Strategies for Recruiting and Retaining Women and Minorities in Orthopaedics

Recorded Session from the 2020 Virtual AOA Annual Leadership Meetings

Recording Date: Monday, July 6, 2020

This recorded session, “Strategies for Recruiting and Retaining Women and Minorities in Orthopaedics” seeks to address this question: What strategies exist to increase the diversity of our specialty, so that all groups of people are welcomed, sponsored, successful, and satisfied with a career choice in orthopaedic surgery? Moderated by Jonathan P. Braman, MD, FAOA, with panelists Katherine Gerull, MD, Scott E. Porter, MD, MBA, FACS, FAOA, and Arghavan Salles, MD, PhD, Panelist.

Key Topic Areas:

• Understand the role that implicit bias plays in leadership decisions and evaluation.
• Recognize and support the role that gender and minority identity play in the sense of belonging in medicine.
• Demonstrate the ability to develop a plan on how to assemble and mentor diverse teams in the health care setting.

The following are questions that were submitted during the live event on July 6, 2020, by attendees. These questions were reviewed by the Symposium moderator, Jonathan P. Braman, MD, FAOA, who offers these responses for consideration.

Question: Do the authors believe that that the approach to improving diversity, equity, and inclusion (DEI) for minorities is the same needed to improve DEI for females? Should these groups be aggregated when trying to fix the problem or separated?

Response: Based on the data from the legal profession mentioned in the introduction [of the live symposium] by Dr. Braman, it seems that there needs to be different types of programs to attract, support, and retain women and minorities. As he mentioned, more work in this are must be done to understand the best practices, particularly in the setting of intersectional individuals.

Question: Most medical schools are being tasked to drive students into primary care careers. How does this mandate affect diversity numbers/applicant pool to surgical specialties as a whole? Do primary care applicant numbers better mirror the medical school diversity profile than surgical field applicants?

Response: General medical school and primary care diversity profiles do reflect the population better than orthopaedic surgical profiles, but there is still opportunity to improve there as well, particularly in the recruitment and support of black, indigenous, and people of color (BIPOC) physicians. Since the pool of medical students is more reflective of our population, it seems unlikely that the perceived pressure to fill primary care slots is the sole reason for the failure of demographics in our profession to become more racially and gender diverse. In essence, if this were the cause, it would seem that the schools would be seeing the impact of the initiative to fill primary care working on all demographic groups, not simply women and BIPOC students.

Question: Is there a relationship between physician burnout and implicit bias?

Response: Great question. While a direct link is hard to prove, programs that improve the support of women and employees of color in other fields have shown better wellness scores.

Question: Any tips on how a department can address a faculty member who does not see or is unwilling to participate in addressing their unconscious bias or systemic racism?

Response: Continued work with the faculty, and engagement by the departmental leadership are necessary to facilitate change in a faculty member who is this resistant. If diversity, welcoming, and anti-sexist and anti-racist behavior are priorities of the organization, then the culture will change. In extreme cases where this is not possible, the faculty may need to be removed from the teaching faculty to prevent harming the positive growth of culture in the organization. As Dr. Porter said in the symposium, when people are not willing to engage, just keep them from hindering the growth of others and move on to those willing to do this work.

Question: What is a good way to address microaggressions? We have well-defined processes to punish “macro” aggressions. For microaggressions, we need a less punitive way to address these issues with the offenders to promote understanding rather than just having severe punishment?

Response: Microaggressions can be toxic to our colleagues of color and our female colleagues. One significant step is recognizing them and calling these out through culture change in the organization. Good resources exist to train groups to recognize and engage these moments to reduce the prevalence of microaggressions in the organization.

Question: Should there be a minimum requirement for residents to be involved in the care of underserved populations?

Response Great question! Perhaps this should be a core competency with metrics like the milestones.

Question: As a department chair, what can I do to make our program more attractive to a diverse applicant pool?

Response: One major step is to show that the department is serious about these issues. As was mentioned in the discussion, part of this is done by hiring, supporting, and retaining diverse faculty. It can also be a conscious and public priority of the department. Finally, interim steps such as being a mentor site for Nth Dimension, participating in Perry Initiative programs, and joining and supporting organizations such as the J. Robert Gladden Orthopaedic Society and the Ruth Jackson Society demonstrate commitment to this important area.