March 30th marks National Doctors’ Day – a day meant to honor the immense work and impact physicians have in caring for our patients and their communities. As resident physicians, we are proud and honored to have joined this noble profession.
However, on this particular Doctors’ Day, we are also acutely aware that medicine is–once again–at a historic crossroads. The recent waves of sweeping anti-diversity, equity, and inclusion (DEI) legislation threaten to undermine the critical strides our profession has made over the past decade. This begs the question: Will we stand firm in our commitment or let the meritocracy tide overtake us?
On March 19th, 2024, House Representative (3rd District-North Carolina) and surgeon Dr. Gregory Murphy proposed the Embracing Anti-Discrimination, Unbiased Curricula, and Advancing Truth in Education (EDUCATE) Act. The bill aims to eliminate federal funding from medical schools that continue to promote diversity, equity, and inclusion work in medicine and medical education by amending the Higher Education Act of 1965. With this bill, Congressman Murphy believes the United States medical system as a whole will become fixed by solely focusing on meritocracy when teaching and preparing the next generation of physicians–a flawed myth rooted in structural inequalities as well as centuries of racism that have robbed whole communities of resources and opportunities.
Evidence of individual exceptionalism or meritocracy falsely attributes individual success to individual effort while failing to acknowledge contributory systemic, structural, or environmental factors that make each individual unique.
This “meritocratic inheritance,” as described in Daniel Markovits’s The Meritocracy Trap, is prevalent in medicine and used to disguise privilege–that is, being born to the right family, in the right environment, with the right connections, will lead one to find and attain the “calling” of being a physician.
Falling into the meritocracy trap is akin to believing the world and our lives to be a dichotomy of black and white, yes and no. As physicians, when we reflect on our own lived experiences, we know that this is simply not the case. We see the societal consequences of a meritocracy every day of our careers–from the way some of our colleagues’ accomplishments have been ignored or undervalued to the numerous health disparities that continue to plague the American health care system.
Twenty years ago, the Unequal Treatment report, spearheaded by the National Institute of Health (NIH), was released to define how racial and ethnic disparities impact our health care system’s costs and outcomes. This report yielded recommendations centered on increasing the number of minority health professionals, educating providers on the impact of biases in health care, and implementing initiatives centered on eliminating health disparities within hospital systems.
Now, 20 years later, despite the implementation of these recommendations, health care disparities continue to persist with harrowing consequences for minoritized and marginalized patient populations, including missed cancer diagnoses, worse pain control, and increased rates of maternal mortality.
Without providing evidence, it is easy to say that “DEI initiatives” are to blame when, in fact, social inequity drivers are the true culprits. Dr. Nancy Krieger, a Harvard scholar, reflected on the Unequal Treatment report, saying, “It’s not enough to recommend people get more exercise and eat more nutritious food if they don’t have adequate green space in their neighborhood or accessible grocery stores with affordable healthy foods.”
Likewise, the argument for meritocracy-centered medical education falls flat when trying to address health disparities. The lack of diversity in medical education has had ramifications in clinical medicine, including the disparate care of marginalized populations–from the high rate of maternal mortality among Black mothers to delayed diagnosis of cervical cancer – both circumstances recently seen with Krystal Anderson and Jessica Pettway, respectively.
Whether the physician was “meritorious” is insufficient and fails to address the crux of the problem. The harms our medical education system has inflicted on these patients are irreparable, but DEI initiatives have at least brought these issues to the forefront for our profession to try again and improve. It’s been shown that physicians from racially/ethnically underrepresented groups in medicine (URiM) are more likely to serve underserved and rural communities than their white counterparts.
The art and storytelling aspect of clinical medicine will always make our profession unique. However, both aspects can lead to biases that lead to the health disparities outcomes that our profession is riddled with. As Congressman Murphy noted in a prior National Doctors’ Day, when he highlighted the alarming physician shortage in the United States, “at one point or another, everyone will need a doctor in their life.” DEI initiatives aim to ensure that when that point comes, the physician taking care of you is listening, culturally sensitive, and empathic to your experiences. Now is not the time to threaten cutting funding to medical schools that are essential pipelines for the physician workforce of the near future.
As mentioned before, our profession is at a crossroads as to whether we embrace techniques that can help us solve these ever-mounting health disparities or continue to provide unequal care to certain populations. We need more than statements from our medical societies and associations to ensure DEI-centered initiatives in medicine remain in order to solve the former and fix our health care system. So, will we be swept by the tide of meritocracy, or will we hold firm to our mission and the true needs of the populations that we care for? Only time will tell.
Faith Crittenden is a pediatric resident. Pratiksha Yalakkishettar is a family medicine physician and preventive medicine fellow. Pauline Huynh is an otolaryngology resident. Whitney Sambhariya is an ophthalmology resident.
The views expressed in this article are those of the authors and do not necessarily reflect the views or policies of their respective institutions.
