A Roadmap to Diversity in Surgery

As a society, we've talked about diversity and inclusion for years. Amid everything that’s been proposed, purported, discussed, and debated, the question remains: Are we actually making any progress?

Paris Butler, MD, MPH, FACS an academic plastic surgeon at the University of Pennsylvania in Philadelphia, says one thing is certain: The existing physician workforce does not accurately reflect the racial and ethnic diversity of the patients it treats.

“Within the medical profession, the surgical disciplines have historically had some of the most challenging experiences pertaining to the lack of diversity of our physician workforce on the gender, race, ethnicity, and sexual orientation fronts. Unfortunately, academic surgery is even more challenged,” says Dr. Butler who completed a policy fellowship in the Department of Health and Human Services’Office of Minority Health when the Affordable Care Act was unrolled during the Obama administration.

“…during that policy fellowship experience, [I] got a real flavor and understanding of the persistent healthcare disparities that we have in this country,” he says, pointing out that this is an issue that requires a multifaceted and multidisciplinary approach.

One of those approaches, he says, is improving diversity in the academic surgical workforce. As an academic plastic surgeon, Dr. Butler recognizes these challenges first-hand.

“And in my opinion, it’s a really important component of this health care disparity issue. As academic physicians—academic surgeons—we're responsible for not only taking care of patients, but we also carry out research and are also responsible for teaching and educating the next generation of physicians.”

Thus, he decided to put data behind this concern with the lack of racial and ethnic diversity in academic surgery.

Dr. Butler is lead author of the recent paper “Benchmarking Accomplishments of Leaders in American Surgery and Justification for Enhancing Diversity and Inclusion,” published in the Annals of Surgery, which analyzes leadership in surgery and evaluates and offers a strategic roadmap to enhance diversity and inclusion.

According to Dr. Butler, the intent of this research was to be able to demonstrate what it takes to achieve positions of surgical leadership in the U.S.

To do so, he and colleagues methodically examined the CVs of the past 16 years of former presidents of four surgical societies: two prominent and prestigious surgical societies, the American Surgical Association (ASA) and American College of Surgeons (ACS); and two affinity surgical societies, the Society of Black Academic Surgeons (SBAS) and Association of Women Surgeons (AWS).

“…all four of these organizations have very high-achieving, extremely motivated surgeons that hold faculty appointments at the most respected academic medical centers in the country,” says Dr. Butler.

What he and colleagues found was that surgeon leaders in both the prominent and affinity societies shared similar metrics. “…and that is a nice way to show members of our discipline that there's justification for enhancing gender, race, and ethnic diversity within the house of surgery.”

Not only did their results reveal benchmarks for achieving leadership in the field, but the researchers were also able to provide a “roadmap” for aspiring young surgeons, according to Dr. Butler.

The Roadmap to Diversity

Dr. Butler says first and foremost on the road to increasing diversity in surgical leadership is understanding the playing field, including the level of achievement required, and recognizing deficiencies.

Despite sharing similar metrics across CVs, a key discrepancy between the ASA and ACS presidents and those in the SBAS and AWS cohorts is the overall number of peer-reviewed publications, which, according to Dr. Butler, can be partly overcome by making a concerted effort to spread out authorship more uniformly.

“We believe that both the Society of Black Academic Surgeons and the Association of Women Surgeons groups should really promote their members to get as scholastically active and collaborate as much as humanly possible in order to make their CVs more robust on the number of peer reviewed publications.”

Another differentiator was the number of professional society memberships.

Therefore, “We recommend that we look at networking, we look at level of mentorship and sponsorship, to ensure that these individuals from previously underrepresented groups have access—have exposure—to a number of societies to get their names out there so they’re considered for some of these positions.”

From peer-reviewed publications and networking to more traditional evaluation measures including grant writing and research funding, “These are all mechanisms that we can use to help ensure that the playing field is leveled a bit,” explains Dr. Butler.

The paper is available as an epub ahead of print and has not been presented at major conferences or widely circulated yet (secondary to COVID19). But Dr. Butler says he believes it is setting the stage for important things to come.

“It's going to yield lots of conversation. We need to do some additional brainstorming around ideas. We need to make sure that it's appropriately resourced when we start putting forth some of these initiatives,” he says.

Study co-author Colin Martin, wrote on Twitter: “We think this paper sits at the intersection of strong data and action,” a particularly poignant observation that suggests that this paper may be just the catalyst to make actionable, result-oriented progress.

“We have lots of hopes and dreams and aspirations for what a manuscript like this can potentially provide,” says Dr. Butler. “In my opinion, with disparity work, it's not enough to just describe it anymore. We have to provide some suggestions for improvement. We have to recommend strategies on how we're going to alleviate or at least mitigate some of these disparities. And that's what we do in this manuscript.”

Reference:

Butler PD, Pugh CM, Meer E, et al. Benchmarking Accomplishments of Leaders in American Surgery and Justification for Enhancing Diversity and Inclusion. Ann Surg. 2020. Epub ahead of print.