Last year, Oregon Health & Science University Hillsboro Medical Center began developing an "anti-racism and structural competency curriculum" for internal medicine residents. The school wasn't alone. Georgetown University Hospital created a "social medicine and health equity track" for its residents. And this year, the health care system Honor Health started a project "to demonstrate how health care organizations can address DEI [diversity, equity, and inclusion] through the formation of People Resource Groups, affinity groups"—that is, segregated groups—"based on race, ethnicity, gender, and/or orientation."
The throughline is the American Board of Internal Medicine (ABIM) Foundation, the charity arm of the American Board of Internal Medicine, which certifies internists and is funding the development of the curricula. Both organizations wield significant influence in medicine, and over the past few years, they have used that influence to push an ideological agenda under the guise of DEI, health equity, and "antiracism."
ABIM's shift toward the promotion of DEI began with its release of a statement in June 2020 decrying the "structural inequity" embedded in the health care system and pledging to confront the "constructed social world"—whatever that is—that allows illness to spread. The organization released a progress report, declaring in Kendian language how it had transitioned from being "passively non-racist" to "actively anti-racist."
Now, ABIM is using every bit of influence it has to push DEI in medicine, requiring physicians to educate themselves in this political pablum to practice their craft. It is part of a trend, underwritten by some of the country's largest foundations, that has seen accrediting bodies incorporate social justice ideology into their requirements for member schools. The American Bar Association, which accredits almost every law school in the country, approved a standard in February that requires law students to learn about "bias, cross-cultural competency, and racism." The National Association of Independent Schools, which oversees accreditation standards for more than 1,600 American private schools, requires members to practice "cross-cultural competency" to promote "diversity, inclusion, equity, and justice."
ABIM's push for DEI has found its way into the most basic function of the organization, which is the certification of internal medicine practitioners. Internists must pass ABIM's Maintenance of Certification Exam every 10 years. As of April 2021, "health equity" questions are now included on all exams.
ABIM has not elaborated on the "health equity" questions it will pose, but it has dropped hints. Earlier this month, the Association of American Medical Colleges (AAMC) released a list of "DEI competencies" that ABIM has endorsed. They include the practice of "allyship" in the face of "microaggression[s]" and call on residents to demonstrate their knowledge of "intersectionality" and "engage with systems to disrupt oppressive practices."
They are a set of medical education standards that are filled with the watchwords of identity politics and draw from the even more explicitly ideological report Advancing Health Equity: A Guide to Language, Narratives, and Concepts. ABIM endorsed these competencies, posting on Twitter that "ABIM stands with AAMC as they release their new DEI competencies to better care for patients. Future physicians will benefit from a better understanding of barriers and learn skills in how to be culturally responsive." Internists should hope that ABIM doesn't follow the AAMC's lead.
But ABIM's efforts go beyond certification requirements. "When ABIM decides to do something, it pours jet fuel on the issue," said a senior physician familiar with the board. "And over the last few years, it has chosen DEI, and in particular, anti-racism." The organization's Summer Forum last year, described by one physician as a gathering of the "who's who" of medicine, focused on "building trust" through DEI efforts.
The Summer Forum is often the launchpad for a broader policy agenda. The ABIM Foundation has flexed its muscles in medical education before, most notably with "Choosing Wisely," an educational campaign designed to reduce unnecessary medical procedures. The campaign was also first conceived at a Summer Forum. By 2015, ABIM received a $4.2 million grant from the Robert Wood Johnson Foundation for the campaign, which by then had already gained notable traction. As one physician at an elite medical school told me, the campaign "really made a difference in medicine."
The ABIM Foundation is now investing the same energy—and a fair bit of money—in spreading DEI education throughout medical institutions. In collaboration with the Josiah Macy Jr. Foundation, ABIM has launched the Building Trust & Equity in Internal Medicine Training Grant, designed to support projects "incorporating diversity, equity, and inclusion (DEI) into the fabric of internal medicine education and training."
Thus, ABIM is now underwriting the DEI curricula at medical schools and hospitals across the country. These grants include $20,000 to the University of California-San Diego for developing a "social justice" curriculum for its internal medicine residency program; $20,000 to University of Illinois at Chicago to "develop educational sessions targeting the microaggressions"; and $5,000 to the University of California-Davis for a program designed "to build trustworthiness among residents and faculty by challenging traditional hierarchical advising structures."
A large portion of medical DEI programming proves to be ideologically charged, even when it hides behind the vague language of "health equity." A lot of DEI training, moreover, raises obvious concerns. Microaggression training, for example, can easily foster hypersensitivity, self-censorship, and language policing—an especially dangerous combination in the context of medical education and residency, when teaching physicians need the freedom to give honest feedback.
Many of the physicians I spoke with were concerned that ABIM's attempts to "build trust" through DEI would have the opposite effect. Already, one physician told me, "poor interactions with our inefficient and impersonal medical system are now increasingly interpreted through the lens of race." ABIM's initiatives could easily exacerbate that problem, condemning the American medical system as plagued by "structural inequity." As the doctor put it: "Addressing mistrust by creating mistrust."
John Sailer is a fellow at the National Association of Scholars.