Medical School Has Gotten Too Political
"Over the past decade, we’ve grown ever more concerned about dubious strains of social-justice advocacy infiltrating medicine. Following the murder of George Floyd in 2020, doctors’ pursuit of social reform coalesced, almost overnight, into a mission.
Within
a week of Floyd’s death, for example, the Association of American
Medical Colleges, which is a co-sponsor of a major accrediting body, announced
that the nation’s 155 medical schools “must employ antiracist and
unconscious bias training and engage in interracial dialogues.” A year
later (and again in 2024), the American Medical Association released
a Strategic Plan to Embed Racial Justice and Advance Health Equity that
encouraged physicians to dismantle “white patriarchy and other systems
of oppression.” Over two dozen medical schools issued their own similar plans.
According
to Columbia University’s department of medical humanities and ethics,
advocacy is “the bridge that links patient care with efforts to address
social determinants of health, institutionalized prejudices, and
structural dislocations faced by patients and communities.” The
department sought to develop a “cadre of advocates with expertise in
achieving policy change at the local, state, and national level.”
Medical
students are now immersed in the notion that undertaking political
advocacy is as important as learning gross anatomy, physiology, and
pharmacology. This is the wrong lesson. Their professors should lead
them, instead, to ponder important questions about the impact of
advocacy on patients and the profession.
Today,
doctors perform political advocacy in myriad ways. State medical boards
have added a requirement for training in “antiracism” in order to be
eligible for a medical license, according to the Federation of State Medical Boards. The University of California at San Francisco (UCSF) created a document titled “Anti-Racism and Race Literacy: A Primer and Toolkit for Medical Educators.”
Certain
debates have become off-limits. Consider, for instance, a 2020 incident
involving Norman C. Wang, a cardiologist with the University of
Pittsburgh School of Medicine. After Wang published a peer-reviewed
critique of affirmative action in a respected medical journal, his
colleagues denounced him on social media for his “racist thinking” and
condemned his paper as scientifically invalid and “racist.” The journal
retracted his article and the school removed him as director of the
electrophysiology program. (Wang sued for retaliation and
discrimination, but was unsuccessful.)
Researchers
are promoting unscientific modes of thinking about group-based
disparities in health access and status. The University of Minnesota’s
Center for Antiracism Research for Health Equity decrees “structural
racism as a fundamental cause of health inequities,” despite the fact
that this is at best an arguable thesis, not a fact. (The center was shut down last month.) The Kaiser Family Foundation states that health differentials “stem from broader social and economic inequities.”
In what borders on compelled speech, the State University of New York’s Upstate Medical University issued a 164-page report
from a diversity task force insisting that “Health care professionals
must explicitly acknowledge that race and racism are at the root of
[Black-white] health disparities.” Other variables influencing the
course of chronic disease, prominently the patient’s health literacy and
self-care, receive scant attention.
Some medical professionals have even endorsed racial reparations in health care decision-making. At one point, the CDC vaccine advisory committee proposed
prioritizing the anticipated Covid vaccine by race rather than age,
solely because older cohorts disproportionately comprised whites. This
plan would have delayed vaccination of the elderly — the highest risk
group — and, according to the CDC’s own projections, resulted in more overall deaths. Other sponsors of health equity lobbied for a rationing scheme that prioritized the assignment of ventilators to Black patients, negating customary triage procedures.
Perhaps
the most dramatic recent display of ideological intrusion into the
medical sphere took place last June at the UCSF Medical Center, where keffiyeh-draped
doctors gathered on the grounds to demand that their institution call
for a ceasefire in the war between Israel and Hamas. Their chants of
“intifada, intifada, long live intifada!” echoed into patients’ rooms.
These
doctors were not putting patients first — if anything, they were
offending and intimidating patients. They were putting their notion of
social justice first.
As
doctors, we believe that it is enough for us to demand of ourselves
that we be good at taking care of patients. But for individual doctors
who wish to responsibly leverage their professional standing to effect
political change, we propose three guidelines. They should advocate for
policies that 1) directly help patients and 2) are rooted in
professional expertise, while 3) ensuring that their advocacy does not
interfere with their relationships with their colleagues, students, and
patients.
First,
the reform they promote must have a high likelihood of directly
improving patient health. “Dismantling white patriarchy and other
systems of oppression” is not an actionable goal. Our primary job is to
diagnose and treat, and to do no harm in the process. We have no
expertise in redistributing power and wealth. Even seasoned policy
analysts cannot readily tease out strong causal links between health and
economic and social factors that lie upstream.
Indeed,
with so many variables at play, manipulating policy in the service of
health may not have the intended effect — and can easily create unwanted
repercussions elsewhere in the system. The costs and benefits would be
almost impossible to assess ahead of time. Moreover, patients suffering
today have no time to wait for fundamental societal reorganization.
We
do not deny that much of the health disadvantage suffered by minority
groups is the cumulative product of legal, political, and social
institutions that historically discriminated against them. But past
discrimination is not necessarily a factor sustaining those problems
now. We must address the discrete causes that operate today.
Second,
physicians’ actions or their advice to policymakers should be rooted in
expertise that is unique to their profession. Opining and advocating on
behalf of general social issues exploits their moral authority, turns
medicine into a vehicle for politics, and risks the trust of the public.
Medical professionals will, of course, have their own views of the
public good. They are free to take to the barricades as citizens — but
not while wearing their white coats.
Third,
doctors must not lose sight of the impact of advocacy on patients and
students. While advocating for one’s own patients is a basic obligation
of being a doctor, advocating on behalf of societal change can work
against those patients, drawing time and attention away from their care.
The
faculty must also protect medical students’ education, an imperative
complicated by advocacy, which seeks change rather than knowledge.
Taking strong political stands at work also risks alienating trainees
and colleagues with whom faculty members must collaborate in caring for
patients. Trainees who hold different political views may withhold their
opinions out of concern for their career prospects.
Our health-care system has many problems, including high costs, limited access, and plummeting
trust following the Covid-19 pandemic. As America’s poor and
marginalized bear these and other burdens most acutely, it is natural
that some physicians will want to go beyond the day-to-day care of
individual patients.
One meaningful action that young doctors — who are among the most
left-leaning, politically active in medicine, and most apt to assume
leadership roles — could take is to work in underserved areas. According
to a 2020 analysis
led by Adam Bonica of Stanford University, young physicians in the
prior decade had been moving so “sharply to the left” and flocking so
densely to urban areas — “ideological sorting,” the authors called it —
that rural areas were suffering from shortages of physicians.
A new report in the Journal of the American Medical Association
found that newly licensed clinicians from top-ranked medical
institutions were half as likely to initially practice in
socioeconomically deprived areas as graduates from other medical
institutions. Specialists were also less likely to practice in deprived
areas compared with primary-care clinicians.
Our
profession appears to confront a growing paradox. Young physicians
trained at elite schools are least likely to care for patients in the
places they are most needed and could do the most good. At the same
time, they are the most apt to promote vague goals of social justice as a
professional duty. In so doing, they are helping neither patients nor
the profession."
