Matthew D. Beal, MD | Cara A. Cipriano, MD, MSc | Joshua C. Patt, MD, MPH, FAAOS, FAOA
May 27, 2020
Diversity has become a buzz word in many areas of our lives. Sometimes it is just a box that needs to be checked, while other times it is presented as an overwhelming problem that it’s hard to know where to start as an individual – and especially as a trainee.
Where are we now?
The lack of diversity in our field is staggering. Women have made up approximately half of the medical students in the U.S. since 2000, and approximately one-third of current students identify as African American, Asian American, Hispanic, or Latino. [1,2] By contrast, the proportion of women and underrepresented minority (URM) orthopedic surgeons in 2018 was 7.6% and 15.3%, respectively, while orthopedic residencies currently include approximately 13% women and almost 20% URM. [2,3] Superficially, the increased presence of minority groups in training sounds like progress; however, the proportion of these groups in orthopedic training and practice haven’t changed much over the past decade (for example, women only increased from 3.6 to 5.3% in the decade between 2007 and 2017). [4,5] That means we are falling short not only in recruiting, but also in retaining gender and URM surgeons.
Why is it important?
Diversity breeds opportunity, which is valuable in itself. But it’s so much more. It is a strategy to be more productive, impactful, and successful in terms of individual growth, teamwork within organizations, and as a society. The data supporting these benefits of diversity are as strong as any of the evidence we use to guide our practice as clinicians. Inclusion, which describes a situation where everyone feels welcomed, is arguably even more important than diversity, and remains the ultimate goal.
Where do we need to go?
In short, we should strive to mirror the communities that we live and work in for the benefit of our patients, our profession, and ourselves.
What is already being done?
Several organizations have been established to tackle the diversity challenge. This process starts at the most basic levels by improving access to education and mentorship for women and URMs at the formative stages. Science, Technology, Engineering, and Math (STEM) programs have made strides to increase general interest in science at young ages. The Perry Initiative Outreach Programs are designed to introduce women high school and medical students to orthopedics through talks, sawbones lab sessions, and direct contact with orthopedic faculty and residents. The Nth Dimension is an organization that has opened doors for many minority students through internships and mentoring. Others such as the Ruth Jackson Orthopedic Society and, more recently, the Women in Arthroplasty Committee of the American Association of Hip and Knee Surgeons have established mentor-matching programs in an attempt to build the pipeline of women in orthopedics.
How can a department set the tone?
Departmental leadership and all of the faculty must take an active role in setting the tone. Many hospitals and departments have created formal diversity committees to advocate for and support underrepresented minorities. Having these individuals focused on diversity and inclusion ensures that these important goals will not be neglected among the many other competing interests that we all face. The creation of formal mentoring and support systems for new faculty from these less represented groups can help recruit as well as retain and ensure long-term success for these new hires. Leaders should be mindful not only of who they hire and promote, but also of who they invite as speakers from other institutions. Choosing diverse speakers supports their careers and demonstrates that they are valued. If you’re having trouble thinking of someone to invite, organizations such as 500 Women in Medicine exist to help identify qualified speakers.
What can we do as trainees?
Change needs to happen on every level, and it’s important that we are ALL involved.
If you are an orthopedic surgery trainee reading this blog, you are statistically most likely to be a white male. That does not mean you can’t add to the diversity in our field. In fact, some would argue that, as a majority population, you are actually in the strongest position to make a difference. All of us need to keep our eyes open for opportunities to educate those around us and draw attention to bias and inequality. These occur all too frequently in our world – only as a majority individual, you may need to look harder to see them. Regardless of who you are, learn and practice how to do this effectively.
If you’re a woman or URM, you can have additional impact simply by being visible. For example, if your patients have never had an orthopedic doctor that looks like you, they may be surprised, amused, impressed, or hesitant. Through your interaction, they can learn that women/URM can be excellent surgeons. If you encounter discrimination, try to educate and persist. Trainees will be inspired and empowered by your example. In this way, an orthopedic surgeon can educate thousands of patients, colleagues, and others in the community.
Lastly, and perhaps most importantly, all of us should strive to be inclusive. It may seem easiest for us to develop bonds with people who have obvious similarities to ourselves. But make that extra effort to reach out to others who may not look like you or share your experiences. Develop the curiosity and courage to learn about and support them. Help them feel that they can be successful and included in our field, because otherwise they may never consider orthopedics. You can be the person who encourages them to set foot on that path.
Lastly, try to remember that we are all in this together. While this is understandably a stressful time, as an orthopedic community we will continue to work together to overcome this adversity. While the unknown can be scary, perhaps in the long run this will allow us to continue to improve on the residency application process. Best of luck!
DISCLOSURES: Dr. Beal AAOS: Board or committee member, American Orthopaedic Association, Board or committee member, Medacta: IP royalties; Paid consultant; Research support, National Institute of Health (NIAMS & NICHD), Zimmer, Stryker, Mako Surgical: Research support, Zimmer: Paid consultant Dr. Cipriano KCI: Paid consultant, Link Orthopaedics: Paid consultant, Musculoskeletal Tumor Society: Board or committee member Dr. Patt American Orthopaedic Association: Board or committee member, North American Spine Society: Board or committee member.
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