ACGME President and CEO Thomas J. Nasca, MD, MACP has issued the following statement on the Presidential Executive Order on Combating Race and Sex Stereotyping:
The Presidential Executive Order on Combating Race and Sex Stereotyping issued September 22, 2020 seemingly promotes training of employees to create an inclusive environment by avoiding race and sex stereotyping; however, that intent is subverted by defining divisive concepts1 in a way that turns mechanisms intended to protect into weapons of divisiveness and exclusion. The Executive Order is inconsistent with work done over the past 50 years to advance civil rights of minoritized and thereby marginalized communities in the United States and, through its mandates, risks further division and fostering a culture of enmity. This approach works against the ACGME’s mission to improve both health and health care for patients and communities and ultimately results in worsening health outcomes for those we are dedicated to serve.
The ACGME has sought to advance the work of diversity, equity, and inclusion and the elimination of health disparities through its programs, policies, and requirements. The goal of the ACGME is to foster a professional, equitable, respectful, and civil environment that is free from discrimination, sexual and other forms of harassment, mistreatment, abuse, or coercion of students, residents, and faculty and staff members, for the betterment of patient care through its accreditation processes.
Prohibiting institutions from providing certain types of education and training that the Executive Order deems to be promoting racial and sexual stereotypes would have devastating consequences on educating residents and fellows toward the goal of eliminating disparities in health outcomes and achieving equity within the health care profession. The Executive Order would similarly preclude residency and fellowship programs from developing curricula that reflect the needs of their communities, particularly in those of color and women, and promote inclusivity. The Executive Order seemingly attempts to diminish the impact of oppressive behavior based on race and sex as evidenced in the medical literature. As a result, the Executive Order puts all institutions that educate and train residents and fellows at risk of losing federal funding if they attempt to meet the ACGME’s Common Program Requirements for curriculum (IV.A.) and for providing a professional, equitable, respectful, and civil environments (VI.B.6.).
The Executive Order is thus inconsistent with ideals it seeks to espouse and could undermine care of patients, appropriate education of physicians, and the entire health care workforce, both now and into the future.
The ACGME’s Department of Diversity, Equity, and Inclusion analyzed the impact of the Executive Order on ACGME Sponsoring Institutions, revealing the potential negative consequences if their programs continue to do the work necessary to eliminate health care disparities and meet the ACGME’s requirements outlined above. These types of institutions and programs include:
- federally funded Sponsoring Institutions and their graduate medical education (residency and fellowship) programs;
- federally funded health care institutions and their educational and community programs, such as the Veterans Health Administration, United States Military, Federally Qualified Health Centers, Indian Health Service, and National Institutes of Health; and,
- federally funded health care workforce pathway programs, such as those supported by the Health Resources and Services Administration.
Per Sections 4 and 5 of the Executive Order, reducing funding for the above institutions and programs would exacerbate health care disparities by limiting or eliminating patient access to care due to the decreased funding of vulnerable health care institutions. In turn, the economic impact of exacerbated health care disparities would continue to increase health care costs nationwide.
In addition, this Executive Order has the potential to limit the ability of experts in medical education to determine the direction and to design the content of curricula to achieve a diverse and equitable learning environment in compliance with ACGME requirements. The Executive Order will limit the ability of programs to develop unbiased faculty members who, through the monitoring and evaluation of programs, impact the diversity of the physician workforce and the care those physicians will render in the future. It is imperative that faculty members be allowed to guide residents and fellows in understanding their implicit biases, the historic systemic racism interposed into clinical protocols, and the disparate clinical outcomes that medicine has yet to fully address.
Conclusion
The ACGME remains committed to promoting an educational and training environment for residents and fellows that roots out the adverse consequences of systemic racism and leads to the development of a diverse physician workforce that treats all patients with dignity and respect and achieves equitable health outcomes for all. The Executive Order undermines these goals, disrupting and reversing the ACGME’s and the medical community’s efforts to address issues of diversity, equity, inclusion and health care disparities. The Executive Order similarly disrupts or outright prohibits the graduate medical education community’s efforts to advance physician workforce diversity and build safe, inclusive, and equitable learning environments for physicians, with the goal of improving patient access and health care outcomes.
For these reasons, the ACGME stands in solidarity with the Association of American Medical Colleges and other national health care organizations in opposing the Executive Order on Combating Race and Sex Stereotyping. The ACGME will continue to enforce and enhance its requirements to promote safe and inclusive clinical and work environments in institutions to ensure delivery of high-quality care to the patients and communities they serve.
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1E.O. 13950, Combating Race and Stereotyping, 85 Fed Reg 60685 (2020). Section 2(a) states, “Divisive concepts” means the concepts that (1) one race or sex is inherently superior to another race or sex; (2) the United States is fundamentally racist or sexist; (3) an individual, by virtue of his or her race or sex, is inherently racist, sexist, or oppressive, whether consciously or unconsciously; (4) an individual should be discriminated against or receive adverse treatment solely or partly because of his or her race or sex; (5) members of one race or sex cannot and should not attempt to treat others without respect to race or sex; (6) an individual’s moral character is necessarily determined by his or her race or sex; (7) an individual, by virtue of his or her race or sex, bears responsibility for actions committed in the past by other members of the same race or sex; (8) any individual should feel discomfort, guilt, anguish, or any other form of psychological distress on account of his or her race or sex; or (9) meritocracy or traits such as a hard work ethic are racist or sexist, or were created by a particular race to oppress another race. The term “divisive concepts” also includes any other form of race or sex stereotyping or any other form of race or sex scapegoating.
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