Doctors Rebel: Forced Bias Lessons On Trial

Doctor reviewing a file at a desk — Photo: Elnur / Shutterstock

California’s mandate forcing every medical education course to include “implicit bias” instruction now faces a Supreme Court test that could redraw First Amendment lines for professionals.

Story Highlights

Doctors and a nonprofit ask the Supreme Court to strike California’s implicit-bias mandate for continuing medical education as compelled speech.
California requires nearly all continuing medical education courses to include implicit-bias content starting January 1, 2022.
The Ninth Circuit upheld dismissal of the challenge by calling the courses “government speech,” avoiding First Amendment scrutiny.
The outcome could affect speech rules across licensed fields, not just medicine.

What California Requires Doctors To Learn

California law requires physicians to complete continuing medical education to renew a license. Starting January 1, 2022, the state said courses, with limited exemptions, must include an “understanding of implicit bias,” defined in statute and board guidance. A state appendix in the Supreme Court petition quotes the law saying all courses “shall contain curriculum that includes the understanding of implicit bias”. Supporters say the aim is to reduce unequal treatment in care and improve outcomes.

Doctors who design or teach these courses say the rule is not neutral training but forced messaging. They argue the state compels them to speak about contested ideas on bias and race to access a professional platform they built through study and practice. They add that the requirement applies to every course, even those on unrelated topics like cardiology devices or anesthesia safety, which makes the rule broader than typical safety or ethics content.

How The Legal Fight Reached The Supreme Court

Two doctors and the group Do No Harm sued California officials who oversee physician licensing. They claim the mandate violates the First Amendment by forcing private instructors to include state-approved ideas and by attaching speech conditions to a license-linked program. A federal district court dismissed the case. The United States Court of Appeals for the Ninth Circuit affirmed, holding that courses eligible for credit are “government speech,” which removes them from Free Speech Clause review.

The petitioners now ask the Supreme Court to reverse. Their filing says California may regulate medicine but cannot force professionals to carry an ideological message to keep their voice in a required forum. Their briefs urge the Court to reject the “government speech” label for private lectures and to apply established compelled-speech limits. They warn that upholding the mandate would let states insert political themes into any license-tied learning across professions.

Why The Case Matters Beyond California

Professional education rules exist nationwide, and many states set content lists on ethics, opioids, safety, and patient privacy. This case turns on something else: whether government can compel private instructors to add a disputed message to courses simply because the state links those courses to license renewal. If the Court accepts the petition and sides with the doctors, states would need to stop content mandates that go beyond objective skills and into contested social theories.

If the Court declines review or agrees with the Ninth Circuit, states could call license-linked teaching “government speech” and expand required themes. That could include race, sex, climate, or other policy goals placed inside mandatory education. Petitioners say that would chill academic freedom, turn teachers into mouthpieces, and erode a core First Amendment safeguard against compelled speech in professional life.

What Each Side Argues About Free Speech

California argues it lawfully regulates continuing education and seeks to fix real gaps in care. The Medical Board says the rule is designed to reduce harmful disparities and ensure fair treatment for all patients, and that the state can set content for credit-bearing courses tied to a license. The Ninth Circuit agreed with that framing, calling the courses government speech, which ends the constitutional inquiry at the threshold.

The doctors counter that the state can require hours and topics like safety, but cannot force a viewpoint on bias in every course. They say instructors remain private speakers who choose content, style, and messages, and that the state’s role is approving credit, not scripting lectures. They point to Supreme Court compelled-speech cases to argue that the Constitution bars the government from making private citizens mouth ideas they do not share, even in regulated fields.

What To Watch Next

The Supreme Court will decide whether to hear the case. If the Court grants review, briefing would focus on when speech in a license-linked program is private or government speech, and how compelled-speech rules apply to professional education. For doctors, and for teachers in law, engineering, and beyond, the ruling could shape whether states can embed controversial messages as the price of keeping a license or teaching for credit.