Arshia Madni, MD FAAP, Corey Tapper, MD MS, Noelle Marie Javier, MD, Shellie N. Williams, MD FAAHPM, Jon P. Furuno, PhD FAAHPM
Diversity, equity, and inclusion (DEI) in medicine was born out of the attempt to protect diverse and marginalized patient populations and clinicians from the impacts of bias and racism they face in healthcare spaces. As a result, DEI initiatives intend to equalize the starting point and resources for populations with historically limited access to ensure equitable opportunities. Multiple studies in the fields of hospice and palliative medicine have revealed that Black, Indigenous, and people of color (BIPOC; inclusive of Latinx, Hispanic, Asian American, and Pacific Islander) as well as lesbian, gay, bisexual, transgender, queer, intersex plus (LGBTQI+) patient populations have been on the receiving end of ineffective symptom management, poor communication, and unfulfilled end-of-life wishes compared to their White, cisgender, straight counterparts. Similarly, BIPOC and LGBTQI+ clinicians have felt unseen, unheard, and continue to experience bias and racism by patients and colleagues alike. This type of negative work environment is demoralizing and can lead to qualified individuals not receiving promotions and not having mentorship and allyship opportunities for career development.
Anti-DEI bills have been passed in multiple states across the country, which are undoing the progress made over the last several years. Benefits and services that have grown from DEI programs charged with protecting underrepresented populations to promote equitable care and equal access to academic opportunities are being abolished.
Dismantling DEI initiatives in medicine and in academic medicine curricula presents devastating consequences of access to care, quality of care, and associated patient outcomes. This would further expand disparities between marginalized and majority populations in medicine. Studies strongly support the association between patients’ experiences with their medical care and race, ethnicity, and gender concordance with their healthcare providers. Furthermore, a less diverse provider population will result in reduced provider knowledge and ability to provide patient-centered care to an increasingly diverse patient population.
Impact of Anti-DEI Efforts: Voices from the Frontlines
The following is a collection of voices from the AAHPM community impacted by anti-DEI legislation. They preferred to remain anonymous.
“I am worried about the future of care for my pediatric palliative care patients. My state has been very vocal about removing any DEI education for our students, which can impact how they view the importance of giving equitable care.”
“I was at a conference where board members were very loudly and proudly sharing their views on supporting anti-DEI bills. I was taken aback at how they felt so comfortable, if not entitled, to proclaim these views, and now I, being someone who stands for justice, is expected to bite my tongue”.
“With more than 500 bills being introduced in congress impacting the LGBTQI+ community, I am worried about further oppression and disenfranchisement regarding basic human rights to high-quality health care, education, and policies that are supposed to be protective for the community.”
“The backlash by some in society towards DEI initiatives has led some academic institutions—including mine—to both backstep from these activities and withhold support from leaders in this field. As a member of the LGBTQI+ community who promotes DEI initiatives, it makes me wonder if my institution will continue to have my back.”
“I practice in a state that is a DEI champion; however, I fear the impact on recruitment and retention of talented clinicians of BIPOC identification in anti-DEI states. We have the privilege of career to geographically be selective; however, no one is considering the impact on loss of race concordance in care in these states when we further limit access to medical training for marginalized communities!”
What Are the Next Steps?
Though anti-DEI legislation impacts the landscape of DEI presence in institutions, it does not impact the vision, especially from those who are passionate. AAHPM remains committed to diversity, equity, inclusion, and justice. Those of us caring for patients who are marginalized and from underrepresented communities are still responsible for providing high-quality, inclusive, affirming, and equitable care. Furthermore, and addressing a common misperception, implementing DEI initiatives does not threaten majority access, but rather seeks to limit disparities in opportunities resulting from environmental and socioeconomic disadvantages. It is critical to dispel this misconception and continue to vocalize the needs and goals of DEI and how a more equitable healthcare environment will benefit us all.
Bibliography
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Arshia Madni, MD FAAP, is an assistant professor of pediatrics and associate program director of the hospice and palliative medicine fellowship at the University of Tennessee Health Sciences Center/Le Bonheur Children’s Hospital. She also is chair of AAHPM’s DEI Committee.
Corey Tapper, MD MS, is an assistant professor of medicine at Johns Hopkins University School of Medicine.
Noelle Marie Javier, MD, is an associate professor in the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai in New York. She also is chair-elect of AAHPM’s DEI Committee and past-chair of AAHPM’s LGBTQI+ special interest group.
Shellie N. Williams, MD FAAHPM, is an associate professor of medicine in the section of geriatrics and palliative medicine at The University of Chicago.
Jon P. Furuno, PhD FSHEA FAAHPM, is a professor in the department of pharmacy practice at Oregon State University College of Pharmacy.