Activist MDs have abandoned their duty: teaching students how to treat patients.
The actions of the so-called Department of Government Efficiency, or DOGE, have turned thousands of physicians into political activists.
The American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the American College of Physicians have implored Congress and President Trump to reverse staff cuts at the National Institutes of Health, the Centers for Disease Control and Prevention (CDC), and the Food and Drug Administration. Panicked physicians are sounding the alarm over the prospect of 7.6 million Medicaid recipients losing health-care coverage.
Such physician advocacy, aimed at protecting patients, is not especially controversial. But other forms of advocacy are more troubling.
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, 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 publishing a peer-reviewed critique of affirmative action in a respected medical journal, Wang’s 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.In late 2019, 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.
