deadly decision, one that will disproportionately harm people of color.

The accreditation standard was created to help better align demographics of medical schools with our nation’s diversity, which has long been a problem. Ensuring that classrooms and hospital training environments are inclusive for women, students of color and other aspiring physicians who will diversify medical fields also was among the accreditor’s aims. But above all, they saw it as their responsibility to ensure that doctors were not going into hospitals, clinics and other health-care settings with harmful stereotypes and biases about diverse patient populations and that they developed the skills to engage with those patients without offense, properly diagnose and treat their medical conditions, and take cultural contexts into account when delivering care. 

Advil collaborated with the Morehouse School of Medicine and BLKHLTH (an organization that exposes and addresses racism in Black people’s health-care experiences) to launch the Advil Pain Equity Project. The project highlights inequities in how physicians respond to patients’ reports of pain. Consistent with Black participants in other research studies, 74 percent who were surveyed for the Advil study agreed that there is racial bias in how health-care professionals diagnose and treat pain. Two-thirds reported that conditions worsened or did not improve after negative experiences with health-care professionals. In addition to the survey data, the project also includes powerful videos in which Black people describe awful encounters with doctors who ignored or otherwise mishandled their pain.

Untreated symptoms sometimes progress from pain to death. I speak about the Black maternal mortality crisis several times each month. I always cite CDC data that shows among every 100,000 pregnant women in America, 50.3 Black and 14.5 white mothers die during live childbirth. Multiple factors explain these disparities; numerous research studies confirm that racial bias is one of them. In presentations on this topic, I also show this Blue Cross commercial featuring Serena Williams. In it, the tennis legend and other women highlight the importance of listening and taking seriously what diverse patients are saying in health-care settings. They also advocate for eradicating biases that contribute to disparities in maternal mortality and other health outcomes. This is just one of far too many health crises that lopsidedly affect people of color.

No racial disparity on any health outcome will eliminate itself. Physicians who are miseducated by raceless med school curricula will not know how to fix these problems. Instead, it is highly likely that they will unknowingly and unintentionally contribute to the exacerbation of racial gaps in existing health outcomes and become complicit in the manufacturing of new disparities. As diversity standards in med schools are relaxed and eliminated, students of color and their white classmates will be denied opportunities to learn about and amass the expertise required to address racial inequities.

In a pair of anti-DEI congressional hearings (one in March 2024 and another held on Capitol Hill last week), witnesses from Do No Harm—an organization that espouses on its website a commitment to “keeping identity politics out of medical education”—spent considerable time talking about what they deemed insufficient evidence pertaining to racial concordance (meaning, the reported benefits of patients being matched with doctors who are the same race). In a compendium of evidence-based essays I commissioned, Shawn Smith, a physician and assistant professor of pediatrics at the Northwestern University Feinberg School of Medicine, cited a corpus of studies that show the positive outcomes associated with racial concordance. For example, “Black newborns treated by Black physicians had 58% lower mortality penalty than Black infants treated by white physicians,” Smith noted.

But let’s imagine that Stanley Goldfarb and Kurt Miceli, the two medical doctors who testified on behalf of Do No Harm in the congressional hearings, are somehow right that the race of doctors plays little to no role in health outcomes for patients of color. An inescapable reality is that sending white med school graduates into the profession knowing far too little about people of color, historical and contemporary evidence of medical racism, implicit and explicit biases, diverse patients’ experiences with and appraisals of white doctors, and other racial topics will, in fact, do harm. Disproportionately, people of color will pay the price of this harm with their lives.

Goldfarb declared the following in his congressional testimony: “[Patients] need doctors who will treat their illnesses and cure their diseases, not discriminate by race and advocate for divisive political demands. DEI puts Americans’ lives at risk. The best way to save lives is to get DEI out of medicine.” He is right that we do not need physicians who will engage in racially discriminatory behaviors and practices. But where and how will they learn what those are, as well as how not to engage in them?

It is possible that Goldfarb considers advocacy for racial justice and racial equity as DEI or “divisive political demands.” If so, as a person of color, I think it is important for doctors to advocate for the discontinuation of mindsets, policies and practices that cyclically reproduce racial inequities in health care and health outcomes. If I were having a medical procedure, I would want my doctor to know how to advocate on my behalf to everyone involved—nurses and other hospital workers, insurers, pharmacists, policymakers, my employer, and whoever else has the power to ensure that circumstances that have lopsidedly ruined the lives of other Black patients do not kill me or otherwise ruin mine. I would also expect them to leverage their expertise in advocacy for other people of color.

Physicians will not be able to advocate for diverse patients if they do not learn how to do so in med school. They probably will not even be compelled to do so if med school curricula deny them opportunities to know why race-conscious advocacy is necessary. Consequently, even more people of color will continue to be served less well than white patients—and too many of us and our family members will suffer the painful, preventable and at times deadly consequences.