When Monica Payares, MD, FAAOS, was a child growing up in Colombia, she watched her two younger brothers struggle with the hip disorder Legg-Calve-Perthes disease. By the time she was 9 years old, she knew she wanted to be a pediatric orthopaedic surgeon, to fulfill an instinct to help and nurture injured children.
“I gained a reputation early as the resident future doctor; when other children would shy away squeamishly at the sight of a wound, I was always the first to offer assistance,” she recalled. “In grade school, I had a regular ‘practice,’ nursing the bumps and bruises that friends and cousins would bring to me.”
Her deep-seated conviction helped her weather frequent discouragement—often racist and sexist—along the way to fulfilling her dream.
“It is no easy task to pursue a career in orthopaedics as a five-foot-tall Hispanic female, and I have encountered much discouragement through the years,” she said. “However, since I was very young, I have been clear about my aims, even when I was told by my own medical school deans to do something different than orthopaedics because someone like me may be better suited for social or family medicine,” she said.
It was the kind of quiet, coded message heard by too many women of color who aspire to be surgeons. But along with her ambition, Dr. Payares found allies in a small community of women and Latinos practicing orthopaedics, along with her current partners, who supported her through times when she felt unwelcomed and undervalued.
Today, she practices at Nicklaus Children’s Hospital in Miami, with a focus on patients with cerebral palsy. Dr. Payares embodies the type of physician the Academy would like to enlist in much greater numbers through its efforts to cultivate diversity. She is an active participant in that effort as well. She is a member of the Diversity Advisory Board (DAB), which reports to the AAOS Membership Council, and she serves on the board of the American Association of Latino Orthopaedic Surgeons (AALOS) and as liaison to the DAB.
“I have never seen the Academy as interested in diversity as I have seen in the past couple of years,” she said, pointing to Goal 3 of the Academy’s 2019–2023 Strategic Plan: Evolve the culture and governance of AAOS’ board and volunteer structure to become more strategic, innovative, and diverse.
“Diversity has become so crucial, and the effort is timely,” she continued. “We are doing a lot more with webinars and education for people not just within the Academy but expanding and trying to increase our numbers,” she said. She added that although orthopaedics is far from reflecting the diversity of America at large, something feels different now: “I heard some colleagues say, ‘Do they really want to hear us this time?’ I think it’s true. I think this time they are ready to support us. I’m very hopeful.”
Her optimistic outlook was further kindled by her participation in two different 2020 meetings with the Presidential Line, one with the DAB and the other with AALOS. “It’s nice to see interest all the way from the top—AAOS Past President Joseph A. Bosco III, MD, FAAOS, encouraging us and helping to spread the word. I think they are listening from the top down, which is better than when it just comes from the bottom and trying to make it to the top.”
Such meetings are important starting points, Dr. Payares said, but she added, “I want to be sure that we continue to make progress and follow through on execution of those plans.”
From dream to reality
Dr. Payares came to the United States from Colombia at the age of 16. “I would be considered one of the Dreamers, but I’m no longer dreaming—I’m living here,” she said.
She attended Florida International University and then ventured north to Albert Einstein College of Medicine in the Bronx, New York, for medical school and residency at Montefiore Medical Center. She completed her fellowship at Nemours/Alfred I. duPont Hospital for Children, one of the premier institutions for pediatric orthopaedics.
“It wasn’t always easy,” she recalled. "At Montefiore, they saw from the beginning that I loved orthopaedics. They always knew how hard a worker I was. I may not have had the best boards, which is not an uncommon thing for underrepresented minorities, for many reasons. English is not my first language; maybe I didn’t understand the question—but what we do know is how to translate that to excellent clinical work. I think they saw that. I thank them for giving me that opportunity because I got all the tools I needed.”
Dr. Payares encountered indignities and discrimination that are unfortunately familiar to all women during their training in medical school and residency and continuing in practice, which often are even more deflatingly acute for underrepresented minorities.
“You’ve heard it a million times from female physicians that you walk in the room and the patient says, ‘Are you the nurse? Who’s doing my surgery?’ I brush it off, but you still get a lot of, ‘When is the real surgeon coming?’ Or, ‘I was expecting a white man to do my son’s surgery,’ and I’ll say, ‘Well, we have those too.’ It happens often. We deal with a lot of passive-aggressive type of things, like none of my equipment would be ready. In the beginning, there was a lot of that. I dealt with it—put my list together, because at the end of the day, you are here for your patient.”
She initially gravitated toward professional organizations that connected with her specialty interests and her experiences as a woman and minority—the Ruth Jackson Orthopaedic Society, the Pediatric Orthopaedic Society of North America (POSNA), and AALOS. She felt detached from AAOS, “like the organization didn’t really represent me.”
But over time, she received encouragement and support from women in the Academy, including Jennifer Weiss, MD, FAAOS, chair of the AAOS Communications Committee, and Julie Balch Samora, MD, PhD, MPH, FAAOS, FAOA, member of the Communications Committee and the DAB, as well as member of the POSNA board (she also is deputy editor of AAOS Now). Dr. Payares also had long counted the legendary Ramon L. Jimenez, MD, FAAOS, as a mentor. Dr. Jimenez was recipient of the 2009 AAOS Diversity Award. A son of Mexican immigrants, he has served as a mentor to countless individuals grappling with the challenges that Latinos and underrepresented minorities face as they seek to succeed in a medical specialty dominated by white men. He also is a champion of the concept of “culturally competent care” and instilling it in the education of all orthopaedists.
“My orthopaedics padrinos, or my ‘godparents,’ are Drs. Jimenez and Weiss. They acted like sponsors for me, a Latina, and others, in an effort to increase diversity and help younger people get involved,” Dr. Payares said.
The seminal event that really drew Dr. Payares into the Academy fold, however, occurred in Las Vegas in 2019, when she witnessed the installation of Kristy L. Weber, MD, FAAOS, as the Academy’s first female president. “I remember being there as Dr. Weber got up on that stage and became president,” Dr. Payares said. “That was a huge breaking of the glass ceiling. It was the year that I personally was coming back to AAOS, and I think that struck me as a moment of: ‘OK, it’s really not just the good old boys club anymore.’ For me to be there and hear her speech was definitely the beginning of much-needed change within the Academy."
The obstacle course
Miami, where Dr. Payares practices, is an international hub for Spanish-speaking culture and for Latinos of various origins and national affiliations, and the groups are by no means homogeneous; the outlook and politics of older-generation Cubans or more recently arrived Venezuelans may be greatly shaped by their experiences with socialist dictators. Many in the burgeoning Puerto Rican population feel ostracized and isolated as immigrants, even though they are American citizens. Those who arrived from Mexico and Central America may have a completely different perspective, as might South American immigrants such as Dr. Payares.
“I probably saw a lot more discrimination in Miami than I ever did when I was in the Northeast,” Dr. Payares said. “Not just from patients but from colleagues and staff. As a young surgeon, one of my partners with whom I was a fellow at duPont was a white male. We did the exact same fellowship, started at the same institution here in Miami, and started the same date, and his experience was completely different from mine.”
At the same time, she said, “There’s also a large population that is very happy to see somebody who looks like them. It’s a mix. Within the Hispanic population, we are not all the same. We are all so different.”
Five years later, her professional situation is much improved, she said: “Now everybody wants to be in my room. They say, ‘We enjoy being with you—your energy and you put the good music on.’” It is, of course, concerning that surgeons like Dr. Payares have to go through a protracted period of “proving themselves” that is unfamiliar to most white males. “It took a while to get that acceptance that they get right away,” she said.
She gets positive feedback from patients, convincing proof of the value of diversity, that inclusiveness is not just an abstract social concept but a practice that benefits patient health and strengthens the professions of medicine and orthopaedics.
“Every day that I come to work and a kid brings me a nice little card, or a family member gives me a hug and thanks me for explaining something and helping their kid, is special,” she said. “It may be something as simple as an elbow fracture that I pin, treating a child with cerebral palsy, or meeting someone in the community, which I do a lot of in a cerebral palsy group.”
“Parents say, ‘I wish you were around 20 years ago when my kid was first diagnosed.’ I feel like now I am making a difference in people’s lives. I think that being in societies that support us as we spread the word to educate others, to help us tell that 10-year-old girl in the Bronx who wants to become an orthopaedic surgeon because she had someone treat her elbow who was like her, is so valuable. Getting those common goals and being part of that—I am all in. I want to give back. To those to whom much is given, much is expected. I am blessed. With this new perspective, I hope this initiative can continue, so the Academy can be the mother organization for all the others to follow. It can set the tone for minorities, women, the LGBTQ community, for everybody. We are all here on the same planet. We want to get people’s musculoskeletal health better. Let us all do it together. If we can provide the leadership to provide that guidance to get us to that level, then that is what we can call a successful society that we all want to be part of,” she said.
Terry Stanton is the senior medical writer for AAOS Now. He can be reached at email@example.com.