Structural inequities built into the American healthcare system and American society have received renewed attention of late due to disparities in COVID-19 treatment and outcomes. Unjust and racially motivated deaths of minoritized and marginalized individuals—often at the hands of those who are meant to offer protection—and significant disparities in key health indicators have become evident. This attention on structural inequities has caused many individuals and organizations to look inward and examine their own histories, policies, and procedures to identify past wrongs and current areas that are open to bias and discrimination. The Federation of State Medical Boards (FSMB) is among such organizations. In 2019, the FSMB embarked on a journey to closely examine its past and to educate itself about how best to move forward in a way that balances the needs and priorities of all those it serves.

Under the leadership of FSMB Past Chair Cheryl Walker-McGill, MD, MBA, the FSMB Board of Directors was provided with education and training about systemic racism, other forms of discrimination, and strategies for identifying and mitigating bias. Dr. Walker-McGill also created a Task Force on Health Equity and Medical Regulation that was charged with exploring what state medical boards can do to address health inequities and implicit bias, while also evaluating current policies and processes in medical licensing, discipline, and regulation. This Task Force provided guidance to the FSMB Board of Directors as it developed a Statement on Diversity, Equity and Inclusion (DEI) in Medical Regulation and Health Care, as well as a DEI “Blueprint.” This Blueprint is comprised of seven categories that provide broad guidance for ongoing and future work of the FSMB in anti-discrimination and DEI: Looking Inward; Fair and Transparent Processes; Advocating for Cultural Safety; Research and Data Optimization; Education and Support; Trust; and Collaboration. These have all been foundational themes in the FSMB’s work since the development of the Blueprint.

Much of the subsequent work of the FSMB has been carried forward by the Workgroup on DEI in Medical Regulation and Patient Care, created by FSMB Immediate Past Chair Kenneth Simons, MD, in May of 2021. Dr. Simons charged the Workgroup, for which I have the honor of serving as Chair, with collecting and analyzing data about membership on state medical boards, considering educational opportunities for increasing the understanding of DEI among medical regulators and physicians, identifying best regulatory practices for ensuring fairness and incorporating the principles of equity and inclusion in board decision making, and promoting a better understanding of the impacts of bias, inequity and systemic racism on medical regulation, health and health care.

The Workgroup began addressing its charge by examining the history of DEI in medical regulation and collecting information about the work that was already underway at the state level to address bias, combat discrimination, and increase DEI. Work-group members considered many helpful examples of training programs in implicit bias for board members and staff, strategic plans and initiatives of state medical boards, statements from board leadership in newsletters and on board websites, examples of data analysis and reporting that provided helpful and transparent insights into board processes, and practice guidance for licensees. It was extremely illuminating to learn about the wide variety of ways in which state medical boards from across the country are making meaningful progress on numerous aspects of anti-discrimination and DEI. Perhaps most illuminating are examples of special committees and staff positions that have been created at state medical boards to closely analyze policies and procedures vulnerable to bias. One such example comes from the Washington Medical Commission’s Health Equity Advisory Committee which conducted a review of rules, policies, procedures, and guidelines to identify several priority areas for change1 . Notable changes include a blinded hiring process where applicants cannot be seen by Commission staff, redaction of demographic data from complainant statements, changes to licensing application processes to remove potentially biasing categories or information, and a newly drafted Policy Statement on Discrimination in Health Care.

The Workgroup was also impressed to see legislation enacted in several states that mandate a minimum level of board diversity in terms of gender, race, ethnicity, and other demographics. This demonstrates recognition by state legislatures that diversity brings great value to state medical boards in fulfillment of their mission to protect the public, an idea our Workgroup members agree with wholeheartedly. This type of legislative strategy for increasing diversity on boards features prominently in an Interim Report of the Workgroup that was presented to the FSMB House of Delegates at its Annual Business Meeting in April of this year. The Interim Report provides an overview of the above-mentioned initiatives by state medical boards and the FSMB, while addressing numerous other concepts related to DEI that pertain to the work of state medical boards.

The FSMB House of Delegates voted to adopt all seven of the recommendations in the Interim Report which address board composition, data gathering and analytic capacity among boards, education for board members, staff, licensees, and patients, and call for formal adoption of the statement of the FSMB Board of Directors on DEI in Medical Regulation and Health Care2 .

While we are very pleased with the progress made by our Workgroup thus far, we recognize that there remains a great deal of work to be done. Over the course of the coming year, we will attempt to build on the content of our interim report and engage with partners in medical practice and patient care, particularly those representing minoritized and otherwise marginalized physicians, to address elements of DEI that have a nexus to medical regulation. This will include a deeper look into social determinants of health and how knowledge of these factors can be incorporated into patient care to help address barriers to health and improve social justice.

We will also look to turn policy into practice by leveraging a key element of the Workgroup’s interim report: the “DEI Playbook” which categorizes the state medical board practices that are vulnerable to bias and discrimination and provides strategies for mitigating and eliminating the potential biases associated with each one2 . The Playbook, summarized in Table 1, is the Workgroup’s attempt to provide practical steps and solutions for state medical boards, regardless of their level of resources or operational autonomy. We hope that the Workgroup’s final report will offer meaningful ways to impact DEI for all state medical boards, wherever they are on their journeys to eliminate bias and discrimination in their own processes and improve health equity for the public they serve.

Table 1

Summary of DEI Playbook

Summary of DEI Playbook
Summary of DEI Playbook
Washington Medical Commission, Discrimination in Health Care Policy, Effective Date March 4, 2022. Accessed June 6, 2022.
FSMB Workgroup on Diversity, Equity and Inclusion in Medical Regulation and Patient Care. Diversity, Equity and Inclusion in Medical Regulation and Patient Care. Accessed June 6, 2022.