Leaders in health care set the bar for diversity, equity, inclusion

Physicians and patients continue to be adversely affected by racial, ethnic and sex discrimination, but leaders in health care can help drive change, according to a keynote speaker at the virtual Women in Medicine Summit.

During her presentation, Bonnie Simpson Mason, MD, vice president of Diversity and Inclusion at the Accreditation Council for Graduate Medical Education (ACGME), cited a study from the National Academy of Medicine that demonstrated significantly higher mortality rates from cancer, heart disease and diabetes among Black patients vs. white patients in the United States. Other data, she said, showed that dismissals for residency are disproportionately occurring among residents who are Black or Latinx compared with those who are white.

“We have evidence that shows bias is affecting who we train, who successfully becomes a doctor, and also our patients’ outcomes,” Mason said. “We can’t negate the data. If we do the same thing, we’re going to get the same results. The results we have right now are chaos and disparities. We have to get leadership on board with shifting the mindset. Otherwise, we’re not going to escape it.”

Be an ally

A study published earlier this year in JAMA Surgery revealed that 70.7% of Black physicians, 25.3% of Hispanic physicians and 45.9% of Asian physicians experienced racial and ethnic discrimination in surgical residency programs compared with 12.6% of white physicians.

“These acts of discrimination are being witnessed,” Mason said. “Who is speaking up on behalf of our colleagues?”

Leaders can set the example by serving as allies, she added. During her surgery internship at UCLA, Mason said her chief resident showed his support for her after a patient refused Mason’s care because she was a Black woman.

“Without missing a beat, my chief resident — who was a tall, white male — said, ‘Sir, Dr. Simpson is your doctor. She is well-equipped. She is part of our team. She will be taking care of you. If you do not want her caring for you, you can seek your care somewhere else.’

“That was helpful. That was supportive. That is how you serve as an ally to your colleagues.”

Change starts from the top

Mason called on attendees to be proactive about change. Recently, she helped write a statement on behalf of ACGME denouncing an executive order issued by President Donald J. Trump on Sept. 21. The order claims “to combat offensive and anti-American race and sex stereotyping and scapegoating” in federally funded entities. However, Mason said there is concern that the order could block sex and racism education and training.

Specifically, the ACGME statement notes that the executive order prohibits federally funded institutions from providing education and training that the order “deems to be promoting racial and sexual stereotypes.”

“The impact of this executive order is critical,” Mason said. “Every association should stand up against this because this will preclude data from being collected — from us being able to do bias training.”

The Association of American Medical Colleagues (AAMC) also released a statement that said it was “concerned and alarmed” by the order. Both AAMC and ACGME said they will continue to support bias training because of its importance for physician wellbeing and patient care.

AAMC also developed a framework to address racism in academic medicine. Mason encouraged attendees to ask their faculty members and deans to promote and implement the framework at their institutions.

“This sets the bar,” Mason said. “We need this to be a leadership approach because culture change happens from the top down; it does not happen from the bottom up. Although, enough voices on the ground can push, move and influence leadership to change.”

Keep the door open

Mentorship is also important for promoting diversity, equity and inclusion. After being diagnosed with rheumatoid arthritis and forced into early retirement from surgical and clinical practice, Mason founded Nth Dimensions, a nonprofit organization that promotes diversity in medicine.

“[If] I’m not going to be able to be an orthopedic surgeon, let me figure out what I can do to keep the door behind me open for other people like me who want to become an orthopedic surgeon,” she said.

Orthopedic surgery is the second-least diverse specialty in medicine, according to Mason. To increase diversity, Mason and colleagues at Nth Dimensions created the Orthopaedic Summer Internship Program, a curriculum designed to expose medical students to orthopedic surgery. The internship included an 8-week clinical and research program and a series of musculoskeletal lectures, hands-on workshops, ongoing mentoring, professional development and counseling through subsequent years of medical school.

A study assessing the value of the program showed that women who participated in it were 45 times more likely to apply for orthopedic surgery in the National Resident Matching Program than controls. Similarly, underrepresented minorities who participated in the program were 15 times more likely to pursue a career in orthopedic surgery.

“This type of mentoring really does work,” Mason said. “I want to challenge each one of you to do the work that you can do at your particular stage to make sure that we’re keeping the door open behind us.”

References:

• AAMC. AAMC statement on executive order on combating race and sex stereotyping. https://www.aamc.org/news-insights/press-releases/aamc-statement-executive-order-combating-race-and-sex-stereotyping. Accessed Oct. 13, 2020.
• AAMC. Addressing and eliminating racism at the AAMC and beyond. https://www.aamc.org/addressing-and-eliminating-racism-aamc-and-beyond. Accessed Oct. 12, 2020.
• ACGME. ACGME issues statement on the Executive Order on race and sex stereotyping. https://www.acgme.org/Newsroom/Newsroom-Details/ArticleID/10647/ACGME-Statement-on-the-Executive-Order-on-Race-and-Sex-Stereotyping. Accessed Oct. 12, 2020.
• Mason BS. Keynote Address: A to point or through point. Present at: Women in Medicine Summit; Oct. 9-10, 2020 (virtual).
• Mason BS, et al. Clin Orthop Relat Res. 2016;doi:10.1007/s11999-016-4846-8.
• Smedley BD, et al. J Natl Med Assoc. 2002;doi:10.17226/12875.
• U.S. News & World Report. Healthiest Communities. https://www.usnews.com/news/healthiest-communities. Accessed Sept. 21, 2020.
• White House. Executive order on combating race and sex stereotyping. https://www.whitehouse.gov/presidential-actions/executive-order-combating-race-sex-stereotyping/. Accessed Oct. 13, 2020.
• Yuce TK, et al. JAMA Surg. 2020;doi:10.1001/jamasurg.2020.0260.