Inspiring Change

The Sunday morning was like any other for Eugene L. Alford, MD, except for a general sense of foreboding he couldn’t shake. Instead of joining his family at church on that late December day in 2007, Dr. Alford decided to hop on a tractor and mow the pasture on his 86-acre farm west of Houston. When he came upon a dead oak tree, he decided to use the tractor’s frontend loader to remove the trunk from his path. On his third attempt, the giant oak snapped in half and pinned Dr. Alford against the tractor’s steering wheel, crushing his spine and immediately paralyzing him from the waist down. A desperate cellphone call to his wife saved his life, but Dr. Alford’s world had been shattered.

His return to the OR as a nationally known facial plastic and reconstructive surgeon at Houston Methodist Hospital didn’t seem possible — at least initially. During a grueling rehab program and some admittedly dark days, Dr. Alford began to think about operating again.

“My biggest fear after the injury was who is the world going to see? A paraplegic or a surgeon?” he says. “It took me a while, a great deal of training and the enthusiasm of occupational and physical therapists for me to realize that the one thing I couldn’t do was stand. My hands and brain still work.”

After 10 months of rehab and recuperation, he returned to work at Houston Methodist in October 2008. His colleagues began to refer him patients. “I’m not sure why — I think it was because they’re my friends,” says Dr. Alford. “Once I was able to demonstrate I could once again care for patients, my regular referral patterns returned.”

His first case back was a straightforward repair of a broken nose suffered by the son of one of his colleagues. He now operates in a power wheelchair that can be adjusted into a standing position and works at a surgical table with an unobtrusive base that allows him to freely maneuver his chair around the patient.

Dr. Alford focuses exclusively on facial plastic and reconstructive surgeries and is booked two to three months in advance. Most patients don’t think twice about his disability.

Dr. Alford’s return to full-time practice wouldn’t have been possible without the overwhelming support he received from Houston Methodist, which he calls a leader in accessibility for disabled staff and patients. “The hospital’s leadership never said no,” says Dr. Alford. “They applied processes to ensure patient safety just like they would do for anyone else. It was a fair, welcoming and encouraging environment. Everyone was so accepting and supportive, and never made me feel like I couldn’t return.”

Laura Matthews, a human resource director at Houston Methodist, says accommodating physicians and employees with disabilities is a key part of the hospital’s culture. When Dr. Alford returned to work, the hospital’s leadership rebuilt an empty office space to widen the hallways and doorways and expand the exam rooms and his office, making the entire space large enough to comfortably accommodate his wheelchair. “He could continue to see patients in a better work environment and be more productive,” says Ms. Matthews. “It’s worked out so well for him.”

Patients appreciate seeing Dr. Alford functioning and practicing, according to Ms. Matthews. “It speaks to them,” she says. “He can identify with individuals who are going through tough times.”

Dr. Alford isn’t the only one to benefit from Houston Methodist’s workplace culture. One of the hospital’s top orthopedic surgeons was paralyzed after a serious bike accident and was eventually able to return to work by teaching residents and conducting virtual appointments with patients. “We want employees to work in a capacity where they feel empowered and don’t lose a sense of self,” says Ms. Matthews.

An employee in the hospital’s research institute is a paraplegic who has helped lead efforts to hold job fairs specifically for individuals with disabilities. “Creating a welcoming environment is what makes us so good,” says Ms. Matthews.

Dr. Alford doesn’t embrace the attention he receives because of his disability, but he realizes the impact he can have on the lives of others who are struggling to overcome physical limitations. “I don’t think I’m important, but I realize I’m an example of full acceptance for the disabled community,” he says. “I don’t like to be called an inspiration. I demonstrate resilience and still put patients first.

That’s the most important thing.”            

— Dan Cook

Tracey Dechert, MD, FACS, a trauma surgeon at Boston Medical Center, has always had a keen interest in equity in surgery and universally equitable patient care. Despite these passions, Dr. Dechert quickly discovered most people falsely believe busy surgeons don’t care about the broad social issues impacting the ORs in which they operate. “I got tired of people believing this misconception, so I did something about it,” she says.

In 2014, Dr. Dechert and a handful of other like-minded healthcare professionals created Socially Responsible Surgery (SRS), which has evolved into a national organization with five chapters in four states (sociallyresponsiblesurgery.org). The group’s mission is to establish social responsibility as a core value of surgical practice, efforts that include equal access to surgical care, eliminating healthcare disparities and increasing patient advocacy, as well as educating and servicing the local and global community. “This is very much a grassroots effort where we thought of how we can effectively make change,” says Dr. Dechert. “There are four major areas in which we create projects and focus our work.”

• Research. SRS focuses on examining factors that will help healthcare providers better understand disparities in surgical care and corresponding interventions to remedy those issues. “We recently published a whitepaper to help physicians not only understand what it means to be socially responsible, but also to help those of us working in medicine understand how to be more accountable for living up to that social responsibility,” says Dr. Dechert.

• Education. The organization is geared toward proactively educating future generations of surgeons on the underlying causes of disparity in surgical care and arming them with tools to advocate for both their patients and their communities. One way is through lectures. “We give talks to medical students and residents about social determinants specific to surgery because too often people think these factors don’t apply,” says Dr. Dechert.

• Advocacy. SRS members use political and social platforms to improve the care of surgical patients and allocate available resources toward the inequality they’ve uncovered. “Whether it’s through policy or law changes, or simply by giving demonstrations or participating in protests, we’re trying to fight the issues our patients are dealing with and advocate for our communities,” says Dr. Dechert. For instance, the group hosts monthly advocacy roundtable discussions on topics ranging from gun violence to immigration status.

• Service. The organization looks beyond simply providing surgical care for patients. “We don’t want our initiatives to become too academic in nature, and that is where the service component comes into play,” says Dr. Dechert.

Her advice to fellow healthcare professionals who want to generate momentum for their DEI efforts is straightforward. “Just keep going,” she says. “This is the type of work that resonates with people. We were a small group for a while, but we just kept at it.”

— Jared Bilski

Growing up, Cherise Hamblin, MD, wanted to be a teacher. But when she took her first biology class in the ninth grade, she became fascinated with how the body worked. “My father said, ‘If you like biology, then you can be a doctor,’” recalls Dr. Hamblin.

To some, her father’s remark might not seem that significant. But to a young Black girl, it was just the kind of motivation she needed. “I decided to become a doctor right then and there,” she says. “My family’s encouragement was a key factor. Looking back, Mr. Taylor, my biology teacher, made an impact on my decision as well. He was the first Black teacher I had since kindergarten. His presence in the classroom was inspiring.”

Dr. Hamblin is now a board-certified OB-GYN at Penn Medicine Lancaster (Pa.) General Health’s Family & Maternity Medicine practice. “Mentorships were pivotal and critical pieces for my advancement,” she says. “But I found out that many of my colleagues, particularly other Black aspiring physicians, did not have the same level of support.”

As soon as Dr. Hamblin became an attending physician, she began working with undergrads at her alma mater, Franklin & Marshall College. “I mentored students in similar ways that I had been mentored,” she says. “This led me to launch Patients R Waiting in 2019, a nonprofit that focuses on increasing the pipeline of minority clinicians and supporting minority clinicians in practice.”

The name Patients R Waiting (PatientsRWaiting.com) is Dr. Hamblin’s way of inflating the self-confidence of the students with whom she works. “When a student does not think they’re good enough or smart enough, my response is ‘Patients are waiting for you,’” she says. “I tell them about the times I’ve walked into a room and a patient’s face lights up because they’ve never been cared for by a Black doctor. Part of what’s needed in health care is varied perspectives and different life experiences. When you bring those things to medicine, patients benefit.”

With the help of grants, donations and fundraising, the organization sponsors college students from underrepresented backgrounds to attend conferences, such as the Student National Medical Association’s (SNMA) annual meeting, which is the oldest and largest independent, student-run organization that focuses on the needs and concerns of Black medical students. “We don’t just pay their fee, we show them how to work a conference, make connections and network,” says Dr. Hamblin.

The organization also helps students prepare to take the MCAT. “We have a prep group, which offers a way for students to work together while practicing for the test,” she says.
While plenty of discussions have been had about improving diversity in medicine, many providers don’t know how to move from discussion to action. Dr. Hamblin says the best way to start is to focus on what is within your sphere of knowledge and influence. “That is where the rubber meets the road,” she says. “We need to do different. We need to do better.”     

— Danielle Bouchat-Friedman 

Transhealth Northampton (Mass.) is to its knowledge the only trans-led organization providing health care for trans and gender-diverse patients in a rural area in the U.S. The clinic opened in May 2021 and continues to grow not just as a valuable healthcare resource in its immediate community, but as a regional beacon, attracting patients who live hours away in surrounding states.

Transhealth provides primary care for adults and children. It also provides mental health services, as well as gender-affirming hormonal care. Its mental health providers and therapists counsel patients who are pursuing gender-affirming surgery.

The clinic supports trans, non-binary and gender-diverse individuals with care from a compassionate team. Its goal in every patient interaction is to make trans and gender-diverse patients feel welcome, safe and valued — and thus better able to access care that leads healthier lives.

Pediatrician Andrew Cronyn, MD, FAAP, moved from Tucson, Ariz., to join Transhealth after starting a program for trans youth in the mid-2010s that was part of a large healthcare system. “I really wanted to work somewhere that is specifically dedicated to transgender health care, rather than within a larger organization that sees trans people as a niche part of what it does,” he says.

Starting this summer at Transhealth, mental health providers and social workers will be present at intake along with the primary care physician for all new pediatric patients and other patients who request it.

Some trans individuals haven’t accessed health care in many years due to past traumatic experiences, but Dr. Cronyn says patients feel comfortable at his facility because they see people like themselves providing care. “We have an openly trans CEO and so many trans people on our staff,” he says. “Patients can walk in and know they feel safe right from the beginning.”             

— Joe Paone

It’s not hard to figure out why only 22% of surgeons are women, despite being roughly half of today’s medical school graduates. There aren’t a lot of women surgeons, so new doctors often opt for another line of medicine. There is also an underlying assumption that women must choose between a career in surgery and raising a family, and that men are more suited for the physical demands of being a surgeon.

“These things happen all the time and they have a real impact on a female medical student,” says Barbara C.S. Hamilton, MD, MAS, a clinical instructor of cardiac surgery at University of California, San Francisco (UCSF). “The message is clear: Don’t choose surgery, because there are going to be more obstacles and less support for you as a woman.”

Dr. Hamilton co-authored a global study that offers a snapshot of the cardiothoracic surgery workforce. The study, which is still under review, shows the field, while still dominated by older males, has more younger women entering it. More than 12,000 profiles of members of the Society of Thoracic Surgeons (STS), the American Association for Thoracic Surgery (AATS), and then the European Association for Cardiothoracic Surgery (EACTS) and the Asian Society for Cardiovascular & Thoracic (ASCVTS) were reviewed.

The research shows that 93% of surgeons in all four organizations are male and only 7% are female. However, 25% of EACTS trainees are female and Association of American Medical College (AAMC) data shows a steady increase in female cardiothoracic surgery trainees.

A first step toward growing the role of female surgeons is to install more women into positions of leadership, says Dr. Hamilton. For example, 60% of the STS, AATS, EACTS and ASCVTS female members practice academic medicine, but only 5% are full professors.

More health systems need to be like UCSF, which Dr. Hamilton says she’s fortunate to work in. The chairperson is female and there are multiple female division chiefs. UCSF even has the Muriel Steele Society — named after the first woman surgeon at San Francisco General Hospital — which is designed to support women surgeons via mentoring, events and other programs. Mentoring programs are also available through Women in Thoracic Surgery and the Association of Women Surgeons.

“There’s no dearth of visual support in terms of the faculty. I barely feel like I’m in the minority here, which is not everybody’s experience elsewhere,” says Dr. Hamilton, who is the mother of two young children. “I watched multiple women ahead of me show me that it was possible to be pregnant while working and have children and continue working, so I was not carving a new path at all. Having examples and close mentorships of women doing the same thing I’m doing has been key.”

Formalized mentor programs are wonderful, but informal alliances with other women surgeons can be just as helpful. “I have been formally paired with mentors who I found to be very helpful, but what I found the most influential is the informal communication — conversations in the hallway, and quick check-ins from somebody about life events, career moves and other things,” says Dr. Hamilton.

Gains are being made. Seven of the eight incoming general surgery intern class at UCSF are women. But that’s not the case at many other schools, and Dr. Hamilton says aggressive efforts to get more women in surgery and into leadership positions are needed.

— Adam Taylor