When I applied to medical school in the midst of the pandemic and in the wake of the death of George Floyd, I had reason to think I was a competitive applicant, particularly for my state’s public medical school, which favors in-state candidates with strong academic records. I didn’t assume I was entitled to admission, but I thought I would get in somewhere. I didn’t.
So I did what failed applicants are told to do: I sought feedback. Eventually, I spoke with an admissions officer at one of the schools that rejected me. He told me that I was extremely qualified and had everything the school looked for in an applicant. He said he couldn’t give me a concrete reason I wasn’t accepted, other than that I didn’t fit the demographic the school was prioritizing, and that other applicants were viewed as having “traveled a longer distance” to medicine. My application, he said, was evaluated through that lens.
That conversation unsettled me in a way I didn’t immediately recognize. I was being told I was qualified, capable, and deserving but simultaneously that those qualities were not enough due to certain immutable characteristics. I had spent years learning about discrimination as something that happened to other people. Nothing in my education had prepared me to think that it could happen to people like me.
Then it did.
Perhaps I should have seen it coming. The requirements for admission into medical school vary markedly depending on who the applicant is. According to data from the Association of American Medical Colleges (AAMC), the academic thresholds required for acceptance differ substantially between racial groups. The average MCAT score of a white applicant who is accepted into a medical school is 512.4, approximately the 85th percentile nationally. By contrast, the average MCAT score for accepted American Indian applicants is 502.2 (56th percentile), for accepted black applicants 505.7 (67th percentile), and for accepted Hispanic applicants 506.4 (69th percentile).
The disparities are even more pronounced when we look at the applicant pool as a whole. White applicants overall, including those who are rejected, have an average MCAT score of 507.8, roughly the 73rd percentile. In other words, accepted black, Hispanic, and American Indian medical students matriculate with lower MCAT scores, on average, than white applicants who have not yet been accepted to medical school. The same pattern appears when we turn to undergraduate GPA. White applicants apply with an average GPA of 3.7, but require an average GPA of 3.8 to gain admission, while accepted black, Hispanic, and American Indian applicants matriculate with average GPAs of 3.59, 3.66, and 3.64, respectively.
I ended that phone call with a realization: If I wanted to succeed in medicine, I couldn’t leave room for doubt. So I pursued a NIH research fellowship, received research training, published scientific papers, and obtained letters of recommendation from prominent virologists. When I reapplied, I was accepted to multiple medical schools and received significant scholarship offers to many of them. But once again, my state’s flagship institution rejected me. I don’t claim to know precisely why. But patterns are hard to ignore.
When I arrived at medical school, it became clear that admissions were only the beginning. The same ideological framework that governed entry into the system shaped the culture inside it. Orientation included an entire day devoted to diversity, equity, and inclusion (DEI). We were asked, and even pressed, to publicly recount moments of discrimination from our lives. The exercise assumed a shared framework of identity and victimhood. At one point, a student asked the DEI instructor to explain the meaning of “demisexual,” which was written next to the “Gender Unicorn” they were teaching us about. After a long pause, the instructor admitted she didn’t know how to define it.
Similar things were happening at medical schools nationwide. The same year, students in the first-year cohort at the University of Minnesota were presented with an “anti-racism” pledge during their White Coat Ceremony that went well beyond traditional professional oaths. The pledge, read aloud by the entire incoming class, included a formal land acknowledgment and required students to affirm a recognition of “inequities built by past and present traumas rooted in white supremacy, colonialism, the gender binary, ableism, and all forms of oppression.”
In 2021, the Department of Medicine at Georgetown held a grand rounds lecture on anti-racism in medical education in which the invited speaker framed our healthcare system as operating within a “culture of white supremacy.” Residents and attending physicians were given an online document outlining the features of this culture. Traits such as “objectivity,” “perfectionism,” “a sense of urgency,” “worship of the written word,” and an emphasis on “measurable outcomes” are labeled as manifestations of white supremacy and presented as aspects of our society that must be dismantled. In the context of medicine, one might assume that objectivity, rigorous documentation, timely decision-making, and high standards of care are central to patient safety and clinical competence rather than expressions of racism. Yet a suspicion of these principles was being instilled into future physicians.
“Faculty members made sweeping, negative statements about ‘old white men in medicine.’”
As my preclinical years unfolded, faculty members made sweeping, negative statements about “old white men in medicine,” often pausing mid-sentence to add “no offense” while glancing in my direction. When classmates learned that my family lives in rural Montana and that my adopted sister is Asian, one student remarked that she couldn’t imagine how my sister could “feel safe” living around “that many white people.”
Even scientific language became a site of moral enforcement. In anatomy, we were instructed to avoid long-established eponyms, such as the “fallopian tube” (named after Italian anatomist Gabriele Falloppio) not because they were unclear or outdated, but because they were named for historical white figures, now deemed unacceptable. On examinations, points were deducted for using the “wrong” term.
During this same period, our faculty held a mandatory session where they openly criticized the Supreme Court’s 2023 decision to overturn race-conscious admissions in higher education, presenting it not as a contested legal ruling but as a moral failure. In the lecture, a senior faculty member on our school’s Diversity & Inclusion Team referred to the Tuskegee Syphilis Study as the “Tuskegee Airmen Project,” confusing an infamous violation of medical research ethics with the first cohort of black military aviators. The faculty member went on to describe it as a case in which white physicians had intentionally infected black men with syphilis. The real atrocity, that treatment was deliberately withheld after a cure was discovered, was bad enough. No one corrected the error.
At one point, when a classmate unintentionally misstated a peer’s pronouns on a written evaluation, the result was a disciplinary process that included a formal apology and mandatory posting of his own pronouns on his school account, which was optional for everyone else. Later in our education, a senior faculty member who was a mentor to the offended student made the same mistake in front of our entire class, without consequence.
Medical students face powerful incentives to affirm the reigning values. At my school, one of the most prestigious student awards, factored into scholarships, dean’s letters, and Alpha Omega Alpha (AOA) Honor Society consideration, explicitly included “activities related to DEI” as a core selection criterion, with equal weighting alongside a student’s grades, research, leadership, and community service. Many medical education opportunities, including prestigious summer research fellowships, scholarship funds, leadership pipelines, and formal mentorship programs, explicitly barred some applicants on the basis of race or ethnicity.
Given these facts, I felt I had only one option. I learned the language, joined the committees, and even served on my institution’s DEI council. Along with my desire to get ahead, there was genuine curiosity. I wanted to understand how decisions were made and what was actually rewarded. It worked. I received the school’s Outstanding Student Award in both my first and second years. I won seven institutional scholarships, some explicitly tied to “championing diversity and inclusion.” I was inducted into the medical honor society AOA, one of the most consequential distinctions in medical training. I eventually received the school’s Excellence in Diversity Award, an annual honor given to just two students, though I later learned some classmates were upset that a white man had been selected.
“I experienced an inescapable cognitive dissonance.”
Yet no matter how successful I was, I experienced an inescapable cognitive dissonance. I was expected to participate enthusiastically in frameworks that portrayed my demographic as morally suspect, to internalize narratives in which my achievements were implicitly discounted, and to affirm values that often excluded me by design. After a mass shooting, a preceptor launched into a tirade about how “white men were a danger to society.” On an audition rotation in the immediate aftermath of Charlie Kirk’s assassination, I watched resident physicians share footage of him bleeding after being shot in the neck, presenting it as a “surprise” for those who had not yet seen it. One person joked about hoping the physician attempting to save Kirk would be a “pregnant female surgeon of color about to get an abortion.” The following day in the operating room with an attending surgeon and resident, I watched as the resident described Kirk as a “misogynistic, fascist, white nationalist pig who had gotten exactly what he advocated for” to our attending without rebuke.
Through all this, I bit my tongue. I knew that speaking out would have negative consequences for my career and accomplish little good. But ever since, I have been ashamed of remaining silent.
In medical education, more diversity means fewer white men. In 2014, white men made up roughly 31 percent of US medical students, a figure closely aligned with their share of the national population. If the stated goal of equity initiatives in medicine were for the field to achieve roughly proportional representation of the national population, that number would not have been treated as a problem in need of correction. And yet, over the following decade, it fell substantially. By 2025, white men accounted for just 20.5 percent of medical students, a 30.6 percent decrease, placing the demographic well below its population share.
“More diversity means fewer white men.”
Throughout my time in medical school, students were repeatedly taught the language of “URiM”, or Underrepresented in Medicine, a designation reserved for racial groups such as African-Americans, Hispanics, and Native Americans. White and Asian students, we were told, were “overrepresented.” In fact, white male students were underrepresented in medical education, while being constantly described as the opposite.
This decline was not simply an organic demographic shift, nor can it be understood apart from the regulatory structures that governed medical education during this period. Beginning in the late-2000s and early-2010s, diversity goals were formally embedded into the national accreditation standards that medical schools and residency programs were required to satisfy in order to continue operating. In 2009, the Liaison Committee on Medical Education (LCME), the accrediting body for US medical schools, adopted Standard 3.3, which required institutions “to achieve mission-appropriate diversity outcomes among its students” in order to maintain accreditation. Schools were obliged to provide “evidence of effective recruitment and retention programs including the offering and acceptance of positions to qualified student, faculty, and staff applicants who are in the school’s diversity groups,” a requirement that brought about a massive expansion of the DEI bureaucracy within medical schools.
Similar expectations were later incorporated into graduate medical education. The Accreditation Council for Graduate Medical Education (ACGME), which accredits all US residency programs, adopted requirements stating that programs “must engage in practices that focus on mission-driven, ongoing, systematic recruitment and retention of a diverse and inclusive workforce of residents, fellows (if present), faculty members, senior administrative GME staff members, and other relevant members of its academic community.” Failure to meet ACGME standards places residency programs at risk of citation, probation, or loss of accreditation, outcomes that can result in program closure and the displacement of trainees. In this way, diversity priorities were enforced across the entire medical training pipeline, from admission to independent practice.
The consequences of DEI policy adoption have manifested, in some cases, at the level of institutional performance. One of the most prominent recent examples comes from the David Geffen School of Medicine at UCLA, which publicly embraced aggressive DEI initiatives and race-conscious admissions practices. In the years that followed, reporting based on internal data and whistleblower accounts described a precipitous decline in student academic performance, including more than 50 percent of medical students failing standardized clinical exams in core subjects in family medicine, internal medicine, emergency medicine, and pediatrics. For context, the national failure rate for these same exams is roughly 5 percent.
Now the Justice Department has found that UCLA violated civil-rights law. But the response to outcomes like these has not been a reckoning with preparation or admission standards, but an assertion that standardized exams and graded assessments are the problem. Instead of addressing deficiencies, institutions are encouraged to mask them, relabeling objective measures of knowledge as inequitable and biased rather than confronting what the results reveal. This impulse ultimately reached the USMLE Step 1 exam, one of the most consequential national board exams medical students must take to graduate, which was converted to pass/fail in part to “minimize racial demographic differences that exist in USMLE performance.” Rather than addressing differences in academic competency, medical education chose to discard the ruler.
Medical school is intensely competitive, and disparities that begin at admission do not disappear once students arrive. Differences in prior academic preparation, standardized test performance, and study skills tend to persist, particularly in the metrics that remain most consequential. Across core clinical clerkships, URiM student groups receive lower clinical grades on average than white students. On national licensing examinations, URiM groups consistently score lower on average than white students. Beyond medical school, URiM surgical residents leave orthopedic training programs unintentionally at nearly four times the rate of their white counterparts, a figure that rises to more than seven times among black residents specifically. But when these disparities reemerge, they are often cited as further evidence of systemic racism within medical education.
Induction into the AOA Honor Society has long been regarded as the highest academic distinction in medical education. In recent years, the underrepresentation of black and Hispanic students among AOA inductees has been framed as proof of institutional bias, prompting some medical schools to stop participating in the society altogether. The Icahn School of Medicine at Mount Sinai, the University of California San Francisco, and Washington University School of Medicine in St. Louis all suspended student induction into AOA after concluding that its selection process disproportionately rewarded the academic achievement of white and Asian students. Notably, prior to suspending AOA inductions, Washington University expanded AOA eligibility to include all students who self-identified as URiM, while limiting non-URiM eligibility to those in the top third of the class based on academic performance. Even the American Medical Association (AMA), the largest professional organization of physicians in the United States, formally endorsed medical school disaffiliation from AOA in its 2024 House of Delegates Resolution 309, declaring that the honor society perpetuates racial inequities in medical training and disproportionately benefits white trainees.
The alternative explanation, of course, is that when members of certain groups are admitted to medical school under meaningfully different academic standards, those who were required to clear a higher bar to enter will, on average, continue to outperform those who were not. This is not a statement about individual capability or potential. It is a statistical expectation. The same pattern extends into residency applications, particularly in the most competitive specialties, where academic metrics, research output, and honors still matter enormously.
The result is a self-reinforcing cycle. Disparities hidden upstream are rediscovered and amplified downstream and then misattributed to new forms of discrimination, which in turn are used to justify even more aggressive DEI interventions. Each round of correction fuels the next. The apparatus created to solve the problem continues to expand, while the role it plays in perpetuating these issues continues to be obscured. The system not only fails to deliver the equity it promises, but actively generates the outcomes that are then cited as proof of its necessity.
The interval between admission to medical school and independent practice routinely spans seven to thirteen years, encompassing medical school, residency, and fellowship training. As a result, the full downstream effects of policies that deemphasize merit at the point of entry are delayed. Many of the individuals admitted under the new set of standards have not yet completed their training, so the system hasn’t yet had to confront the cumulative consequences. When those cohorts eventually emerge as attending physicians, the costs will be borne not by institutions or administrators, but by patients and by a profession that depends on competence to maintain public trust.
Even if some of the most explicit policies have been rolled back under the current presidential administration, it would be a mistake to conclude that the underlying apparatus has disappeared. The administrators, faculty leaders, and professional gatekeepers who built careers and institutional influence around these frameworks are still embedded in medical schools, residency programs, and accreditation bodies. In the absence of overt mandates, many institutions have simply shifted to careful language, emails that speak of “maintaining our core values,” “protecting our educational mission,” and “remaining compliant while preserving our commitments.” The University of Utah has simply renamed its “Office of Health, Equity, Diversity, and Inclusion” to the “Office of Academic Culture and Community.” At the Feinberg School of Medicine at Northwestern University, DEI administrators that once held positions such as “Director of Diversity and Inclusion” and “Associate Dean for Diversity, Inclusion, and Student Support” have been given new titles like “Executive Director of Health Equity Initiatives” and “Vice Dean for Health Equity.” The “Excellence in Diversity Award” that I won two years ago has been officially renamed the “Excellence in Culture, Leadership, and Community Engagement Award.”
“Accreditation requirements continue to promote DEI.”
Even now, formal accreditation requirements continue to promote DEI. For example, LCME Standard 7.6 requires medical schools to provide instruction on bias, cultural competence, and the social determinants of health. It continues to serve as a common vehicle through which DEI ideology is delivered to students under the guise of professionalism and ethics training. Most recently, my own institution announced mandatory bias training for first-, second-, and third-year medical students through an external consulting firm whose leadership has publicly advocated for equity-driven higher education policies and expressed sympathy toward affirmative action as a solution to systemic racism. In total, nine separate sessions are planned across students, faculty, staff, and senior leadership. The machinery remains intact and will be set into motion as soon as incentives shift.
Diversity, equity, and inclusion measures shape lives, foreclose opportunities, and stymie the advance of people who did nothing wrong. They could not be sustained if everyone who silently bears their consequences began to speak out. They would end in an instant if all the people who do not believe in this ideology but nonetheless enforce it out of fear—of professional reprisal and social isolation—stopped doing so.
“They would end in an instant.”
Ending these measures would strengthen the many good things that are happening in medicine. My institution, like many medical schools, is filled with outstanding clinicians and educators whose primary concern is training competent, ethical physicians. Most faculty members are not ideological crusaders, and most students are simply trying to learn medicine. I have benefited in countless ways from my mentors and classmates, and disagree with those who suggest that educational institutions are themselves the problem. The problem lies in the way a system of unequal rewards has been imposed through admissions criteria, grading policies, and professional and financial rewards.
We should be able to acknowledge real disparities and address existing barriers without lowering standards or excluding people based on group identity. Medicine should evaluate applicants and trainees as individuals, not as representatives of demographic categories, and it should reward effort, preparation, and achievement wherever they appear.
Until that happens, people who fall outside favored categories will have two options: overperform or walk away. Many who choose the second option will not lack the ability to become excellent physicians; they will simply understand that they were not welcome. They should not be forced to atone for sins they never committed, nor should others be deprived of the medical care they would have been able to provide.