Medical institutions across the U.S. — including associations, medical schools, and health systems — are facing a defining moment as political shifts threaten to reshape their approach to diversity, equity, and inclusion (DEI) initiatives. With President Trump’s executive orders poised to curtail federally funded DEI programs and gender ideology in healthcare, these institutions must make a consequential decision. Will they persist in advancing DEI-driven policies despite growing resistance, or will they pivot toward a renewed emphasis on merit, excellence, and evidence-based scholarship with no regard for diversity? The answer may determine not only the future of these associations but also the quality of medical care itself.
Proponents of DEI argue that these initiatives address systemic inequities in healthcare, increase representation among marginalized groups, and ultimately lead to better patient outcomes — improved patient compliance, enhanced problem solving, and increased trust and engagement. The emphasis on cultural competence and diverse perspectives is often framed as a means to mitigate health disparities, improve physician-patient relationships, and create a more inclusive medical workforce.
Organizations such as the American Medical Association (AMA) and the Association of American Medical Colleges (AAMC) have embraced these ideals, implementing policies to diversify admissions, faculty hiring, and research funding. Their stance has been that a medical system attuned to social determinants of health is a more effective and just one.
However, critics contend that DEI policies have strayed too far from the core principles of medicine: scientific rigor, meritocracy, and evidence-based practice. They argue that medical schools and residency programs should prioritize selecting the best candidates based on ability rather than demographic quotas. They also contend that affirmative action admission policies in medical schools contravene the 2023 Supreme Court ruling in Students for Fair Admissions v. Harvard.
Moreover, opponents have raised concerns that ideological commitments to DEI have led to the suppression of scientific inquiry, with physicians and researchers discouraged from questioning dominant narratives on topics such as gender-affirming care and race-based treatment protocols. A prime example of this tension is the backlash physicians face when they express concern about the potential long-term side effects of hormone therapy for minors, despite unresolved scientific debates on the subject.
The conflict between DEI and meritocracy is further illustrated by recent controversies in medical education. Some institutions have reduced the emphasis on standardized testing, such as the MCAT and USMLE Step 1 scores, arguing that these exams disadvantage underrepresented applicants. While well-intentioned, this shift has sparked concerns about declining competency standards and the long-term impact on patient safety. If the medical profession moves away from objective measures of skill and knowledge in favor of subjective considerations, it risks eroding public trust and weakening the profession’s commitment to excellence.
Yet, it is worth asking whether DEI and meritocracy must be mutually exclusive. A well-designed system could ensure fairness while maintaining rigorous standards. For example, initiatives that expand educational opportunities for disadvantaged students without lowering the bar for medical competence could strike a balance between inclusivity and excellence. Programs that mentor aspiring physicians from underrepresented backgrounds while holding all applicants to the same academic and clinical benchmarks might achieve diversity without compromising quality. The challenge lies in implementing policies that uplift rather than dilute the profession’s core values.
Medical organizations must also consider the broader societal and legal landscape when determining how staunchly they will adhere to DEI-driven policies. In November 2024, Walmart announced that it would be scaling back its DEI programs, a move that signaled a broader shift among some major corporations. Other businesses have followed suit, recognizing the growing resistance to DEI-based hiring and promotion strategies. The pharmaceutical giant Pfizer recently settled a legal dispute with the “Do No Harm” organization over its “Breakthrough” fellowship, which had excluded white and Asian American applicants. Facing a federal civil rights lawsuit, Pfizer ultimately opened the program to candidates of all racial backgrounds.
These developments highlight the increasing legal and financial risks associated with maintaining rigid DEI policies, particularly those that explicitly favor certain groups over others. As corporations retreat from these initiatives in response to government, public, and legal pressure, medical associations and institutions must decide whether to do the same or to hold firm to DEI principles, despite potential backlash.
As medical associations, schools, and health systems reassess their strategy, they must confront a difficult reality: doubling down on DEI in its current form may alienate physicians, policymakers, and the public who see these initiatives as ideologically driven rather than pragmatically necessary. On the other hand, abandoning DEI entirely could be perceived as ignoring genuine inequities that persist in healthcare access and outcomes.
In fact, in the wake of the Supreme Court decision, medical school matriculants in MD-granting schools from groups that are historically underrepresented in medicine declined across the board in 2024 compared to 2023. What might this mean for care of minority populations?
The path forward requires a recalibration — one that reaffirms a commitment to scientific integrity and high standards while acknowledging the need for a diverse and inclusive medical workforce. Whether associations and institutions will take this balanced approach — and whether it can be achieved — remains to be seen, but the stakes for the future of American medicine could not be higher.
Arthur Lazarus, MD, MBA, is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia. He is the author of several books on narrative medicine, including Medicine on Fire: A Narrative Travelogue and Story Treasures: Medical Essays and Insights in the Narrative Tradition.
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