CMS Takes a Crucial Step Toward Ridding Medical Education of DEI

Recently, the Centers for Medicare & Medicaid Services (CMS) incorporated proposals by Do No Harm and Defending Education in a final rule establishing additional protections to keep unlawful discrimination out of medical residency programs for graduate medical education.

These protections are aimed at preventing graduate medical education accreditors, like the Accreditation Council for Graduate Medical Education (ACGME) and others, from requiring or otherwise encouraging or promoting hospitals to implement discriminatory criteria in their medical residency programs.

Under the final rule, hospitals may continue to receive federal payments for direct and indirect graduate medical education costs for accredited medical residency programs. 

However, for payment purposes, CMS will only deem an accredited program “approved” where the accreditation organization “does not use accreditation criteria that promote or encourage discrimination on the basis of race, color, national origin, sex, age, disability, or religion, including the use of those characteristics or intentional proxies for those characteristics as a selection criterion for employment, program participation, resource allocation, or similar activities, opportunities, or benefits.”

In practice, this means that accreditors continuing to force discriminatory standards in accreditation requirements for graduate medical education will place accredited hospital programs at risk by imposing potentially significant financial burdens to hospitals, who may not be able to recoup costly graduate medical education expenses.

The final rule’s implementation of these anti-discrimination provisions directly reflects the language Do No Harm and Defending Education proposed in a comment to the agency earlier this fall. 

In September, Do No Harm submitted a responsive comment to CMS’s proposed rule, warning the agency that the rule’s anti-discrimination protections may be susceptible to circumvention in which accreditors “engag[e] in word play to circumvent the proposed rule’s reach.”

Given various, ongoing circumvention efforts, our comment laid out the very real possibility that accreditors might easily evade the rule through word gaming and cosmetic changes that merely cloak the continued practice of DEI.

As Do No Harm has documented in our “Zombie DEI” report and elsewhere, many institutions simply rebrand their DEI programs and initiatives while continuing to engage in racially discriminatory practices and promote radical identity politics.

CMS took our concerns seriously.

Indeed, in issuing the final rule, CMS explicitly credited these concerns as motivating its decision to revise the final language.

The agency further stated that it “agree[s] that the regulations should more explicitly specify the types of practices that will be prohibited under [the] finalized policy,” confirming that CMS would “add language to the regulations that would prevent accreditors from engaging in word play as a means of circumventing the proposed policy.”

Do No Harm applauds CMS for taking action to address this urgent problem in medical education.

The role of accreditors in injecting racially discriminatory policies and practices not just in graduate medical education, but throughout medical and healthcare education, is often overlooked. But accreditors, due to the immense power they wield, can effectively extort these programs into implementing DEI policies as a condition of accreditation.

Do No Harm’s March report on medical and healthcare education accreditors highlighted this dynamic. 

We examined ten such accreditors, including the Liaison Committee on Medical Education (LCME), the Council on Podiatric Medical Education (CPME), and the Commission on Dental Accreditation (CODA), and found that each of them imposed various DEI mandates upon professional healthcare degree programs.

These ranged from explicit requirements to maintain DEI offices and programs to more indirect encouragement of efforts to achieve certain diversity-related outcomes. 

And in April, the Trump administration took notice of this problem; President Trump issued an executive order directly targeting discriminatory accreditation standards in medical education. 

The order specifically directed the Department of Justice, the Department of Education, and the Department of Health and Human Services to “investigate and take appropriate action to terminate unlawful discrimination by American medical schools or graduate medical education entities that is advanced by the Liaison Committee on Medical Education or the Accreditation Council for Graduate Medical Education or other accreditors of graduate medical education, including unlawful ‘diversity, equity, and inclusion’ requirements under the guise of accreditation standards.”

Following the executive order, many of the accreditors began to ditch overt language in their accreditation standards that required medical and healthcare education programs to implement DEI policies and/or engage in racial discrimination.

For instance, in May, the LCME voted to eliminate Element 3.3, a requirement that forced medical schools to have in place “programs and/or partnerships” aimed at achieving diversity.

And in September, the ACGME not only eliminated DEI requirements from its accreditation standards, but closed its DEI department. 

CPME, another accreditor of graduate medical education, suspended diversity requirements for podiatric medical colleges and residency programs following the executive order.

The CMS final rule implements crucial protections to cleanse graduate medical education of unlawful DEI mandates, including shutting down surreptitious discrimination in accreditation standards advanced by entities like the ACGME and CPME. Such a rule is necessary given these institutions’ long histories of DEI activism.

The ACGME has been particularly vocal in its endorsements of DEI: back in 2024, the ACGME’s then-DEI officer bemoaned efforts to disband DEI programs as “insane.”

And at its 2023 annual education conference, the ACGME hosted no fewer than 11 sessions dedicated to advancing DEI in medical education. 

These examples underscore the need for strong federal action to ensure that DEI is removed from medical and healthcare education.

In summary, the CMS rule is a crucial step forward toward ridding graduate medical education of harmful racial discrimination.