Diversity & Inclusion: Why Representation Matters

Creating more diversity within academic surgery requires a targeted, long-term and dedicated approach. It's a worthwhile goal. Eliminating long-standing racial and ethnic disparities and inequalities will improve access to surgical care for increasing numbers of diverse patients who feel more comfortable with providers who have a greater understanding of their background, culture and life experiences.

The racial breakdown of the nation's population is drastically different than it was 50 years ago, when 80% of the country's residents were white. By 2060, the percentage of white Americans will be closer to 47%. The growing diversity in communities has to be represented in the surgical workforce, which should reflect the make-up of the patients they treat.

Research shows half of medical school students and residents believe Black patients feel less pain than white patients. Other studies have shown that healthcare professionals have implicit biases in terms of positive attitudes toward white patients and negative attitudes toward patients of color. Increased representation among healthcare providers would lessen the impact of implicit or explicit bias, and foster a greater understanding of cultural and language differences that will ultimately have a positive impact on patient care.

Unfortunately, a diverse healthcare workforce is not being trained. Consider the landscape in top medical schools over the last 20 years. Under-represented minorities make up 10% of graduates from surgical residency programs. The percentage of Black male graduates is on the decline and the percentage of Black female graduates continues to hover at or around just 2.5%.

Achieving an equal playing field among surgeons of the future demands changing the demographics in the field of academic surgery today. Medical schools must increase the pipeline of underrepresented groups by training a diverse workforce and should be intentional in promoting minority faculty members to leadership positions in academia. Of nearly 3,500 professors of surgery, 10 are Black women. Of 337 chairs of surgery, two are Asian women, two are Latina women and none are Black women. In fact, there has yet to be a Black woman to ascend to the role of department of surgery chair. Educating and training a more diverse workforce will eventually filter throughout entire health systems, and down to the frontlines of care.

Improving representation in health care also requires education and allyship at the individual and leadership levels. Leaders in power have the ability to effect change; they must recognize that privilege and use it to be intentional in efforts to achieve greater equality among providers and leadership.

Hannah Valantine, MD, MRCP, chief officer for scientific workforce diversity at the United States National Institutes of Health, talks of creating equality committees within healthcare systems to develop and implement equity metrics for all divisions within departments of surgery. The committees would analyze faculty demographics and ensure diversity in grand rounds speakers or invited lectureships.

National surgical societies such as the American College of Surgeons, the American Surgical Association and the Association of Women Surgeons are beginning to prioritize the issue of diversity, equality and inclusion by creating task forces, and committees, and publishing white papers. These organizations are partnering with the Society of Black Academic Surgeons, the Latino Surgical Society and the Society of Asian Academic Surgeons to promote and give exposure to underrepresented minority faculty.

Be intentional about making your facility more diverse.

Last month, former and current editors of JAMA Surgery provided a perfect example of allyship. They used their privilege to create change by asking all surgery journal editors to improve diversity in the editorial and peer review process. We need more allies who are committed to diversity, equity, inclusion and social justice to take similar action.

Surgical professionals need to be committed to the mission of increasing representation in surgery and intentional in implementing programs aimed at achieving greater equality among the provider workforce and surgical leadership. There are plenty of qualified and diverse professionals available to fill open spots on teams of medical providers, surgical leadership and surgical faculty.

Innovation doesn't occur if every member of a group has the same thought process, background or mentality. Your facility will thrive if staff members, providers and leaders come from different life and workplace experiences. They will bring different perspectives that will help shape how your team thinks, solves problems and taps into a wider spectrum of knowledge.

Creating a diversity, equality and inclusion committee could prove helpful in recognizing where diversity doesn't exist within your organization. People can always argue feelings and emotions, but they can't argue facts. Look at data. Look within your facility and ask the hard questions. How diverse are members of your patient care and leadership teams? If you have zero representation, you might need to create more equality within your workforce. Be intentional about making your facility more diverse from the top down — and be open to changing and improving. OSM