What black women in medicine stand to lose in the US’s war on diversity, equity, and inclusion
BMJ 2025; 388 doi: https://doi.org/10.1136/bmj.r134 (Published 22 January 2025) Cite this as: BMJ 2025;388:r134
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Dear Editor,
The increasing prevalence of Diversity, Equity, and Inclusion (DEI) initiatives across various sectors, including healthcare, education, and corporate environments, has sparked a contentious debate regarding their effectiveness and necessity. While proponents argue that DEI fosters a more inclusive environment, critics contend that these initiatives undermine merit-based systems and prioritize ideological conformity over competence and productivity.
Meritocracy is a cornerstone of functional and successful institutions, ensuring that the most qualified individuals are selected based on their abilities and achievements. More often than not, DEI policies introduce quotas and preferential treatment that risk diluting excellence by emphasizing demographic characteristics over skill and experience. This shift can result in inefficiencies, diminished performance, and resentment among those who feel sidelined by arbitrary criteria unrelated to their capabilities.
DEI initiatives frequently adopt a narrow and politically driven perspective that aligns with contemporary social movements rather than objective fairness. The focus on identity-based hiring and promotions can create divisions within organizations, fostering a culture of grievance rather than collaboration. As a result, these initiatives reinforce a victimhood mentality and distract from the primary objectives such as innovation, patient care, and academic excellence.
The financial and administrative burden associated with implementing DEI programs is another point of concern. Organizations often allocate substantial resources to training, compliance, and reporting requirements, diverting attention and funds away from core functions. This resource allocation raises questions about the opportunity cost and whether such investments yield tangible benefits in terms of improved outcomes or productivity.
Finally, the subjective nature of DEI metrics can lead to ambiguity and inconsistency in decision-making processes. The lack of clear, objective standards undermines transparency and accountability, potentially leading to legal challenges and reputational risks for organizations perceived to be engaging in discriminatory practices under the guise of inclusivity.
While the pursuit of fairness and equal opportunity is commendable, DEI initiatives, as currently implemented, often prioritize ideological goals at the expense of meritocracy and efficiency. A more balanced approach that emphasizes individual achievement, competence, and fairness without succumbing to ideological pressures is essential for maintaining the integrity and effectiveness of institutions. Whilst I commend the author's efforts for highlighting her perceived benefits of DEI schemes, unfortunately history has shown that they fall short in real life practice.
Competing interests: No competing interests
Re: What black women in medicine stand to lose in the US’s war on diversity, equity, and inclusion
Dear Editor,
The movement to dismantle Diversity, Equity, and Inclusion (DEI) initiatives in healthcare threatens to reverse decades of progress toward addressing systemic inequities that harm marginalized patients and providers. As Naeema Hopkins-Kotb poignantly illustrates, Black women in medicine already face disproportionate barriers, from the “minority tax” to workplace discrimination, and the erosion of DEI risks exacerbating these inequities. However, critiques of bureaucratic or performative DEI efforts should not justify abandoning the mission altogether. Instead, the solution lies in reforming DEI to prioritize evidence-based strategies that demonstrably improve patient outcomes, diversify the workforce, and dismantle systemic biases embedded in healthcare systems.
Studies show that racial concordance between patients and physicians improves trust, communication, and adherence to treatment plans, directly enhancing clinical outcomes (1). Similarly, hospitals with diverse staff are better equipped to address cultural and linguistic barriers, reducing misdiagnoses and disparities in care for non-English-speaking patients (2,3). Yet, as Hopkins-Kotb notes, only 2.8% of physicians are Black women, a stark underrepresentation that perpetuates inequities.
To address this, medical institutions must tackle “pathway inequities” to students who have historically faced systemic barriers in accessing medical professions. Auditing biased admissions algorithms and revising selection criteria that inadvertently favour privileged applicants are not about “lowering standards” but about dismantling a historically oppressive system that has excluded qualified individuals from marginalized backgrounds (4,5).
Too often, DEI initiatives rely on superficial workshops led by facilitators lacking clinical expertise. These programs fail to address the realities of healthcare, such as racial disparities in pain management or diagnostic delays. Effective DEI requires clinician-educators with dual expertise in anti-racist pedagogy and medical practice. For instance, workshops led by physicians can demonstrate how implicit biases affect treatment decisions, offering actionable strategies to mitigate harm. Such training must be integrated into clinical workflows, ensuring relevance to daily responsibilities. Moreover, institutions must move beyond tokenizing marginalized individuals. While lived experience is valuable, DEI leadership requires formal training in organizational change, behavioral psychology, and bias mitigation. Hiring leaders with this expertise ensures interventions are both culturally informed and evidence-based.
To counter claims that DEI is “performative,” institutions must tie initiatives to measurable health outcomes. For example, Black patients experience disproportionately lower hypertension control rates, contributing to higher rates of stroke and heart disease. DEI programs should prioritize closing this gap through targeted interventions: community partnerships to expand screenings, culturally tailored education materials, and bias-aware clinical protocols. Rigorous evaluation, tracking metrics like screening rates, medication adherence, and disparity trends, is essential to demonstrate impact.
Transparency is equally vital. Institutions should publish data on DEI’s effectiveness, such as reductions in workplace discrimination or improvements in patient trust. This evidence not only justifies funding but also counters political attacks by showcasing DEI as a cornerstone of equitable care.
Hopkins-Kotb’s experience highlights the human cost of inaction: the exhaustion of underrepresented trainees forced to shoulder DEI labour and the patients who lose trust in a system that excludes providers who share their identity. Dismantling DEI risks cementing a healthcare landscape where bias thrives and disparities widen.
The case for DEI is not about political correctness, it is about rectifying systemic failures that harm patients and providers alike. Diversity and merit are not mutually exclusive. Reform, not abandonment, is the path forward. By centering evidence, accountability, and clinical relevance, healthcare institutions can build DEI initiatives that transcend performativity and deliver on their promise: a system where every patient receives equitable care, and every provider can thrive.
References:
1. Takeshita J, Wang S, Loren AW, et al. Association of racial/ethnic and gender
concordance between patients and physicians with patient experience
ratings. JAMA Netw Open. 2020;3(11):e2024583.
doi:10.1001/jamanetworkopen.2020.24583
2. Weech-Maldonado R, Elliott MN, Pradhan R, Schiller C, Hall A, Hays RD. Can
hospital cultural competency reduce disparities in patient experiences with
care? Med Care. 2012;50(Suppl):S48-S55.
3. Soled D. Language and cultural discordance: Barriers to improved patient care
and understanding. J Patient Exp.2020;7(6):830-832.
doi:10.1177/2374373520942398
4. Weiss J, Nguementi Tiako MJ, Akingbesote ND, et al. Perspectives on medical
school admission for Black students among premedical advisers at historically
Black colleges and universities. JAMA Netw Open. 2024;7(10):e2440887.
doi:10.1001/jamanetworkopen.2024.40887
5. Tello C, Goode CA. Factors and barriers that influence the matriculation of
underrepresented students in medicine. Front Psychol. 2023;14:1141045.
doi:10.3389/fpsyg.2023.1141045
Competing interests: No competing interests