Diversity, Equity & Inclusion: Surgery Is a Human Right

I’m fully committed to integrating the practice of public health into surgery and tapped into my passion for health equity to help launch the Center for Surgical Health (CSH) at Penn Medicine, a program that focuses on improving access to high-quality outpatient surgical services for underserved and undersupported individuals in the Philadelphia community. Patients are referred to CSH from federally qualified and community health centers and health networks, with the aim to eliminate the use of local emergency departments as pre-op clinics for elective care.

The CSH team identifies the clinical and social support needs of each patient, connects them with surgeons who provide world-class care and links them to personal navigators who guide them through the surgical continuum, from pre-op diagnosis to post-op follow-up.

Elective surgery is synonymous with outpatient surgery, which is growing in complexity and urgency for patients suffering from debilitating and potentially life-threatening health conditions. One of the center’s goals is to transition elective surgery to a preventative health model for disease — surgery is not optional for a patient with biliary colic who needs their gallbladder removed to prevent acute cholecystitis — and perform procedures patients need to decrease subsequent morbidity and mortality that results from delays in care. 

The implications of subjecting marginalized patients — who are often living paycheck to paycheck, who are food and housing insecure — to multiple-day hospitalizations for procedures that could be handled in the outpatient space could be catastrophic. We’re trying to provide care to members of our community most at risk of suffering from morbidity associated with the social determinants of surgical health.

Penn Medicine and private foundation grants cover the program’s operational costs and education programming. We take pride in understanding and navigating Medicaid legislation, and try to ensure eligible patients are covered through public benefit for their operations. We understand the complexities of employer-based health plans and help patients navigate those services, as well.

The program’s surgeons are queried to determine whether they have a particular interest in caring for certain sociodemographic communities (Latinx, African-American, African, Eastern European or LGBTQIA). We are extremely proud of our robust plastic and reconstructive division that provides surgical access to patients who need gender affirmation surgery and ensures they feel respected and dignified throughout the entirety of their care.

It’s important to note that while the surgeons involved in the program are committed to curing surgical diseases in underserved patients, they’re also reimbursed for their services. CSH surgeons care for patients who are less likely to receive the gold standard of surgery within a sustainable incentive structure that works.

CSH’s personal patient navigators (PPNs) receive training to ensure they understand the elective surgery process and have the necessary tools and cultural competency to develop substantive relationships with their assigned patients. We believe that it is critical to limit the number of patients with whom the PPNs work. This ensures that all PPNs maintain close connections with the patients they serve.

Medical students make up 90% of the PPN team, but the role is also filled by students studying social work, nursing, business and law. The common denominator is that they’re all enthusiastic and passionate about caring for underserved individuals. They lean into the relationships with patients who are desperately in need of support.

I’m an optimist who truly believes people have an innate interest in helping others.

Working as a PPN is a tremendous opportunity for students, who will take the experience with them wherever they end up practicing or working. That’s a huge motivator for me. I’m an optimist who truly believes people have an innate interest in helping others. A significant benefit of this program is the creation of a workforce that is more attuned to the needs of underserved and undersupported communities with various lived experiences and for whom high-quality surgical care is a human right. Incorporating public health into the practice of surgery and developing workers who are focused on surgical equity will revolutionize the care of historically vulnerable communities. 

Now is the time for a smarter, more cost-conscious approach to surgical care that fits the needs of patients in our own backyards, and I’m proud to say that our innovative program does just that. OSM