Physicians in the United States have long been trained to assess race and ethnicity in the context of clinical interactions. Medical students learn to identify how their patients' "demographic and cultural factors" influence their health behaviors [1]. Interns and residents receive "cultural competency" training to help them communicate with persons of differing "ethnic" backgrounds [2]. And clinicians are taught to observe the races of their patients and to dictate these observations into medical records-"Mr. Smith is a 45-year-old African American man"-as a matter of course [3].To be sure, attention to matters of diversity in clinical settings has been shown to affect a number of factors central to effective diagnosis and treatment [4]. Yet an emerging educational movement challenges the basic premise that having a culturally competent or sensitive clinician reduces patients' overall experience of stigma or improves health outcomes. This movement, called "structural competency" [5], contends that many health-related factors previously attributed to culture or ethnicity also represent the downstream consequences of decisions about larger structural contexts, including health care and food delivery systems, zoning laws, local politics, urban and rural infrastructures, structural racisms, or even the very definitions of illness and health. Locating medical approaches to racial diversity solely in the bodies, backgrounds, or attitudes of patients and doctors, therefore, leaves practitioners unprepared to address the biological, socioeconomic, and racial impacts of upstream decisions on structural factors such as expanding health and wealth disparities [6].In 1968, the US civil rights activist Stokely Carmichael famously assailed racial bias embedded, not in actions or beliefs of individuals, but in the functions of social structures and institutions. "I don't deal with the individual," he said. "I think it's a copout when people talk about the individual" [7]. Instead, speaking to a group of mental-health practitioners, Carmichael protested the silent racism of "established and respected forces in the society" that functioned above the level of individual perceptions or intentions and that worked to maintain the status quo through such structures as zoning laws, economic policies, welfare bureaucracies, school systems, criminal law enforcement, and courts. Institutionalized racism, he argued, "is less overt, far more subtle, less identifiable in terms of specific individuals committing the acts, but is no less destructive of human life" [7].