Published 12/1/2015

Increasing Diversity in Orthopaedics

Roundtable participants discuss role of specialty societies

Although the numbers of women and minorities are increasing among younger orthopaedic surgeons, the profession remains primarily white and male. Recently, AAOS Now editorial board member Wayne A. Johnson, MD, spoke with the following four leaders in the diversity effort about the impact that specialty societies are making in increasing diversity:

  • Melvyn A. Harrington Jr, MD, president of the J. Robert Gladden Orthopaedic Society
  • Ramon L. Jimenez, MD, president and cofounder of the American Association of Latino Orthopaedic Surgeons (AALOS)
  • Mary I. O'Connor, MD, chair of the AAOS Diversity Advisory Board (DAB)
  • Kristy L. Weber, MD, president of the Ruth Jackson Orthopaedic Society (RJOS)

Dr. Johnson: What role does your organization play in enhancing diversity and culturally competent care in orthopaedic surgery?

Dr. Weber: The RJOS was founded in 1983 as a support and networking group for women orthopaedic surgeons. We initially focused on female medical students and residents to attract them to the field.

Recently, we changed our mission statement to promote professional development of and for woman in orthopaedics throughout all stages of their careers. Our members wanted more professional development as practicing surgeons. So we are doing that as well as mentoring young woman prior to and as they enter the field.

Dr. Jimenez: AALOS branched off from the J. Robert Gladden Society to answer the need for racially and ethnically congruent care. Patients like to see and seem to relate and communicate better with physicians who look like them or have similar ethnicities. However, we are inclusive of all orthopaedic surgeons who serve Hispanics and Latinos in their patient populations. Our board includes Caucasians, African Americans, and Hispanics. We hope to increase our membership through mentoring activities, such as the Nth Dimension and Perry Initiative, as well as direct person-to-person recruitment.

Dr. Harrington: The Gladden Society stresses the need for minority orthopaedic surgeons to work collaboratively to address important patient and educational concerns. It was the first orthopaedic society dedicated to meeting the needs of underrepresented minority orthopaedic surgeons and to advancing the ideals of excellent musculoskeletal care for all patients, with particular attention to underserved groups.

Dr. Johnson: Why is diversity and culturally competent care beneficial to orthopaedic surgeons, their practices, and to society?

Dr. Weber: Diversity is important to orthopaedics because it creates a different conversation. We've had a limited conversation for too long. Gender and racial diversity bring different backgrounds, different experiences to the table. That can improve outcomes.

Dr. O'Connor: The human costs of disparities is heartbreaking. But disparities also have an economic cost. I've recently been involved with an effort to create a cost model tool that will enable us to quantify what disparities cost to patients, healthcare systems, and employers.

When we, as a nation, look at evolving health care, we need to understand that the most expensive treatment is no treatment. And we have communities with people that are getting substandard treatment that also cost us more. Not only is that wrong morally, it's wrong economically as well.

Dr. Harrington: As our country becomes more diverse, we as orthopaedic surgeons will be interacting with a more diverse group of patients. It's important to be able to provide culturally appropriate care to all our patients, especially as our practices are being monitored. With the shift toward value-based payments and patient-centered outcomes, providing culturally competent care can be beneficial to our practices.

Dr. Jimenez: It comes back to how do we treat our patients? How do we relate to our patients? Hopefully, we've come away from paternalistic medicine, in which the doctor comes in and tells the patient what the treatment is going to be. Patients want to share in that decision making about their bodies and their health. We should treat our patients as they want to be treated, not as we think they ought to be treated.

Diversity has been shown to increase communication, and if you increase communication, you increase patient safety. At the same time, you may well decrease your malpractice liability and risk. Better informed patients are not only more educated about their care and their health, but they are able to make better shared decisions about their treatment.

Dr. Johnson: We have to know and understand our patients so that we can better provide outstanding care for them. That makes sense.

How can AAOS members, educators, residency directors, and chairpersons help your organizations' efforts to diversify the profession and the orthopaedic workforce?

Dr. Weber: Well, if we're speaking purely about women in orthopaedics, I think that people have to be open and actively seeking women to enter the field. It's not enough to just be nice to the women that are in the field. We have to all be actively recruiting, looking at the pipeline, and seeing what we want practicing orthopaedic surgeons to look like.

Dr. O'Connor: As a profession, we have to go out and proactively recruit woman and underrepresented minorities. We are losing ground. When I was a resident, orthopaedics had the third lowest percentage of women in surgical training programs. Now orthopaedics is last. There's a greater percentage of women in neurology, neurosurgery, and cardiothoracic surgery than in orthopaedics.

Yet women are more than half of our population. If we don't start to reverse this trend, it's going to become harder to become a profession of diverse providers. That matters because patients are often more comfortable seeking care from providers who look like them.

We are in crisis, yet we are not responding. We need to devote considerably more energy and more resources to proactively recruiting women and underrepresented minorities into orthopaedics.

Dr. Harrington: I agree that a proactive stance is needed, particularly for underrepresented minorities. It's important to be open to nontraditional applicants for orthopaedic surgery. Many underrepresented minorities get screened out at different programs.

Dr. Johnson: What kinds of programs and initiatives are underway to promote diversity and enhance the delivery of culturally competent care?

Dr. O'Connor: One of the DAB's major initiatives was to partner with the Annual Meeting Program Committee to create our first medical student program at the annual academy meeting. We found that most other surgical specialties have a program for medical students at their annual academy meeting, which they use to introduce and recruit students to the specialty.

The first medical student program will be held at the 2016 Annual Meeting in Orlando. It will be a half-day program and it's a big step forward for orthopaedics in providing an opportunity for medical students of any gender, race, or ethnicity to experience some aspect of orthopaedics. And for us to share with them what a wonderful professional orthopaedics is.

Dr. Weber: One of the core values of the RJOS is mentoring. We partner with Bonnie Simpson-Mason, MD, and work with high school students as well as medical students. Having someone specifically help younger women, identify specific challenges, foster them into the field, provide a good role model and specific tips is invaluable. Both women and men say that without strong mentorship, they would've really struggled.

We also have a longstanding grants and awards program that highlights medical student scholarships/awards, resident research awards, travelling fellowships, and research grants. We sponsor a woman to attend the Orthopaedic Research Society meeting through a travel award.

Dr. Harrington: The Gladden Society has partnered with Nth Dimensions on various projects. We're planning on cosponsoring several educational sessions for students at various medical schools across the country. One of our other goals is to have a resident program for underrepresented minority residents. We've also looked at improving the pipeline of students starting as far back as middle school.

For example, Tri-County Orthopaedics—a private practice in Leesburg, Fla.—has had a program with the local middle school for several years. They sponsor African-American students, giving them a general education program and bringing them into the practice to learn about orthopaedic surgery. It's been a very positive program.

We have also sponsored a program in Los Angeles with Charles Drew University and Medical School that exposes middle school and high school students to weekly science classes.

Dr. O'Connor: Groups like the Gladden Society, RJOS, Nth Dimension, and the Perry Initiative need to be expanded and given more resources and support. They are excellent programs, and we simply need more of them.

Dr. Johnson: How does someone become a member of your society? Is it open to anyone?

Dr. Jimenez: AALOS is a byproduct of the Gladden Society. Although the initial informal meeting focused on collegiality, we are now focused on increasing the number of Latinos in the orthopaedic profession.

We have expanded over the past 4 years to include all surgeons who serve this population. The Latino population has grown—not only in the Southwest, but across the country; therefore, we reach out to those orthopaedic surgeons. We also have opened our meetings and encourage attendance by medical students, residents, and allied health professionals. We have some international orthopaedic surgeons from Mexico and Central America.

Dr. Harrington: The Gladden Society is open to everyone; it's a multicultural society. Our mission is to increase diversity in the orthopaedic profession, to improve musculoskeletal care by improving culturally competent care, and to eliminate musculoskeletal healthcare disparities. Anyone who is aligned with our mission is welcome to join. We do have medical students, residents, and Academy fellows.

Dr. Weber: RJOS membership is open to women and men who share our vision. Membership is open to students, residents, AAOS fellows, candidate members, and practicing orthopaedic surgeons. There is a running acceptance of applications via our membership committee.

Dr. O'Connor: All of these groups are committed to the same goal and that is to improve diversity in our profession and to promote equitable care for our patients. The DAB is a way of engaging all these groups, to try and coordinate when we can.

The main limitation is resources. Basically, we need more funding and more support so that we can do more. I hope that message comes across; people need to understand that change requires resources. It's really about the future of our profession and the future of the care we provide our patients. And I feel strongly that the need to improve diversity in our profession has never been more acute.

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