The decline and fall of America’s medical schools

February 25, 2023 • 11:30 am

A reader this morning used ChatGPI write me an email saying that he didn’t like the “excessive” amount of antiwoke stuff on this website, and wondered if I had heard this from other readers. (Answer: almost never, though people may vote with their feet).  Although I informed him that I write about what interests me, and that right now in academia (and elsewhere in America) we’re in the midst of a “racial reckoning” that could completely change the nature of the country, I still felt bad—as I always do when someone tells me I write “too much” about this and that.  And that’s despite Rool #6, which says this:

6. Please do not tell me how to run my site.  That is, comments about “too many cats,” “too many boots,” “not enough biology,” “too much religion,” etc., are not welcome.  I provide content free of charge, and if you don’t like the mix of posts, you’re free to go elsewhere.  By all means take issue with what I say, but don’t argue about the balance of topics.

So, especially today, don’t leave comments agreeing with the reader (i.e., please abide by rule #6).

I’m disturbed enough that although I present this Tablet article, which is antiwoke (its theme is the ruination of America’s medical schools via DEI initiatives), I’m not going to say much about it. It’s free and you can read it for yourself by clicking on the screenshot. There’s a reason to be more concerned with the quality of doctors that is being turned out than with, say, experts on English literature or evolution, for a poorly trained doctor can do a lot of damage to people’s lives and health.

I will give a few excerpts below.

Most of this is about UCSF, a terrific medical school, which has implemented a stringent new DEI policy:

These race-first imperatives have now come to influence the research priorities of major institutions. Perhaps no better case study exists than that of the University of California, San Francisco (UCSF), an institution devoted exclusively to the medical sciences, and one of the top recipients of federal grants from the National Institutes of Health. Last May, UCSF took the unprecedented step of creating a separate Task Force on Equity and Anti-Racism in Research, which proceeded to make dozens of recommendations.

That task force builds on layers of prior DEI bureaucratic expansion, spanning nearly a decade. This programming includes the “UCSF Anti-Racism Initiative,” started after the summer of 2020, which established dozens of new institutional policies throughout the university, such as “evaluating contributions to diversity statements in faculty advancement portfolios.” The School of Medicine, meanwhile, has published its own Timeline of DEI and Anti-Racism Efforts, which documents such steps as adding a “social justice pillar” to the school’s curriculum and creating an anti-racist curriculum advisory committee.

The policies often promote an idiosyncratic and controversial understanding of concepts like diversity and racism. Through its Difference Matters initiative, the medical school created a document titled “Anti-Racism and Race Literacy: A Primer and Toolkit for Medical Educators”—which is filled with eyebrow-raising assertions. Racism, the guide asserts, “refers to the prioritization of the people who are considered white and the devaluation, exploitation, and exclusion of people racialized as non-white.” Anti-racism, meanwhile, involves directly shifting power from those who are white to those who are Black. “Anti-racism examines and disrupts the power imbalances between racialized and non-racialized people (white people), to shift power away from those who have been historically over-advantaged and towards people of color, especially Black people.” Of course, when applied to the allocation of lifesaving medical care, these ideals can carry weighty consequences. During the height of the COVID pandemic, New York, Minnesota, and Utah issued guidance for allocating monoclonal antibodies that heavily prioritized racial and ethnic minorities.

But race isn’t the only issue for which these initiatives demand action:

Some of these initiatives create obvious issues of academic freedom. In 2020, the UNC School of Medicine created a “Task Force for Integrating Social Justice Into the Curriculum,” issuing a report with dozens of recommendations. One called for faculty to adhere to “core concepts of anti-racism,” listing several of these required “concepts,” including “race is not a set biological category” and “specific organs and cells do not belong to specific genders.” The task force also called for students to “be trained in core advocacy skills”—even listing a number of political causes that it deemed important for students to embrace. These causes, which the report labeled “health realms,” included “restoring U.S. leadership to reverse climate change,” and “achieving radical reform of the US criminal justice system.” The school initially listed every recommendation as “On Time” on an online implementation tracker, though it eventually walked back some of the more controversial requirements.

Finally, UCSF’s (non)response to criticism:

By the time it published the report, the UCSF task force was aware of all of these issues. Each had been brought up by UCSF employees during the comment period. The comments were published in the report’s appendixes, which make up perhaps the most telling part of the whole publication.

One commenter repeated the same line in every answer: “I fundamentally do not feel or have ever felt that UCSF is a racist place. These are grossly misdirected funds and efforts.” Several cautioned against embracing discriminatory policies in the name of anti-racism. “All of the above sounds to me like trying to fight racism with more racism,” one noted. Still others urge the task force not to distract from UCSF’s focus on scientific research. As one commenter put it, “UCSF is a medical and life science campus. Its strength lies in its objective data-driven experimental approach. Qualitative and sociological research has no place at UCSF and no place in scientific medical research and will undermine UCSF’s reputation.”

Yet rather than addressing the concerns of the school’s employees, the report attacks them while presenting its authors as the real victims.

It is important to note that while many of the comments received were constructive and helpful, task force members were traumatized by a striking number of comments that denied the existence of inequities and racism, and others that minimized the burden that racism has imposed, particularly on Black Americans at UCSF.

The forward to the report quotes one of the task force co-chairs, Sun Yu Cotter, who adds:

It is extremely important to acknowledge the magnitude of the emotional labor and trauma that many of the Task Force members endured in doing this work, particularly during the public comment period. Not only are many of the Task Force members, especially our Black colleagues, encountering and navigating racism on a daily basis at work and outside of work, we are also volunteering our very limited time to dive into grueling work (the minority tax is real!). Then to be gaslit by some members of our very own UCSF community was very painful.

Take note. This is the future of American medicine.

I have no comment but to add that for obvious reasons we really need to worry about the politicization of medical schools, and also about the extreme lowering of standards that has gone with it.

h/t: Adam

52 thoughts on “The decline and fall of America’s medical schools

  1. Woke ideology tries to control what you can say, what you can read, and what you can think.

    I think it is very telling that people like Anna Krylov and other people with first-hand knowledge of totalitarian regimes are deeply worried about the spread of woke ideology.

    I see two big dangers if this ideology continues to spread:

    1) The slow death of meritocracy.

    2) The idea that it is OK for the government to treat some groups of people differently than other groups of people. This is absolute poison to a multi-racial, multicultural society.

    1. “This is absolute poison…”
      It is fertilizer to the authoritarians who have taken over the Republican party.

    1. Agreed. I absolutely agree that fascists on both ends of the political spectrum need to be exposed for what they are. “All that is required for evil to flourish is for good men to do nothing.”

  2. From the report:

    “It is important to note that while many of the comments received were constructive and helpful, task force members were traumatized by a striking number of comments that denied the existence of inequities and racism, and others that minimized the burden that racism has imposed, particularly on Black Americans at UCSF.”

    Trauma was experienced by Blacks when enslaved families were broken up when masters, hard up for cash” had to sell a family member. Trauma was experienced by slaves when whipped by the master. Trauma was experienced by Blacks when some neighbors were lynched during Jim Crow. To call negative comments as inducing trauma is a perversion of the meaning of the word. Such hyperbole by the report members will only accelerate the blowback to the anti-racist programs in place at UCSF. Extremists of any stripe live in an ideological bubble, hermetically sealed off from reality.

    In the United States today, right and left extremists are vying for political and cultural hegemony. It is unclear whether the sane center can fend off the attacks from both flanks. However, it seems that if the center can’t hold, the right radicals win will win. They control a major political party and the Supreme Court. They will crush the left as a fly swatter crushes a mosquito. DeSantis in Florida has provided a preview of this. But, as has been the case for more than a hundred years, leftist extremists, with their abysmal understanding of American history and politics, will not leave their ideological bubble, wondering how things went wrong once again.

  3. There is no such thing as too much anti-woke.
    Most Americans have no idea how much our institutions have been captured by this ideology. The longer it goes on the harder it’s going to be to get rid of the entrenched bureaucrats and DEI employees. In the words of Governor Lepetomane, “We’ve got to protect our phony baloney jobs, gentlemen!”

  4. This article concentrated on UCSF. John Sailer reports an identical flood of wokeliness at Mt. Sinai’s Icahn School of Medicine in NY at: The latter article notes that the Icahn School’s officials are vigorously disseminating this point of view to administrators at other medical schools— and those of us at these places observe similar trends at our own institutions.

    The trend’s pervasiveness no doubt reflects woke capture of national organizations involved in med school administration. Heather MacDonald reports in City Journal as follows: “Virtually every major medical organization—from the American Medical Association (AMA) and the American Association of Medical Colleges (AAMC) to the American Association of Pediatrics—has embraced the idea that medicine is an inequity-producing enterprise. The AMA’s 2021 Organizational Strategic Plan to Embed Racial Justice and Advance Health Equity is virtually indistinguishable from a black studies department’s mission statement.”

    1. Let them look after their own then. What’s it to me if a black or indigenous family doesn’t want me to look after their sick relative? If they are going to sue me or, worse, complain to my regulator that their outcome was disappointing because of my implicit bias, and the system will back them up, then I will cheerfully contrive to organize my life so that I need have nothing to do with the lot of them. Our regulator tells us that even if we think we acquired cultural competence after taking their CME about it, that’s bad because it just means we failed to understand that we can never have it.

      My advice to high school students contemplating medicine is to study hard and learn to be good with your hands, so you get the highly competitive surgical residencies that only a few people can actually do. (Seriously, take wood shop and auto or aircraft mechanics along with calculus and chemistry. And you might discover you like engineering better.) Sure, they will want to take in equity applicants preferentially but when the chips are down…..

      A so-called “non-patient-care specialty” like radiology or pathology is good, too, because the family with the chip on their shoulder will likely never know what race you were, and they’ll blame everything on the doctor they saw at the bedside every day.

      A white man going into something like primary care and ending up in a free clinic for the inner-city uninsured is cannon fodder under DEI. Everything you do will be wrong.
      Primary care, where every insoluble social problem is medicalized in order that the practice can bill for it, is already demoralizing enough.

      I wish I could say something more constructive but people, if this is what you want, this is what you are going to get good and hard.

      1. I don’t know about you, Leslie, but when I was at UCHMS it was pretty obvious that the intake was of a nature/calibre/intelligence that no matter what we were exposed to, we would remain true to our own opinions. It was fashionable at the time to talk of medical school being like a sausage machine that took all of us and extruded us as look-alike simulacrums of our teachers. Turned out not to be true. Even one of my colleagues in rural Canada, who trained at a provincial full-of-itself school, said to me one day, “You know, we’re an odd lot who choose to come and work here”! And so we were. No interest in algorithms and protocols, but a strong desire to respond to calls for help. Everyone got seen same day or next day, not in six weeks. I would have been ashamed to call in my neighbour for a stupid PSA test just because it had been a year, but I’d have got out of bed at 2am when he had a problem sufficient for him to call me (yes, doctors’ home numbers in the phonebook—just imagine!) We kept the ER open 24/7, even if there was just one doc in town for a couple of weeks—ask me about sleep paralysis after two weeks of little sleep! Most interesting. So the system worked wonderfully for patients (who preferred a sleepy doc to none at all), and the price was paid by the docs who worked in a way not considered sustainable by today’s grads. I can’t say to them they should work like that, but I can say there were rewards both personally and in terms of making the system work for the patients. If it was your calling, you’d do it and be glad, but if it is only to be done for the right amount of pay, and with the right “life-work balance” I guess we are screwed.

        1. I think you and I would have liked each other, Christopher. Even if you couldn’t stand me, you’d know I had your back in a crisis, not because I owed you but because a patient’s life or health depended on it. No matter how badly you screw up, a colleague won’t leave you hanging out of spite with a patient he can help rescue. I know that from experience.

          I’m hoping smart medical students will still realize when they are being socially engineered — our class of incorrigibles was hard to indoctrinate on the social science theory and were prone to hiss softly in unison which got the Dean upset, officially at least, and yes it was rude. Some of the things you have to mark as the correct answer on med school exams now, in order to pass, curl your hair. These are starting to leak out into the public domain since that nurse in B.C. is being worked over by her regulator for saying JK Rowling is right that there are two sexes. The ones I’m worried about are the ones who come in already indoctrinated to presume bad faith in their colleagues.

          The presumption that we don’t care enough because we let our implicit biases hurt people who don’t look like us might not matter when we’re called in at night, because we’ll always come, but they have to matter to what your grandchildren see in it.

          Stay healthy.

  5. Great that you are highlighting the Tablet article, which is very good indeed. The Tablet is on my go-to list of sites for good writing and thoughtful commentary.

    We need clear voices to speak out in support of rational thought. Speaking out against “wokeness” is no vice.

  6. While there has been a greater emphasis on DEI in recent years, I’m not witnessing a discernable decline in the quality of medical education at my institution. We are still graduating exceptionally bright future physicians and compassionate, level-headed citizens of the world. We have not gone down the extremist route yet.

    I believe that there is a moderate middle way, where certain legitimate inequities can be acknowledged and addressed while not compromising the integrity of our institutions and our responsibilities as educators.

    1. 1. Where is your institution? Does it practice affirmative action?
      2. How do you know the quality of physicians graduated by your school has not declines.
      3. What is your “middle way”? Does it involved relaxing admission standards.
      4. What are the “legitimate inequities”, a term that doesn’t make sense.

  7. I agree 100% with Sonia. I would not be aware of the extent to which woke ideology is taking over this country were it not for this website.

    As a retired educator, I am especially concerned about the attempts to “reform”–or, I might say, “reprogram”–the educational system from kindergarten through university. The efforts in medical schools to follow a DEI program bode ill for the medical treatment of patients throughout the country.

    The educational system certainly needs to be reformed, but it should start with the providing of an equal education to all children from the lower elementary grades up so all students then have equal opportunities. That can never be achieved unless, for example, funding of public schools is changed in states like PA (where I live)–where funds are not distributed equally, but where property taxes provide a large part of the funding. Thus, wealthy districts for the most part have better schools, whereas inner city schools suffer from lack of funding. One cannot just decide the that lack of opportunity suddenly needs to be compensated for by putting DEI principles into effect in colleges and universities in order to give students so-called equal opportunities when those opportunities should have existed all along.

    So thank you for covering this issue–as well as making cats an on-going part of this website!

  8. To truly rectify the entrenched, structural harms from racism in research,” the task force report notes, “we must start from its foundations in the way that we privilege knowledge, methods, and people. The overarching changes required to mitigate racism in research is a philosophical shift in the mindset of those in power and those who produce research.”

    They’re going after “the way we privilege knowledge, methods and people” and I can’t help but think of what’s taking place in New Zealand with its Other Ways of Knowing based on the wisdom of indigenous tribes. What this is likely to translate to in the States is elevating “lived experience” over objective research designed to test lived experience. This fits in nicely with the surge in Alternative Medicine in mainstream medical schools and hospitals.

  9. Agree with the piece, except: “… and also about the extreme lowering of standards that has gone with it.” This may follow logically from extreme DEI efforts. But where is the evidence? Is there a metric being tracked that will reveal this?

    If we are going to demand evidence that “structural racism” underlies current inequalities, then we need to hold ourselves to the same standard.

    Maybe there is evidence? Would like to see it presented.


    1. I didn’t want to give it because one is accused of racism by showing the data. But if you insist, here is one site. You know, you could have looked this up yourself if you wanted evidence:

      The disparity of admissions by race is huge–and this is 7-10 years ago. I would say that is lowering the admissions bar for ethnicity quite a bit.

      1. Thanks. Certainly can never be racist to show data.
        Speaking of data I’m still chewing through that 2020 article someone cited from PNAS the other day on the disparity in black infant mortality when the doctor of record was not black.

        1. That study threw me for a loop until I looked into it. It’s very badly flawed. And the premise–that white doctors deliberately neglect back babies–is what made me look into it. I think some physicians are preparing a rebuttal of it.

        2. “Certainly can never be racist to show data.”

          I agree with you, in principle; but it won’t stop some from making the accusation or insinuation.

      2. That’s not what I am asking for. I am looking for evidence that these shifts in admissions result in actual reductions in competency in the graduates, and/or evidence that the practice of medicine (in this case) is affected.
        Despite your chastising, of course I looked for it, but can’t find. it. Admittedly, it’s a hard thing to measure, but is essential in the big picture. If the evidence doesn’t exist, then those advocating for DEI can just say, see it helps with equity, and while incoming. GPA’s, etc., may be watered down a bit, the outcomes that matter aren’t affected.
        If that were true, wouldn’t we have to have to consider that when judging these efforts?

        1. Your contention amounts to saying that grades and standardized test scores have nothing to do with the quality of being a doctor. If that were the case, why don’t we just have a lottery to let people into med school: anybody who wants to can simply join the lottery. Or do you favor “holistic” admissions that disregards formal qualifications and lets people in based on “spunk” (yes, that’s been suggested as a criterion for college admissions).

          Also, see comment of Jackie T. below on the success of minority applicants during the three tests GIVEN during med school. You’re dissimulating when you say scores have been watered down “a bit”. Look at the data in the paper cited by Jackie: they’re watered down a LOT if you’re a member of a minority. It seems that you’re so driven to produce “equity” that you’ll accept any dilution of qualifications for med school, and then you claim “it doesn’t matter: formal qualifications have nothing to do with the quality of medicine practiced by a doctor”. Sorry, but I don’t buy that.

    2. For more background on affirmative action in medical school admission, I recommend this 2021 paper written by Richard Sander: “Affirmative Action in Medical School: A Comparative Exploration”

      For the past 20 years, Sander has investigated the pernicious effects of law school admission preferences on underrepresented minorities (URMs). In this paper he reviews the case for preferences in medical school admissions.

  10. It is arrogant for someone to tell you what to write about on your own website that you create for all to read without cost. Da Roolz make reading the comments on WEIT worthwhile unlike the comment sections on most websites. Your concern about wokeness is realistic and appreciated.

    1. I didn’t tell him what to write. I agree with his view of wokeness and support that. The point of the email wasn’t to tell him what to write or Yada Yada as some of you have already jumped to conclusions. I’m a very big fan of Jerry and his website. His recent mention about wokeness in chatgpt gave me an idea to feed some of my thoughts into the program and see what it would come up with. I meant no disrespect which I told him in the email. It was a bit of an experiment and was merely my own opinions. Get over it.

      Regardless I have plenty of respect for Jerry and his topics and writing.

      I can attach the email if you’d like so some of you can put away your jump to conclusions mat. Honestly would’ve expected more from intellectuals instead of bandwagon sentiments.


  11. The UCSF Task Force’s response to insufficiently supportive comments strikes me as a form of Kafkatrapping: “You’re [bad thing x], and if you deny being x, that PROVES you’re x!”

    Here, it takes the form of: “Our campus is full of structural racism, and when commenters deny it, this PROVES that our campus is full of racism! We are hereby traumatized by all the racism evident in the comments!”

  12. I’m not certain about whether there is an explicit affirmative action policy at my institution. What I can say is that there has been a greater emphasis on raising awareness of racism, misogyny, anti-LGBT, and inequities in medical care, and on socioeconomic determinants of education and health, which are undeniably real in our society. So far, I don’t see any signs that our medical students or faculty have been harmed by these training initiatives. To my knowledge, students and faculty are not required to pledge allegiance to any dogmas or principles that go much beyond the spirit of the Hippocratic oath and a basic commitment to act ethically, responsibly, and compassionately. But perhaps these are still early days..

    In defending our educational institutions against dogma, I would also caution against going to the opposite extreme and inadvertently feeding the ever-growing bigotry on the conservative right and Faux News, where anything that smells ‘woke’, ‘progressive’, ‘socialist’, or ‘liberal’ is branded as an existential threat to the integrity of American society.

    1. I see, it’s your personal observation without data. I see some evidence that affirmative action is exercised at your institution through newly created “holistic admissions”, but I won’t give the link lest I compromise the anonymity you’ve chosen.

      As for your last paragraph, it’s patronizing and I don’t appreciate it.

      1. Dr. Coyne, I certainly did not intend to patronize and I appreciate you not ‘outing’ me, though I stand by my (admittedly anecdotal) observations that our students do not seem to be harmed by the current DEI initiatives at our institution; in my conversations with students I have yet to hear that these initiatives are negatively impacting their academic performance, critical thinking skills, freedom of speech, or well-being. At the same time I acknowledge that educational policies may become more extreme in the future and I am grateful to you for pointing out these excesses. In general, I am concerned about the outrage (manufactured or real) on both the left and the right exacerbating the polarization of our society.

  13. As I see it, our host isn’t an anti-woke culture warrior, just a liberal believer in education, science, democracy, and free speech concerned about the denigration of those important things (regardless of which side of the political divide the attacks on them come from). I’m pretty sure that he’d be very happy not to have to devote so many posts to defending them, but sadly it is very necessary at the present time.

  14. Shock horror, I identify as a “dog person” (was assigned cats at birth, by mum, but with the help of friends and supportive family I was able to transition against my parents wishes).

    But never, in a million years, would I think to email Jerry and tell him to write less about cats! Where does that arrogance come from? I just (trigger warning) scroll past the cat posts. And feel thankful for all the wonderful content Jerry posts that does interest me. It’s clearly very time consuming and he puts great care into the website.

    Keep posting as you see fit Jerry. (I do even sometimes learn something about cats and even smile occasionally.)

    Thanks for your efforts! Brilliant website.

  15. The “antiwoke stuff” is a key reason I became interested in this site. Politically, I’m fairly American centrist, a bit fiscally conservative but socially liberal. I am not happy the way both sides of the political spectrum in this country seem to be tending towards extremism. There also is a tendency to dismiss criticism as propaganda coming from the other side. For that matter, I’ve seen people dismiss criticism outright if the word “woke” was used, with the claim that only far right extremists use the word in a negative way, though I’ve seen a number of obviously politically left folks use it to refer to a type of extremism.

    Anyway, this is just a vote for continued “antiwoke stuff.”

  16. When you first started writing about woke shenanigans, I didn’t consider it a big deal, but you brought early attention to the creep and at the time, it was absent from my spheres of interaction/influence. As time has progressed, so has progressive wokeism, and now I’m strident in my anti-woke position, as I am in my anti-religion and anti-modern-GOP positions. (I’ve been criticized by friends, too, for being “anti-woke”…yup, guilty as charged.) But it’s thanks to you, highlighting the subtleties, the nuance, the way it pervades our institutions that makes it such important work. You’re like a anti-woke gumshoe, turning up the myriad stones where it lurks, and I thank you very much for your efforts in fighting this blight. Plus cats!

  17. Jerry, please take no notice of your bad-mannered correspondent. Not only are they at odds with probably 99% of your readership, they’re just plain rude. It’s free content, they’re not forced to read it, so why on earth do they think they have any business writing to complain?

    I thank and salute you for continuing to write about of wokeness. It’s a scourge that most right-minded people are absolutely sick of. It needs to be spoken of at every opportunity; the very fact it’s being forced onto the curricula of medical schools is evidence enough for that.

    Their article is just full of the same woke newspeak we see in every other woke article:

    ”task force members were traumatized”

    ”emotional labor and trauma that many of the Task Force members endured”

    ”Then to be gaslit by some members of our very own UCSF community was very painful”

    I have had enough of these censorious control freaks. I’m absolutely sick of them – just this week Puffin books was in the news for getting sensitivity reviewers to edit Roald Dahl’s books! Thankfully they have backed down (at least slightly) by promising to also publish unedited versions. But they only did this because people called them out on it. This is why we all need to keep speaking up. We must stop these authoritarian idiots getting their own way and enforcing their narrow, joyless worldview on the rest of us.

    So again, I thank you, and please keep doing what you’re doing!

    1. Settle down big fella. You’re missing context…

      I didn’t tell him what to write. I agree with his view of wokeness and support that. The point of the email wasn’t to tell him what to write or Yada Yada as some of you have already jumped to conclusions. I’m a very big fan of Jerry and his website. His recent mention about wokeness in chatgpt gave me an idea to feed some of my thoughts into the program and see what it would come up with. I meant no disrespect which I told him in the email. It was a bit of an experiment and was merely my own opinions. Get over it.

      Regardless I have plenty of respect for Jerry and his topics and writing.

      I can attach the email if you’d like so some of you can put away your jump to conclusions mat. Honestly would’ve expected more from intellectuals instead of bandwagon sentiments.

  18. Wokeism and identity politics are polarizing and divisive. As a traditional liberal, I abhor the circus in my own camp. Keep speaking out.

  19. I have not particular issue with the interrogation of “woke” on the site, it’s your site after all. The only point I’d like to make is when you characterise it as an increase in polarization, the implication seems to be that there were no politics before until the “wokeness” came in. I would think that it was merely that the politics was less visible to you before and is changing to a politics you disagree with so is now more visible. Apoligies if I’ve misunderstood.

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