The Irony of the EDUCATE Act

By Madeleine Burry
February 21, 2025 | VOLUME 3, ISSUE 1

Following the introduction of the EDUCATE Act (Embracing anti-Discrimination, Unbiased Curricula, and Advancing Truth in Education) in April 2024, CHEST joined 15 medical associations in putting forth a congressional resolution affirming the need for physicians and advanced practice providers who reflect the diverse patient population served to advance health equity and improve outcomes.

Since then, the new White House administration has issued a series of executive orders directly impacting diversity, equity, and inclusion (DEI) programs. CHEST responded with a pledge to hold steadfast to our values and the necessity for diversity and inclusion to achieve our goal of health equity and improved patient outcomes.

The EDUCATE Act, the executive orders, and the following actions by the administration to limit and/or remove access to medical information all have the potential for irreversible harm to patients and the medical profession. But there is already proof that this will harm the clinician community, and, most importantly, it will worsen patient outcomes.

The following interviews were held in November 2024 and reflect the growing and realistic concerns of the medical community. Some names have since been redacted to protect the individuals from reprisals.

Unbalancing the scales

“What kind of world do we want to learn and practice in? Five years from now, what will the country look like?” said J.M., a leading health equity practitioner at a top medical program who requested anonymity. “What is the profession going to look like? What are our colleges and universities going to look like?”

J.M. (Requested Anonymity)

Currently, there’s a mismatch between the demographics of the US and the demographics of people in the medical field. While 13% of the population is Black, only 5% of doctors are Black; and women, who comprise 50.5% of the population, comprise only 38% of practicing physicians as of 2023. Similarly, while Native Americans comprise 3% of the United States population, Native physicians account for less than 1% of the physician workforce, with less than 10% of medical schools reporting total enrollment of more than four Native students.

The withdrawal of support for programs that seek to address underrepresentation opens the door for the regressive practices of the past. This includes reduced funding for qualified students seeking to enter the medical profession. J.M. believes the EDUCATE Act and similar actions will "tremendously affect the recruitment and retention of underrepresented students [not only] within the schools of nursing but also within the profession.”

The annual data report from the Association of American Medical Colleges on first-year enrollees in medical schools shows that this trend is already underway. The number of first-year enrollees (matriculants) from all groups historically underrepresented in medicine significantly declined compared with 2023 data. Notably, there was an increase in the number of applicants from these groups, but there was a decrease across the board in acceptances.

“If medicine becomes a profession where we are not allowed to promote diversity—which makes medicine so strong—we're going to lose good people,” said Dr. Adan (Adam) Mora, Jr., MD, FCCP, Intensivist and Associate Professor of Medicine in the Department of Internal Medicine at UT Southwestern Medical Center.

Adan (Adam) Mora, Jr., MD, FCCP

Living in Texas, Dr. Mora has felt the impact of legislative action, such as Texas Senate Bill 17, which bars public higher education institutions from specific DEI activities if receiving state funds. Since the law went into effect in January 2024, he’s seen residents set their sights on other states for fellowships. Senate Bill 17, in conjunction with other state laws around reproduction health, “has made a lot of people feel that Texas is not the best place for them to train,” Dr. Mora said.

Hurting patient outcomes

Prior to his time at UT Southwest, Dr. Mora led physician recruitment and retention efforts at Baylor University Medical Center in Dallas. “We were exploring what were the best ways to recruit a diverse population, because diversity brings strength,” Dr. Mora said.

If physician representation and patient outcomes are linked, as research shows, the lack of diverse medical school representation has dire consequences for matriculation, job recruitment, retention, and promotion. Research also indicates that a diverse medical workforce improves cultural competence and can help clinicians better meet the needs of patients from differing backgrounds and ethnicities than theirs.

One longitudinal study examining more than 1,600 counties in the US found that increased numbers of Black primary care providers led to an uptick in life expectancy for Black people and a reduction in mortality rate disparities between Black and White individuals. Research also shows that Black patients who see doctors matching their race are more likely to take advantage of preventative services, and patients with have better post-surgery outcomes.

Therefore, recruitment changes can lead to worsened outcomes and reduced health access and quality of care for patients. People who are interested in health equity tend also to be interested in DEI measures, according to Dr. Mora, who believes these changes may make people hesitant to promote health equity issues.

“The trend may be to not put anyone at risk, especially of losing funding sources,” Dr. Mora said. Schools may hold off on conversations or engaging in research due to concerns about running afoul of legislation, which would negatively impact vulnerable and disenfranchised populations, he said. “It's going to be harder to find some people if you can't discuss these topics during the interview process.”

What can you do?

If you’re in the medical field, whether as a student or practicing clinician, there are actions you can take if you’re disturbed by anti-DEI efforts.

Educate yourself and others

“Neither the intent nor the inclusion of DEI means disenfranchising other populations,” Dr. Mora noted. Rather, “it’s what will make health care stronger in the United States.”

One way to start is by clarifying terms: What is the intent of including DEI in admissions, education, and training? Define these terms, and communicate the meaning widely.

J.M. points out that diversity, which is often viewed as race only, includes considerations of gender and disability. For example, given the female-dominated characteristics of the nursing field, one high-priority goal at their institution is “creating more pathways for men to get into nursing and also to be successful within the profession.”

Hold conversations

“People should be vocal about the downstream effects of prohibiting diversity, equity, and inclusion in their recruitment activities and [not] creating a space that allows the conversation,” Dr. Mora said. “What avoiding the conversation does is it lessens the quality of medicine overall.”

Be clear and focused on your mission

“If your mission is to reduce health disparities, your curriculum will reflect that, and you’ll recruit [based on] that,” explained E.S., a physician and associate dean at a medical institution who requested anonymity. “That may mean thoughtful choices around admission standards and calibrated support for students once they’re admitted.”

E.S. (Requested Anonymity)

Because rural communities have higher rates for many conditions, including cancer and cardiovascular disease, and have an age-adjusted death rate that’s 20% higher compared with the death rate in urban areas, the institution where E.S. works is interested in attracting people from rural communities and having them serve those communities.

Students from rural communities may not come to this school with the same educational foundations, and the school is prepared to address them. Removing DEI-focused criteria from admissions could benefit students with educational advantages, working against underrepresented students.

The key to avoiding that: “Ensure that we are recruiting and admitting based on our mission and not strictly numerical scores or any one single point… [as well as] using holistic admissions so that we continue to recruit aligned to our mission and [are] very strategic and deliberate in how we support learners in different phases,” E.S. said.

Harness the power of organizations

Professional organizations in medicine have a significant role to play as leaders. CHEST issued statements of support for DEI within medical education, affirming the importance of health equity for patient care, and doubled down on our mission to prevent, diagnose, and treat chest diseases through evidence-based medicine and patient-centered care.

The American Medical Association (AMA) has expressed commitment to diversity initiatives in education. That means, J.M. noted, that despite any proposed bill, the AMA’s stated position is that these issues should continue to be woven into the curricula and part of the professional ethics of the profession.

The Association of American Medical Colleges helps with advocacy efforts and digs into how to create a student body that’s appropriate for the American workforce in the years to come, E.S. said. “As a school, as an organization, lean into those resources.”

Get involved with the local community

“Get involved in teaching at a local medical school, or invite students in your community to shadow you in your office,” E.S. suggested. “Your mentorship can spark young people’s interest in pursuing a career in health care.” Creating a pathway to medicine for underrepresented communities doesn’t require big actions.

E.S. recommends asking students about their interest in medical school, if they know what they want to major in, or if they’re ready for next week’s tests. “Those are things that help prepare and develop learners earlier in that pathway,” E.S. said.

The future lies with you

The medical community has always faced “unprecedented” challenges and repeatedly risen to the need. As CHEST celebrates its 90th anniversary, we are reflecting on the times that finding the cure seemed impossible, getting warnings on cigarettes looked insurmountable, and weathering the worst pandemic of the age felt unendurable. It is the unrelenting nature of individuals who make up the medical community that has made every obstacle surmountable.

“I do believe that we are in control of the future,” E.S. said. “I don’t feel powerless in this space to affect that future.”