Almost everyone who is currently enrolled in medical school has only ever trained in the context of crisis. Since the moment we submitted our applications in 2020, the United States has grappled with a never-ending stream of previously unprecedented public health events. A global pandemic, a reckoning with systemic racism, and a historic reversal of abortion rights have punctuated the consistent stream of environmental catastrophes, socioeconomic injustices, mass shootings, hate crimes, and overdose deaths that have unfortunately become our norm.
Staring down this reality, our generation of physicians has reliably been taught that there is an inextricable link between politics, social determinants of health, and health outcomes. Sometimes, this cause-and-effect follows a clear path: the U.S. Supreme Court (SCOTUS) overturned Roe v. Wade, allowing an onslaught of abortion bans and restrictions to take effect and in turn, decimating reproductive health care rights and access in roughly half the country. Other times, the through line is more insidious, as with how structural racism influenced the operational and financial models of our modern health care system, thereby creating and perpetuating health disparities. It is consequently understandable that public trust in U.S. health care has been dwindling throughout our lifetimes, as the system has become increasingly commodified and politicized.
Despite this, when it comes to public discourse around social policy, academic medicine—the community of medical schools, teaching hospitals, and professional societies chiefly concerned with shaping the future of health and care—is often nowhere to be found.
How do we know this?
It's in the data. New research we co-authored in last month's BMJ Global Health found that within six months of the Dobbs v. Jackson Women's Health Organization decision that overturned Roe v. Wade, medical schools and their parent medical centers were resoundingly silent on abortion. Just 1 in 3 issued a public statement regarding the decision at all, and even fewer—1 in 5—stood up for abortion rights and access amid an onslaught of bans and restrictions. Similar restraint on Dobbs was also shown among professional medical societies, which traditionally serve as thought leaders and lobbyists for medical specialties and subspecialties. In their case, fewer than 10 percent made a statement within two weeks of the leaked U.S. Supreme Court draft opinion, and fewer than 40 percent made one after the final decision was released. This trend is made even more concerning by the fact that abortion is essential, evidence-based health care, and the loss of abortion rights and access poses known harms to patients, providers, and the health care system.
Abortion is not a standalone issue that academic medicine has failed to weigh in on. Similar reticence was also documented in the literature after George Floyd's murder in 2020, which sparked a national conversation around systemic racism that persists today. Multiple studies found that academic medicine largely side-stepped hard conversations around race in America, and rarely paired their words with meaningful action.
In spite or perhaps because of these institutional leadership failures, health care workers are organizing themselves and their communities to advocate for social policy reform. As student leaders within Medical Students for Choice, we have found purpose and strength through grassroots political and legislative action, rallying our members, and finding allies in organizations like Physicians for Reproductive Health, Physicians for a National Health Program, and White Coats For Black Lives. Yet, even as our movements have secured important wins, we know that ours will remain an uphill battle until the health care establishment sees our sociopolitical struggle as its urgent collective responsibility.
Academic medicine should be the first movers in catalyzing a much-needed shift in U.S. social policy. Among establishment forces—including the likes of pharmaceutical, medical device, and insurance industry giants—academic medicine is unique in both its unadulterated, mission-driven commitment to advancing health and its powerful roots in communities. Our medical schools, hospitals, and health systems are not only denizens of clinical and scientific experts, but also major employers, landlords, and business partners. This stature grants them significant political and cultural sway, particularly at the local level, where social policy issues like abortion are often adjudicated.
As we embark on a major election year, academic medicine has a can't-miss opportunity to course correct. At every level of government, there are ample opportunities for our institutions to abate harmful laws and policies. On the heels of its decision that there is no right to medically necessary abortion in Idaho and Texas, SCOTUS' public health-packed agenda will include whether mifepristone, the drug used in more than half of pregnancy terminations, will retain its FDA approval. Meanwhile, at the state level, Republican governments and candidates are promising to double down on their fervent efforts to restrict abortion, contraception, and gender-affirming care all over the 2024 campaign trails. It is imperative that academic medicine speak out against these alarming trends, and soon.
The policies and practices our health care system supports or fails to support will continue to shape our health and our lives, whether we take accountability for it or not. Academic medicine must urgently recognize its untapped leadership potential—and at long last, stand publicly and proudly with those we claim to serve.
Sarah McNeilly and Vivian Kim are third-year medical students in The Bronx and members of Medical Students for Choice. Their work has been featured in BMJ Global Health, BMJ Opinion, and MedPage Today.
The views expressed in this article are the writers' own.
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