The Benefits of Diversifying Surgery


Representative teams of providers provide welcoming care for patients of various cultures, races, ethnicities and religions.

CARING TOUCH Diverse care teams understand the culturally appropriate needs of different patient groups.

The nation's melting pot is at a full boil. Consider that racial and ethnic minorities in this country will become the majority population in the coming decades. The United States Census Bureau says the point at which Whites comprise less than 50% of the nation's population, a time when the U.S. becomes a "majority minority" nation, is expected to occur in 2044.

According to an analysis of 2020 census data conducted by William H. Frey, a senior fellow at the Brookings Institute, between 2010 and 2019 the population of Latinos and Hispanics increased by approximately 10 million; Asian Americans by 4.3 million; Blacks by 3.2 million; and people of more than two races by 1.6 million. The White population decreased by 16,612 over the same period. The analysis notes that millennials and members of Gen Z and post-Gen Z make up more than half of the nation's population, and the younger generations are more diverse: whites comprise 49% of post-Gen Z, 51% of Gen Z and 55% of millennials. In comparison, whites comprise 59.7% of Gen X, 71.6% of Boomers and 77.7% of pre-Boomers.

Additionally, according to a Gallup Poll, 5.6% of Americans identified as LGBTQ+ in 2020, up from 4.5% in 2017.

The number of minority providers does not reflect these trends. For example, the number of Black physicians in the United States has increased by only 4% in the last 120 years. There has been an increase in racial and ethnic groups in nursing to 20%, but this is still short of the 37% of the U.S. population considered to be racial and ethnic minorities. Unfortunately, there continue to be barriers to increasing diversity in nursing education.

These statistics reflect poorly on the nation's healthcare system and its ability to recognize and respond to the needs of the communities it serves. Surgical leaders with the foresight to recognize the growing need to connect with increasingly diverse communities will position their facilities to capture cases from patients seeking culturally appropriate care. 

Cultural awareness matters

Minorities have an inherent mistrust of U.S. healthcare systems due to past atrocities such as the Tuskegee Syphilis Experiment, the harvesting of cancer cells from Henrietta Lacks, and J. Marion Sims — known as the "Father of Modern Gynecology" — performing experimental surgeries on enslaved Black women without the use of anesthesia. Everyday structural racism supports this distrust, which we're seeing play out with low COVID-19 vaccination rates among people of color.

Ensuring that the healthcare workforce reflects the racial and ethnic minority communities it serves projects important messages: It's OK for you to be here. We acknowledge and value you as individuals, and we will treat you with equitable care. These messages are perhaps more important in surgery than in other aspects of medicine. Surgical patients lie unconscious and vulnerable on operating room tables, and they trust surgical team members will care for their body with dignity and respect.

Patients who see providers who look like they do and have cultural awareness across diverse populations are more trusting of the care they receive. For example, some providers within the Harvard medical community self-identify that they provide a welcoming experience for members of the LGBTQ+ community, who use that information when deciding where to go for treatment.

It's known that Black patients prefer to be seen by Black physicians. A study conducted by the National Association for the Advancement of Colored People (NAACP) found that Black Americans were twice as likely to trust a message delivered by members of their racial or ethnic group than from someone outside of it. Black women who desperately want to treat their obesity will wait months for an appointment with me because they believe I'll be able to provide care with a higher level of cultural understanding than my white colleagues.

Providers who are aware of the religious beliefs and backgrounds of their patients and advocate for them based on sensitivities to their culture improve medical care. For instance, Jehovah's Witnesses have varying beliefs in terms of which blood products — cell saver, red blood cells, albumin, frozen plasma — they will allow to be transfused into their bodies. Having the cultural awareness to discuss these needs with them is essential.

Patients, within a few seconds of seeing a physician, are asked about very personal and private information they wouldn't typically share with anyone else — perhaps even their loved ones. It makes sense that they're more willing to share that information with providers who make them feel comfortable and who relate to them. Patients who trust their providers share their full lived experiences as it relates to their health. Physicians are then able to provide better care based on the full breadth of clinical information they receive. That level of comfort increases the quality of care and level of satisfaction for all patients — regardless of their cultural background, sexual preference or identity, and socioeconomic status.

It’s important for healthcare providers to remember how it feels to relinquish personal control to someone else.

I'm a Black physician, and I'm also a Black patient. When I walk into clinics for appointments and see people who look like me, I'm comforted in knowing the providers will take the time to listen to my needs and understand who I am as a person. When I'm a patient, my voice is not valued as an expert in the field, despite my years of medical training and numerous degrees. I immediately become vulnerable. It's important for healthcare providers to remember how it feels to relinquish personal control to someone else. That intangible feeling of discomfort can have significant implications on the overall quality of care.

Increasing diversity in health care also improves workplace culture. I'm often the only Black person among a group of healthcare providers. It would be nice to have contributions and perspectives from various races and cultures to represent the variability among our patient population. Bringing different viewpoints to the table will ultimately provide care teams with a range of thoughts and opinions, and lead to rich conversations that result in better outcomes in care. 

Focus on the future

Many attempts are being made to increase diversity in health care, but whether the changes are making a difference in the day-to-day experiences of healthcare workers and the increasingly diverse patient populations they serve remains to be seen. In fact, many experts argue there's much work left to be done. It's not enough to assign a single person to oversee and implement diversity-growing efforts. Diversity must become part of organizations' core values, integral aspects of their mission statements and measurable metrics that are constantly assessed and improved upon.

Remember this powerful quote from Dr. Martin Luther King, Jr.: "Of all the forms of inequality, injustice in health care is the most shocking and inhumane." Let's keep striving to improve equity and inclusion among providers to improve the accessibility of care for all patients. It's the decent — and the smart — thing to do. OSM

The Time to Act Is Now
GROUP EFFORT Diversity, equity and inclusion programs are more effective when every member of an organization supports the initiatives and are invested in the outcomes.

Making surgery a more welcoming place for staff and patients has never been more important. Follow these basic strategies to increase the level of diversity and inclusion in your facility:

  • Ensure that diversity and inclusion are ingrained within the culture by making it integral to the mission and outputs within the organization.
  • Integrate stakeholders from all levels of the organization, and ensure that all groups are included in discussions to enact and maintain diversity and inclusion efforts.
  • Share successes and failures with similar organizations. These discourses allow both groups to reflect on strengths and weaknesses in previous diversity and inclusion strategies.
  • Engage with local communities and schools to ensure that persons from underrepresented groups get early exposure to fields in health care.

Don’t hesitate to implement systematic strategies that develop teams of diverse providers. Even the smallest step taken is a step in the right direction.

Fatima C. Stanford, MD, MPH, MPA, MBA

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