Texas HB 5294 mandates A-F letter grading and standardized test consideration at state medical schools while banning race- and ethnicity-conscious admissions — Plain English Decode
Texas HB 5294 mandates A-F letter grading and standardized test consideration at state medical schools while banning race- and ethnicity-conscious admissions — a move the medical establishment says will harm Texas's physician pipeline.
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What It Does
HB 5294 amends the Texas Education Code to impose three distinct mandates on state medical schools. First, on grading: after Senate amendment, at least 50% of coursework required for a medical degree or certificate must be assessed using traditional A-F letter grades — a departure from the national trend in which most U.S. medical schools use pass-fail or honors/pass/fail systems for preclinical years. Second, on admissions: schools must consider applicants' performance on a standardized science and critical-thinking exam (implicitly the MCAT, though not named) as part of the admissions process, while explicitly prohibiting that exam score from being the *sole* criterion for admission. Third, on non-discrimination: schools may not grant any preference in admissions or employment based on race, sex, color, ethnicity, or national origin, with a narrow exception for bona fide occupational qualifications. Separately, any proposed change to a medical school's academic standards must be submitted to both the Texas Legislature and the Texas Higher Education Coordinating Board before taking effect, along with an explanation and proposed effective date. Admissions provisions apply starting with the 2026 spring admissions cycle.
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The Real Story
The surface fight is about grading policy. The deeper fight is about who controls medical school admissions — the legislature or the medical profession — and whether the move away from letter grades was driven by evidence-based pedagogy or by ideological DEI goals. On one side: Rep. Greg Bonnen (R-Friendswood), a physician himself, and conservative groups like Texas Public Policy Foundation argue that pass-fail systems hide academic performance, allow schools to admit less-qualified candidates without accountability, and reduce the rigor expected of doctors. On the other: medical school deans, the Association of American Medical Colleges (AAMC), and faculty argue that pass-fail was adopted after *decades* of research showing it reduces student burnout and competitive toxicity without harming board scores or residency placement rates — and that only about 12 of the nation's 155 accredited medical schools still use A-F grading, meaning Texas would become a national outlier.
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Who Benefits
- Texas Public Policy Foundation and Heritage Foundation-aligned advocacy groups: Gain a legislative victory in the ongoing campaign to extend anti-DEI frameworks into professional education, building a replicable model for other red-state legislatures.
- Applicants with strong A-F academic records who were disadvantaged under holistic admissions: Students who believe their hard GPAs and test scores were being downweighted in favor of "identity-based" criteria may find admissions processes more favorable under the new rules.
- Texas legislature's oversight role: The bill requires medical schools to submit proposed changes to academic standards to the Legislature and the Texas Higher Education Coordinating Board — effectively giving legislators ongoing veto power over curriculum decisions, a significant expansion of political authority over professional education.
- Students who self-select into the Texas system under the new rules: Applicants who value transparent competitive grading and are confident in their standardized test performance may specifically seek Texas schools.
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Who Gets Hurt
- Texas's nine public medical schools (UT Southwestern Medical Center, UT Health Houston, UT Health San Antonio, UTMB Galveston, Texas A&M College of Medicine, Texas Tech University Health Sciences Center, Dell Medical School at UT Austin, UNT Health Science Center, and Sam Houston State University's new program): All face compliance costs to redesign grading structures, rebuild curriculum documentation, and manage the 50% letter-grade threshold — without any additional state funding to do so.
- Underrepresented minority medical applicants: The bill eliminates race- and ethnicity-conscious considerations in a state where the Hispanic population is roughly 40% of residents but significantly underrepresented in physician ranks. Combined with the elimination of DEI offices under SB 17, recruiting pathways for underrepresented students narrow further.
- Current medical students who chose Texas schools partially because of pass-fail systems — research consistently shows those systems improve psychological well-being and reduce competitive anxiety — will now face mandatory grading in at least half their coursework mid-program.
- Rural Texas communities: Already underserved by physicians, rural areas depend on physician pipeline policies. If the law drives strong applicants to out-of-state schools with pass-fail systems, rural communities will feel the shortage downstream, typically 7–10 years later.
- Medical school faculty and administrators: Required to redesign course grading policies, realign curriculum compliance, and report proposed changes to a legislative body — an unprecedented layer of political oversight over professional academic decisions.
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Red Flags
- Competitive disadvantage in the national residency match. Residency programs rank applicants nationally. If Texas graduates have A-F transcripts while applicants from other states have pass-fail transcripts, Texas students may be penalized or advantaged inconsistently depending on the program — introducing uncertainty into one of medicine's most high-stakes competitions.
- Senate compromise creates an incoherent hybrid. The Senate amended the original total A-F mandate to allow 50% of courses to remain pass-fail. There is no pedagogical rationale for why exactly half a curriculum should use one system and half another. Medical school deans now face the burden of redesigning which courses fall into which category — a compliance nightmare with no educational evidence behind the threshold.
- Vague standardized test language. The bill requires schools to "consider performance on a standardized test focused on knowledge and critical thinking applicable to science and medical practice" — but does not name the MCAT or any specific exam. This creates ambiguity about compliance and could be exploited or litigated.
- Physician shortage feedback loop. Texas already has severe rural physician shortages. Approximately 60% of physicians stay and practice in the state where they complete residency training. If the grading law discourages competitive applicants from choosing Texas medical schools over out-of-state alternatives, the state loses future physicians at the training stage. Critics of the bill raised this concern explicitly in committee.
- Institutional autonomy and accreditation risk. The Liaison Committee on Medical Education (LCME), which accredits U.S. medical schools, sets its own standards for curriculum design. State legislation mandating grading structures could create a conflict with LCME accreditation requirements, theoretically threatening the accredited status of Texas medical schools — though this outcome is unlikely, it is not impossible.
- "Bona fide qualifications" exception is undefined. The bill's anti-discrimination provision includes a narrow carve-out for admissions criteria that constitute "bona fide qualifications necessary to the normal operation" of the school. This language is borrowed from employment law but has not been tested in the medical school admissions context, creating litigation uncertainty.
---
Hidden Riders
- Curriculum reporting to the legislature. Buried beneath the grading and admissions provisions is a requirement that medical schools get effective pre-clearance from the Legislature before changing academic standards. This is not framed as anti-DEI policy but as "transparency" — yet it gives politicians ongoing, real-time control over how physicians are trained in Texas. No prior Texas law required medical schools to submit curriculum changes for legislative review.
- Scope potentially covers nursing and allied health. The bill's language applies to "a medical school, or any other public institution of higher education, or school, department, or college of such an institution, that awards medical degrees." Depending on how this is interpreted, it could extend beyond M.D. programs to nursing schools, dental schools, pharmacy programs, and other health sciences programs — none of which were the explicit focus of legislative debate.
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Current Status
Texas HB 5294 was introduced in the 89th Regular Legislative Session (January–June 2025) by Rep. Greg Bonnen and referred to the House Higher Education Committee. It passed the full House on May 28, 2025 on a vote of 82–48. The Senate amended the bill — notably softening the total A-F grading mandate to require letter grades for at least 50% of required coursework — and passed the amended version. As of June 20, 2025, Governor Greg Abbott signed a package of over 300 bills from the 89th Regular Session; the bill's inclusion in that signing batch has not been definitively confirmed in public records searched, but the bill's trajectory through both chambers under strong Republican majorities makes enactment highly likely. The session ended in early June 2025. If signed, the admissions non-discrimination and standardized testing provisions take effect for the 2026 spring admissions cycle; the grading requirements would apply to the 2025–2026 academic year going forward.
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Sources:
- [Texas HB5294 | 2025-2026 | 89th Legislature — LegiScan](https://legiscan.com/TX/bill/HB5294/2025)
- [89(R) HB 5294 — Senate Committee Report version — Texas Capitol](https://capitol.texas.gov/tlodocs/89R/billtext/html/HB05294S.htm)
- [89(R) HB 5294 — Bill Analysis (Committee Report Unamended)](https://capitol.texas.gov/tlodocs/89R/analysis/html/HB05294H.htm)
- [HB 5294 — 89th Legislature — Texas Policy Research](https://www.texaspolicyresearch.com/bills/89th-legislature-hb-5294/)
- [State-mandated grading policies have no place in medical education — STAT News](https://www.statnews.com/2025/07/07/medical-school-grading-pass-fail-letters-texas-indiana-state-bills-dei/)
- [2 states consider nixing pass-fail grading in medical schools — Becker's Hospital Review](https://www.beckershospitalreview.com/quality/hospital-physician-relationships/2-states-consider-nixing-pass-fail-grading-in-medical-schools/)
- [Texas' school DEI bans spur clashing views on discrimination — Texas Tribune](https://www.texastribune.org/2025/03/24/texas-dei-bans-universities-state/)
- [Governor Abbott Signs Over 300 Critical Bills — Office of the Texas Governor](https://gov.texas.gov/news/post/governor-abbott-signs-over-300-critical-bills-passed-during-89th-regular-legislative-session)
- [Texas AFT: Where Major Bills Stand Ahead of Sine Die](https://www.texasaft.org/membership/higher-ed/this-week-in-higher-education-where-major-bills-stand-ahead-of-sine-die/)
- [Oppose Section 1 of HB 5294 — Resist.bot letter campaign](https://resist.bot/letters/d3b0ed2e-cfe8-4feb-8196-809660956f56)
Texas HB 5294 mandates A-F letter grading and standardized test consideration at state medical schools while banning race- and ethnicity-conscious admissions — a move the medical establishment says will harm Texas's physician pipeline.
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Why now
Texas is operating in an accelerating anti-DEI political environment. In 2023 the legislature passed SB 17, which shuttered DEI offices across all Texas public universities (effective January 1, 2024), eliminating over 350 jobs and closing 21 offices in the UT System alone. With the Trump administration's 2025 executive orders pressuring universities to eliminate race-conscious practices under threat of losing federal funding, Republican legislators see a window to extend the DEI rollback deeper into professional education — specifically the admissions and grading systems of medical schools, which they argue evolved pass-fail practices as a covert tool for relaxing academic standards to achieve racial diversity. The national shift of the USMLE Step 1 licensing exam to a pass/fail format in January 2022 gave critics new ammunition: they argue that when the primary national benchmark went pass-fail, medical schools lost a key objective differentiator, creating pressure to restore A-F grades.
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The real story
The surface fight is about grading policy. The deeper fight is about who controls medical school admissions — the legislature or the medical profession — and whether the move away from letter grades was driven by evidence-based pedagogy or by ideological DEI goals. On one side: Rep. Greg Bonnen (R-Friendswood), a physician himself, and conservative groups like Texas Public Policy Foundation argue that pass-fail systems hide academic performance, allow schools to admit less-qualified candidates without accountability, and reduce the rigor expected of doctors. On the other: medical school deans, the Association of American Medical Colleges (AAMC), and faculty argue that pass-fail was adopted after *decades* of research showing it reduces student burnout and competitive toxicity without harming board scores or residency placement rates — and that only about 12 of the nation's 155 accredited medical schools still use A-F grading, meaning Texas would become a national outlier.
---
Red flags
▸ Competitive disadvantage in the national residency match. Residency programs rank applicants nationally. If Texas graduates have A-F transcripts while applicants from other states have pass-fail transcripts, Texas students may be penalized or advantaged inconsistently depending on the program — introducing uncertainty into one of medicine's most high-stakes competitions.
▸ Senate compromise creates an incoherent hybrid. The Senate amended the original total A-F mandate to allow 50% of courses to remain pass-fail. There is no pedagogical rationale for why exactly half a curriculum should use one system and half another. Medical school deans now face the burden of redesigning which courses fall into which category — a compliance nightmare with no educational evidence behind the threshold.
▸ Vague standardized test language. The bill requires schools to "consider performance on a standardized test focused on knowledge and critical thinking applicable to science and medical practice" — but does not name the MCAT or any specific exam. This creates ambiguity about compliance and could be exploited or litigated.
▸ Physician shortage feedback loop. Texas already has severe rural physician shortages. Approximately 60% of physicians stay and practice in the state where they complete residency training. If the grading law discourages competitive applicants from choosing Texas medical schools over out-of-state alternatives, the state loses future physicians at the training stage. Critics of the bill raised this concern explicitly in committee.
▸ Institutional autonomy and accreditation risk. The Liaison Committee on Medical Education (LCME), which accredits U.S. medical schools, sets its own standards for curriculum design. State legislation mandating grading structures could create a conflict with LCME accreditation requirements, theoretically threatening the accredited status of Texas medical schools — though this outcome is unlikely, it is not impossible.
▸ "Bona fide qualifications" exception is undefined. The bill's anti-discrimination provision includes a narrow carve-out for admissions criteria that constitute "bona fide qualifications necessary to the normal operation" of the school. This language is borrowed from employment law but has not been tested in the medical school admissions context, creating litigation uncertainty.
▸ --
Who benefits
• Texas Public Policy Foundation and Heritage Foundation-aligned advocacy groups: Gain a legislative victory in the ongoing campaign to extend anti-DEI frameworks into professional education, building a replicable model for other red-state legislatures.
• Applicants with strong A-F academic records who were disadvantaged under holistic admissions: Students who believe their hard GPAs and test scores were being downweighted in favor of "identity-based" criteria may find admissions processes more favorable under the new rules.
• Texas legislature's oversight role: The bill requires medical schools to submit proposed changes to academic standards to the Legislature and the Texas Higher Education Coordinating Board — effectively giving legislators ongoing veto power over curriculum decisions, a significant expansion of political authority over professional education.
• Students who self-select into the Texas system under the new rules: Applicants who value transparent competitive grading and are confident in their standardized test performance may specifically seek Texas schools.
• --
Who gets hurt
• Texas's nine public medical schools (UT Southwestern Medical Center, UT Health Houston, UT Health San Antonio, UTMB Galveston, Texas A&M College of Medicine, Texas Tech University Health Sciences Center, Dell Medical School at UT Austin, UNT Health Science Center, and Sam Houston State University's new program): All face compliance costs to redesign grading structures, rebuild curriculum documentation, and manage the 50% letter-grade threshold — without any additional state funding to do so.
• Underrepresented minority medical applicants: The bill eliminates race- and ethnicity-conscious considerations in a state where the Hispanic population is roughly 40% of residents but significantly underrepresented in physician ranks. Combined with the elimination of DEI offices under SB 17, recruiting pathways for underrepresented students narrow further.
• Current medical students who chose Texas schools partially because of pass-fail systems — research consistently shows those systems improve psychological well-being and reduce competitive anxiety — will now face mandatory grading in at least half their coursework mid-program.
• Rural Texas communities: Already underserved by physicians, rural areas depend on physician pipeline policies. If the law drives strong applicants to out-of-state schools with pass-fail systems, rural communities will feel the shortage downstream, typically 7–10 years later.
• Medical school faculty and administrators: Required to redesign course grading policies, realign curriculum compliance, and report proposed changes to a legislative body — an unprecedented layer of political oversight over professional academic decisions.
• --
What it does
HB 5294 amends the Texas Education Code to impose three distinct mandates on state medical schools. First, on grading: after Senate amendment, at least 50% of coursework required for a medical degree or certificate must be assessed using traditional A-F letter grades — a departure from the national trend in which most U.S. medical schools use pass-fail or honors/pass/fail systems for preclinical years. Second, on admissions: schools must consider applicants' performance on a standardized science and critical-thinking exam (implicitly the MCAT, though not named) as part of the admissions process, while explicitly prohibiting that exam score from being the *sole* criterion for admission. Third, on non-discrimination: schools may not grant any preference in admissions or employment based on race, sex, color, ethnicity, or national origin, with a narrow exception for bona fide occupational qualifications. Separately, any proposed change to a medical school's academic standards must be submitted to both the Texas Legislature and the Texas Higher Education Coordinating Board before taking effect, along with an explanation and proposed effective date. Admissions provisions apply starting with the 2026 spring admissions cycle.
---
Hidden riders
- Curriculum reporting to the legislature. Buried beneath the grading and admissions provisions is a requirement that medical schools get effective pre-clearance from the Legislature before changing academic standards. This is not framed as anti-DEI policy but as "transparency" — yet it gives politicians ongoing, real-time control over how physicians are trained in Texas. No prior Texas law required medical schools to submit curriculum changes for legislative review.
- Scope potentially covers nursing and allied health. The bill's language applies to "a medical school, or any other public institution of higher education, or school, department, or college of such an institution, that awards medical degrees." Depending on how this is interpreted, it could extend beyond M.D. programs to nursing schools, dental schools, pharmacy programs, and other health sciences programs — none of which were the explicit focus of legislative debate.
---
Precedent
Texas SB 17 (2023) is the direct legislative ancestor, banning DEI offices across all public universities — a model since adopted or attempted in over 20 states. Florida's SB 266 (2023) went further, restricting DEI-related spending and course content at public universities under Gov. DeSantis; Florida's medical schools were part of that law's target zone. Indiana simultaneously considered nearly identical grading legislation (SB 289) in the 2025 session. Nationally, only about 12 of 155 accredited U.S. medical schools still use traditional A-F grading — the overwhelming majority shifted to pass-fail or tiered pass-fail systems after the 2004 Liaison Committee on Medical Education research showed mental health benefits without academic performance loss. Texas HB 5294 is the first successful state-level law to mandate a specific grading structure for medical schools.
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Current status
Texas HB 5294 was introduced in the 89th Regular Legislative Session (January–June 2025) by Rep. Greg Bonnen and referred to the House Higher Education Committee. It passed the full House on May 28, 2025 on a vote of 82–48. The Senate amended the bill — notably softening the total A-F grading mandate to require letter grades for at least 50% of required coursework — and passed the amended version. As of June 20, 2025, Governor Greg Abbott signed a package of over 300 bills from the 89th Regular Session; the bill's inclusion in that signing batch has not been definitively confirmed in public records searched, but the bill's trajectory through both chambers under strong Republican majorities makes enactment highly likely. The session ended in early June 2025. If signed, the admissions non-discrimination and standardized testing provisions take effect for the 2026 spring admissions cycle; the grading requirements would apply to the 2025–2026 academic year going forward.
---
Sources:
- [Texas HB5294 | 2025-2026 | 89th Legislature — LegiScan](https://legiscan.com/TX/bill/HB5294/2025)
- [89(R) HB 5294 — Senate Committee Report version — Texas Capitol](https://capitol.texas.gov/tlodocs/89R/billtext/html/HB05294S.htm)
- [89(R) HB 5294 — Bill Analysis (Committee Report Unamended)](https://capitol.texas.gov/tlodocs/89R/analysis/html/HB05294H.htm)
- [HB 5294 — 89th Legislature — Texas Policy Research](https://www.texaspolicyresearch.com/bills/89th-legislature-hb-5294/)
- [State-mandated grading policies have no place in medical education — STAT News](https://www.statnews.com/2025/07/07/medical-school-grading-pass-fail-letters-texas-indiana-state-bills-dei/)
- [2 states consider nixing pass-fail grading in medical schools — Becker's Hospital Review](https://www.beckershospitalreview.com/quality/hospital-physician-relationships/2-states-consider-nixing-pass-fail-grading-in-medical-schools/)
- [Texas' school DEI bans spur clashing views on discrimination — Texas Tribune](https://www.texastribune.org/2025/03/24/texas-dei-bans-universities-state/)
- [Governor Abbott Signs Over 300 Critical Bills — Office of the Texas Governor](https://gov.texas.gov/news/post/governor-abbott-signs-over-300-critical-bills-passed-during-89th-regular-legislative-session)
- [Texas AFT: Where Major Bills Stand Ahead of Sine Die](https://www.texasaft.org/membership/higher-ed/this-week-in-higher-education-where-major-bills-stand-ahead-of-sine-die/)
- [Oppose Section 1 of HB 5294 — Resist.bot letter campaign](https://resist.bot/letters/d3b0ed2e-cfe8-4feb-8196-809660956f56)
What to watch
The 50% letter-grade threshold in the Senate-amended version was a significant retreat from the House's full A-F mandate — watch whether this compromise holds in implementation or whether future sessions push to raise the threshold to 100%. Medical school administrators are likely to challenge the curriculum-reporting provision as a separation-of-powers overreach, and the AAMC has national resources to support such litigation. Citizens who want to weigh in should contact the Texas Higher Education Coordinating Board, which will be responsible for compliance oversight, and watch for their rulemaking on what constitutes the 50% threshold.
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