Between executive orders and state laws on gender-affirming care, abortion, and diversity equity and inclusion (DEI),1-3 the last few years have been very challenging. No matter where we stand on the political spectrum, all can agree that academic leaders are in a more precarious situation than ever before, and there have been continued legislative actions affecting the patient-doctor relationship. At the 2025 ADFM Annual Conference in Nashville, a group of departmental and institutional leaders teamed up to share strategies for addressing challenges in this new environment. They presented 4 cases adapted from real situations from blue and red states.

Conference participants were then given time in small groups to consider how they would respond, specifically focusing on communication and the way that faculty and staff affected by these laws could be best supported, before panelists shared how the cases were resolved or handled in their original setting.

This conference session brought ADFM members together around common issues departments are facing, with an emphasis on action required of leadership regardless of politics. It was very well received, and participants walked away with new potential solutions to challenges caused by political interventions impacting their work. ADFM plans to hold a similar session again next year.

These cases are shared below for other leaders to consider their own responses.

Situation: Your state has just passed legislation banning all offices titled Diversity, Equity and Inclusion (DEI). You have 3 department members who are affected by this law and you have 4 months to find new assignments for these 3 faculty members, all the while keeping them whole and working to retain them in your department.

Impact: Although the faculty members are senior and mature, they all feel that they need to seek employment elsewhere. In addition, the other DEI leaders outside the health sciences centers were all repurposed, their teams divided, and their leader took a job elsewhere.

Leadership Response: A senior DEI leader in the health sciences side used personal connections and university permission to gain an audience with the committee responsible for the implementation of the anti-DEI law. In that meeting, they asked hard questions and learned that the state did not want the teams divided, nor did they want the leaders to depart. The committee did want, however, for the DEI office to focus on geographic and socioeconomic disparity. The DEI teams were delighted to take on the new task, and today almost everyone who had a DEI title now works at addressing the disparities listed above.

Situation: Your faculty member receives a notice from the NIH that the R01 grant they received in 2023 will be discontinued. The funded project is randomizing patients to receive referrals to an early pregnancy all-options counseling hotline and following intervention and control groups to assess health, social, and economic outcomes.

Impact: This investigator is faced with an abrupt loss of funding for a project that is already underway.

Leadership Response: The leader recognized the impact of this decision on all faculty pursuing research in the department and sought to communicate immediate support and reassurance. The leader then gathered people together to share information, discuss strategy, and build community. The leader also sought out internal and external resources committed to advancing research, making connections and identifying opportunities for their researchers. Alternative funding opportunities were explored as well, including institutional bridge funding, government and foundation grants, and philanthropy. The leader’s last action was to find a short-term plan to continue the project, ensuring that study team members and participants were not abandoned.

Situation: Your institution is sued, accused of having discriminatory diversity scholarship criteria for visiting 4th-year students to a clinical department.

Impact: This has prompted some fear among the other departments with some considering stopping all visiting student scholarships all together.

Leadership Response: The leader ensured legal compliance while staying mission driven. They assembled a diverse team, making decisions regarding this complex issue. They included legal, GME leaders, communications, and learners. They also rearticulated their mission and goals. The diversity scholarship was changed to focus on individuals committed to working with lower socio-economic–status patients and required applicants to provide a track record of working with that population.

Situation: Anti-immigrant rhetoric and deportations are on the rise nationally. In this state, there is heightened activity by Immigration and Customs Enforcement (ICE) temporally associated with reduced access to public services by undocumented communities.

Impact: Staff and patients at the publicly funded community hospital are impacted by anti-immigrant activities. Staff feared remaining in the workforce and even leaving their homes, resulting in absenteeism. Patients missed appointments, and those who came asked for copies of their medical records and extra medications in case they are detained and deported. People impersonating immigration officers or lawyers in predatory scams targeted elderly undocumented immigrants, spreading disinformation.

Leadership response: Leaders promoted accurate knowledge of local, state, and federal immigration policies by arranging educational sessions, including question and answer, sharing verified websites that offer legal assistance and posting timely information. In partnership with local community-based organizations and county offices, “know your rights” materials in multiple languages were made available and distributed to patients. Leaders distributed a message to all patients through the portal, affirming the institution’s stance to continue to provide health care to all, regardless of immigration status.