Supreme Court Review Sought Over California’s Mandate For Private Medical Instructors To Cover Implicit Bias
California has a reputation for heavy-handed regulations, and the medical sector in particular has seen a broad expansion of oversight.
To renew a license, physicians in California must accumulate 50 hours of approved continuing medical education (CME) every two years. Beginning in 2022, the state began requiring clinicians who provide direct patient care to finish CME modules that address implicit bias, which the state describes as the attitudes or internalized stereotypes that shape our perceptions, actions, and decisions and that contribute to unequal treatment of people based on race, ethnicity, gender identity, sexual orientation, age, disability, and other characteristics.
A group of California physicians contends that this mandate breaches free speech, and they are urging the Supreme Court to hear their case and strike down the law as unconstitutional. TheJustices are set to review the petition at their September 28 conference.
Among the plaintiffs is Azadeh Khatibi, an Iranian-born physician who moved to the United States at the age of six. After completing a joint MD program through the University of California, San Francisco, and UC Berkeley, she specialized in ophthalmology in Los Angeles and has taught CME courses in California for several years.
“I believe it is dangerous for the state to compel physicians to speak when they are teaching other physicians, and for the state to intrude so deeply into medical practice,” Khatibi tells Reason. “I’ve never said I oppose implicit bias training… I have actually taught mindfulness and the power of the subconscious mind, but the evidence behind implicit bias training is still early and contentious.”
“This law, which makes the teaching of strategies a central feature, isn’t grounded in science,” she adds. “Not only is the state compelling the private speech of doctors, which is unconstitutional, it is additionally mandating discussion on a topic where the underlying science and methods are poorly established.”
Indeed, there is scant evidence that mandatory implicit bias trainings effectively reduce discrimination. A 2019 meta-analysis of 492 studies with more than 87,000 participants found that such interventions typically produced only minor behavioral changes, and there is little evidence that shifts in implicit measures translate into changes in explicit attitudes and actions. In some cases, these trainings have been shown to increase discrimination. A 2026 study in the Journal of Personality and Social Psychology reported that required diversity training can heighten reactance.
Marilyn Singleton, another plaintiff, argues that diversity requirements can adversely affect patients. In a 2023 Washington Post op-ed describing her experience as “a Black woman in a class of mostly White men,” Singleton wrote: “Black people are effectively being told that White physicians are likely to harm our health. If that is the message, why would you pursue medical care unless you could be absolutely sure you would not be treated by a White physician?”
“Forcing every CME instructor to address implicit bias constitutes compelled speech that the First Amendment prohibits,” argues Caleb Trotter, a senior attorney at the Pacific Legal Foundation who represents Khatibi and Singleton. “This requires instructors to teach a specific topic regardless of their preferences, beliefs, or expertise.”
The case has taken shape over years. In August 2023, the doctors, alongside the medical-advocacy group Do No Harm, filed a federal complaint in the District Court for the Central District of California, a suit that the court later dismissed. In 2025, the Ninth Circuit Court of Appeals rejected the plaintiffs’ challenge and affirmed the district court’s ruling. The appellate panel determined that California’s implicit bias requirements within CME training amounted to government speech—an established doctrine permitting the government to speak for itself without violating the Free Speech Clause—and thus did not infringe the First Amendment.
“What they’re saying is that continuing education is government speech just as if it were a state employee, a public school teacher, or even a historic ad campaign like ‘Got Milk?’,” notes Trotter. He asserts that California is attempting to extend that principle to cover “private speakers speaking in their private capacity in private courses accredited by private organizations.”
Trotter characterizes the law as a sweeping expansion of the government speech doctrine, arguing that if the Supreme Court doesn’t intervene, “there’s nothing to stop any state in the future from requiring professionals of all kinds to incorporate contentious societal topics into licensing requirements.”
The Supreme Court has previously ruled in favor of protecting free expression in related circumstances. In NIFLA v. Becerra (2018), the Court held that California could not compel licensed pregnancy centers to advertise state abortion services merely because they were regulated professionals. The ruling noted that “this Court has never recognized ‘professional speech’ as a standalone category of speech with different rules. Speech is not unprotected simply because it is uttered by professionals.”
California is not alone in pursuing implicit bias training for medical professionals. In 2020, Michigan Governor Gretchen Whitmer issued an executive directive mandating a similar requirement, a move challenged by the Pacific Legal Foundation. Massachusetts, Washington, and Maryland also maintain related mandates, with Maryland requiring both implicit bias and “structural racism” training for all first licenses or renewals.
These laws illustrate a broader array of occupational licensing restrictions that can impede work and push up costs. With the United States maintaining a substantial and intrusive licensing regime, according to Trotter, there is a risk of ongoing mission creep. Around one-fifth of employed Americans currently require a government-issued license to perform their jobs, and these barriers tend to raise prices by limiting competition without necessarily boosting public safety.
This case extends beyond free-speech concerns. It also serves as a cautionary tale about the consequences when governments gain broad authority to determine who may work—and under what conditions.
