Source: AAOS Department of Clinical Quality and Value. Orthopaedic practice in the U.S. 2018. Published January 2019.
Disclosures: Romeo reports he receives royalties from, is on the speakers bureau, is a consultant and does contracted research for Arthrex.
September 22, 2021
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Be an active ally in diversity, equity and inclusion efforts

Source: AAOS Department of Clinical Quality and Value. Orthopaedic practice in the U.S. 2018. Published January 2019.
Disclosures: Romeo reports he receives royalties from, is on the speakers bureau, is a consultant and does contracted research for Arthrex.
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Recent efforts have moved leaders in organizations to go beyond words of support to actions that truly lead to more diverse and inclusive environments for members.

The time has come that the disparity and inequalities in orthopedics can no longer be considered controversial. We are at the center of an evolution in orthopedics to reflect a more culturally competent representation of patients, physicians and the problems we interact with every day. Data suggest we have much work to do to achieve reasonable goals.

Some orthopedic surgeons are already an active part of the transformation, suggesting they support the movement. However, a passive approach does not fulfill the role of an ally. To be an ally, we must actively collaborate, sponsor and drive personal relationships and public behaviors toward a more diverse and inclusive world going forward.

Anthony A. Romeo, MD
Anthony A. Romeo

First, we need to know and accept the facts. A 2021 study published in Clinical Orthopaedics and Related Research reported 8% of practicing orthopedic surgeons are women. In addition, Tyler C. McDonald and colleagues reported less than 5% of practicing orthopedic surgeons are Hispanic/Latino or African American/Black. Orthopedic surgery has the lowest percentage of women and historically underrepresented groups in all areas of medical and surgical subspecialties.

A significant contributor to this disparity is the limited number of female role models. The Association of American Medical Colleges reports 8.7% of orthopedic surgery professors are women, and 2% of orthopedic surgery chairs are women, according to a 2021 American Academy of Orthopaedic Surgeons Annual Meeting study. The AAOS study also found 11% of U.S. orthopedic residency programs had women directors.

Awareness of the facts is critical. Assessing how your behavior may have perpetuated discrimination is the next level of understanding. Taking time to talk with those in underrepresented groups can be enlightening. A corollary would be the willingness to accept feedback with a sincere willingness to improve.

Other efforts to become a valuable ally include mentorship and availability. Being a good mentor can include a special interest and effort in the mentee’s career path, providing guidance and advice, as well as opportunities for enhanced learning experiences and surgical training, role modeling and expanding trusting and confidential relationships. These activities require availability, as well as mindfulness or being present and not distracted when interacting with the mentee.

It is important to show integrity through support of programs that address diversity, equity and inclusion issues, as well as speaking up when violations, omissions or harassment will support the continued exclusion and discrimination. Bias can be subtle, but needs to be addressed, such as group emails and letters using only male pronouns, as well as the absence of effective policies for family leave, childcare and other responsibilities at home.

Once an active commitment to become an ally is in motion, building a coalition or community of allies is critical to bring significant change in organizations. Similar-minded people should be identified among the physicians and staff, as well as other groups that have influence on the transformation. Advocacy and support should focus on mentorship, identifying obvious and subtle areas of bias, educating with evidence-based information regarding long-term and cultural values of a diversified workplace, especially in health care, as well as continued professional and personal development.

These behaviors are essential for orthopedic leaders at all levels to continue their impact on their organizations. Senior leaders cannot delegate this effort to human resource staff or junior members of the practice. They must dedicate time, energy and focus on key principles to develop and actively implement programs that eliminate bias and discrimination, as well as foster a fair and inclusive process for recruiting new orthopedic surgeons.

Continuing education programs and professional development of the team should be developed. Being an ally in orthopedics is not the simple statement that you do not believe in or support bias, discrimination and prejudice. Being an ally requires an active process, commitment of time and energy, and direct involvement in the change necessary to achieve diversity, equity and inclusion in orthopedics. This will benefit to our profession, patients and society.