Crisis of Competence
How DEI Undermines Medical Training and Patient Safety
DEI is a recent label, but the ideology it describes has been a constant presence throughout my academic life. Before the acronym, it went by other names: affirmative action, equity, equality, and most perversely, “color-blind” admissions, a phrase that meant precisely the opposite. The euphemisms change, but the philosophy is not new. I ultimately succeeded within this system and now practice medicine, and my concern is not personal grievance but the long-term consequences of institutional priorities that increasingly subordinate competence to ideology.
One of my earliest encounters with this worldview came long before medicine. In elementary school, my trapper keeper disappeared from my desk. I knew it was stolen. Teachers assumed I was careless or dishonest, manufacturing an excuse rather than accepting responsibility. I was neither. I later found the binder tossed behind lockers, its contents partially destroyed, another child’s name written inside. I brought it to my teacher, vindicated. Nothing happened. No discipline. No acknowledgment of wrongdoing. The lesson was not lost on me. Certain transgressions were excusable depending on who committed them. Whatever the intent, the effect was that accountability yielded to racial discomfort, and misconduct went unaddressed.
That same pattern followed me through every subsequent academic gate. I did not merely have to be competitive. I had to be exceptional. To gain admission to a private high school, I posted one of the highest entrance exam scores in the school’s history, while many minority students were admitted with weaker academic records, subsidized tuition, private tutoring, and broad tolerance for misconduct. This disparity widened rather than narrowed in college and medical school.
By the time I applied to medical school, my résumé would have been regarded as elite had it belonged to a different demographic. A perfect GPA. 99th percentile MCAT. A strong academic pedigree. Yet my acceptances were limited to in-state public schools. The message was implicit but unmistakable. Merit was necessary, but no longer sufficient, and in some cases was actively disfavored.
Medical school stripped away any remaining ambiguity. I served on the admissions committee and saw the process from the inside. Officially, we evaluated applicants on academic performance, personal statements, and interviews. In practice, Black applicants were set aside for special review by the dean of admissions, who personally selected a cohort irrespective of objective qualifications. This was not presented as an exception, but as an explicit institutional commitment.
Once admitted, these students were insulated from the rigor the rest of us faced. They were graded on a different curve. They carried a lighter course load. While the rest of the student body used summers for research or remediation, these students were allowed to stretch preclinical coursework over the additional time. They received extra time on exams and private tutoring unavailable to others. Many still failed to graduate on time. Most were ultimately passed along anyway. These accommodations were not tied to individualized remediation plans or objective performance deficits, but were granted categorically based on group membership.
Residency reproduced the same pattern. Despite women being over-represented in medicine, program leadership openly stated that rank lists would prioritize women and under-represented minorities.1 As chief resident, I interviewed applicants whose board scores and CVs would have disqualified them under any neutral standard, yet they were described as “high flyers.” I could not voice reservations without risking accusations of racism or professionalism violations. Silence was safer.
The outcome was entirely predictable. The residents admitted under these preferences consistently underperformed. The only residents ever held back during my residency training were Black. That fact itself generated accusations of racism, including a graduation boycott. The irony was complete. Those claiming victimhood were the primary beneficiaries of racial preference. Those constrained by it were expected to absorb the consequences quietly.
This inversion is not confined to admissions committees. It now dominates medical research and media interpretation.
A widely publicized study claimed that Black infants experience significantly lower mortality when treated by Black physicians, and that White physicians contribute to racial mortality gaps.2 The story ricocheted through mainstream media, reinforcing a familiar narrative: White doctors are biased, incompetent, or indifferent.3 The original paper was more cautious in its language, but those nuances were discarded in media coverage that framed physician race itself as a causal determinant of infant mortality.
Subsequent reanalysis of the same data revealed a far less ideological conclusion. Once case severity, particularly very low birth weight, was properly controlled for, the purported racial effect largely disappeared. White physicians disproportionately cared for sicker, higher-risk infants and achieved comparable or better outcomes.4
The problem is not that authors and reporters are making honest errors, which overwhelmingly seem to go in the same direction. The problem is motivation and agenda. The medical literature and the press increasingly select for conclusions that affirm racialized moral priors, even when the data do not.
Doctors who challenge this framework learn quickly that dissent carries consequences. The most instructive example is Norman Wang, a cardiologist and academic who published a peer-reviewed critique of DEI policies in cardiology.5 His article questioned the effectiveness and legality of race-based workforce initiatives. It was retracted despite no evidence of fraud or data falsification. He was stripped of leadership roles and marginalized within his institution.6 He later brought civil suit which was ultimately unsuccessful.7 The message to other physicians was clear. Questioning DEI orthodoxy carries professional risk, even when done through peer-reviewed scholarship.
Certain conclusions are impermissible regardless of the quality of evidence supporting them. In academic medicine, disagreement on matters of race and equity is not treated as an intellectual dispute to be resolved through debate or further study, but as a moral transgression requiring correction. Consensus is enforced not by persuasion, but by professional risk: loss of status, loss of authority, and loss of institutional belonging. Within such an environment, self-censorship becomes rational behavior, and conformity masquerades as virtue. In practice, this manifests in admissions meetings, rank list discussions, and curriculum committees where reservations go unspoken and unanimity is mistaken for moral clarity.
DEI has not made medicine fairer. It has made it less honest. It has replaced merit with optics, standards with sensitivities, and truth with narrative management. It has created a class of physicians shielded from accountability and another class taught that silence is the price of survival. Academic medicine and its media partners are active participants in portraying White physicians as moral liabilities and racial minorities as perpetual victims, even when data and lived experience contradict that framing.
The greatest casualty is not professional morale but patient safety. Medical training is not a symbolic exercise or a social credential. It exists to prepare physicians for decisions that carry irreversible consequences, often made under uncertainty and time pressure, where errors are measured in permanent injury or death. When the purpose of training shifts from identifying and developing the most capable physicians to serving as a mechanism for social signaling or retrospective moral repair, merit and competence inevitably lose their primacy. Standards soften, expectations fragment, and ultimately, patients are harmed. If medicine is to remain worthy of public trust, there must be non-negotiable standards of competence that are transparent, uniformly applied, and insulated from political fashion. A system that cannot speak honestly about competence cannot reliably ensure it.
Association of American Medical Colleges. The State of Women in Academic Medicine: 2023–2024. AAMC. https://www.aamc.org/data-reports/faculty-institutions/report/state-women-academic-medicine
Greenwood BN, Hardeman RR, Huang L, Sojourner A.Physician–patient racial concordance and disparities in birthing mortality for newborns. Proceedings of the National Academy of Sciences of the United States of America (PNAS). 2020;117(35):21194–21200. doi: 10.1073/pnas.1913405117. https://www.pnas.org/doi/10.1073/pnas.1913405117
McPhillips D. Black babies more likely to die when cared for by White doctors, study finds. CNN. August 18, 2020. https://www.cnn.com/2020/08/18/health/black-babies-mortality-rate-doctors-study-wellness-scli-intl
Chen A. Study claiming Black doctors save Black newborns challenged after key factor omitted. STAT. October 23, 2024. https://www.statnews.com/2024/10/23/study-finding-physician-race-affects-black-infant-mortality-challenged/
Wang NC. Diversity, Inclusion, and Equity: Evolution of Race and Ethnicity Considerations for the Cardiology Workforce in the United States of America From 1969 to 2019. Journal of the American Heart Association. 2020;9(15):e016959. doi: 10.1161/JAHA.120.016959. https://www.ahajournals.org/doi/pdf/10.1161/JAHA.120.015959
French D. Pittsburgh Med School Punishes a Professor Who Dissents on Diversity. National Review. January 24, 2022. https://www.nationalreview.com/corner/pittsburgh-med-school-punishes-a-professor-who-dissents-on-diversity/
Civil Rights Initiative. Norman Wang v. University of Pittsburgh. Civil Rights Initiative for Freedom of Speech and Equality. https://cir-usa.org/cases/norman-wang-v-university-of-pittsburgh/
Becker’s ASC Review. Cardiologist loses lawsuit against medical school alleging discrimination. Becker’s ASC Review. July 19, 2023. https://www.beckersasc.com/cardiology/cardiologist-loses-lawsuit-against-medical-school-alleging-discrimination/