With a slew of legal cases challenging race-based initiatives and assumptions underway across the country, California’s continuing medical education requirements — which include mandatory implicit bias training — are under fire as doctors say the law compels them to espouse the government’s view on the contentious topic.

Recently transferred to a new judge, Azadeh Khatibi, et al. v. Hawkins, et. al currently has a hearing scheduled in a district court in California on March 11. The lawsuit — whose plaintiffs include doctors Azadeh Khatibi and Marilyn Singleton, joined by a medical advocacy group called Do No Harm — challenges implicit bias training for lacking evidence and says the doctors prefer to “teach different, evidence-based subjects” in medicine. 

California’s law requires doctors to complete 50 hours of continuing medical education every two years as a condition of license renewal. A law passed in 2019 required those courses to include teachings on implicit bias, defined as “internalized stereotypes that affect our perceptions, actions, and decisions in an unconscious manner” and contribute to “unequal treatment” based on race, sex, gender identity, and more. The law declares that implicit bias directly contributes to health disparities, resulting in worse healthcare outcomes for Black patients, women, and LGBTQ people. 

A California-based public interest law firm representing the doctors, the Pacific Legal Foundation, notes that the “doctor-patient relationship is sacrosanct” and thus doctors and patients do not “need California legislators to tell them what they should be thinking about or what advice they should be giving when treating their patients.” The government, the firm adds, cannot “force ideological compliance of preferred viewpoints.” 

In enacting the implicit bias requirements, California’s government forces instructors of continuing medical education to include a topic that some instructors would otherwise not include, an attorney for Pacific Legal Foundation, Caleb Trotter, tells the Sun.

“Because the government is mandating they include certain topics, then the government must satisfy strict scrutiny, which is the most stringent form of judicial scrutiny,” he says, noting that many courts, including the Supreme Court, have held it’s the “proper standard when the government is compelling speech by private actors.” 

A major concern of the doctors is that the time spent teaching implicit bias in medical courses could take away precious time from teaching lifesaving medical techniques and important healthcare developments. Both doctors in the case view requirements to teach implicit bias “as detrimental to their ability to teach what they set out to teach,” Mr. Trotter says. 

Dr. Khatibi, who was born in Iran and immigrated to America as a 6-year-old, is willing to discuss implicit bias if it fits with a topic she is teaching but has concerns about being forced to include it no matter the context, Mr. Trotter says. 

Dr. Singleton, who is Black, thinks the idea of implicit bias in itself is harmful and backfires, he says. Dr. Singleton has been vocal in criticizing the concept, writing an opinion for the Washington Post that the “malignant false assumption that Black people are inherently inferior intellectually has been traded in for the malignant false assumption that White people are inherently racist” and criticizing society for moving back towards “racial obsession.”

The named defendant in the case, the Medical Board of California, argued in its response that since the continuing medical education classes for licenses are controlled by the state, the implicit bias training constitutes government speech and doesn’t infringe on free speech rights. It also states that if the content infringes on personal views, doctors are free to stop teaching the course. “There is no requirement under California law that licensed physicians must teach continuing medical education courses,” the government’s reply adds.

Representatives of the Medical Board of California declined to comment, citing pending litigation. 

“In California alone there are at least 50 professions that require continuing education,” Mr. Trotter says of the government’s arguments. “And for a court to say that continuing education in all of these professions is actually government speech and that they can regulate it in any way they see fit would be a major expansion of the court’s government speech doctrine.”