Leaders in Otolaryngology Are Increasing Racial Diversity

Statistics that appear in a 2021 commentary published in Otolaryngology–Head and Neck Surgery tell the story: In 2018, White people comprised approximately 51% of otolaryngology resident applicants in the United States yet accounted for more than 66% of actual otolaryngology residents that same year—a figure commensurate with that of the White U.S. population at that time (2021;164:6-8). By contrast, that same year, 6% of otolaryngology applicants for residency were Black—despite comprising 13% of the U.S. population—and this group represented only slightly more than 2% of actual otolaryngology residents. The numbers become even more disparate when looking at professorships and residency chairs and chiefs (Laryngoscope. 2022;132:1729–1737). 

Although the 2021 commentary also shows some incremental progress from 2010 to 2018, the evidence is clear. Otolaryngology still has a long way to go to achieve a level of diversity that accurately reflects the public it serves. The good news is, leaders in the field are actively developing and engaging in organized, multifaceted programs to increase lasting opportunities for potential and existing otolaryngologists from underrepresented groups through early exposure, mentorships, networking programs, and more.

An Obsolete Model

Achieving true diversity is a question of will, contended Rodney J. Taylor, MD, MPH, chair of the otorhinolaryngology department at the University of Maryland School of Medicine in Baltimore. “First and foremost, there needs to be a recognition among colleagues that this goal is important and has value,” he said. “Second, there needs to be buy-in, such that it becomes clear among otolaryngologists throughout the country that programs and initiatives to increase diversity are widely endorsed and of great importance to the future of our specialty. It needs to be a priority item.”

There needs to be buy-in, such that it becomes clear among otolaryngologists throughout the country that programs and initiatives to increase diversity are widely endorsed and of great importance to the future of our specialty. It needs to be a priority item. —Rodney J. Taylor, MD, MPH

Prioritizing diversity is more than a moral imperative, Dr. Taylor noted. “What we learn from the data is that, when we’re trying to solve complex problems such as patient care and disease, a diverse group of leaders and thinkers does a better job than a homogeneous group of similarly talented individuals,” he explained. “They’re able to view those issues with the advantage of people who bring a wealth of different experiences, ways of looking at things, and manners of solving problems.”

The traditional model of medicine wasn’t established by a diverse group of individuals, however. And, as Dr. Taylor observed, people tend to get stuck in the status quo. He pointed to residency interviews as an example. “Some of the comments and questions during the course of these interviews reflect that some folks haven’t been exposed to thinking differently about how we evaluate people,” he said. As department chair, he strives to message faculty as to the narrowness of that traditional model, which was “not designed to measure important values and components that would build a broader and more diverse pipeline of individuals.”

From the candidates’ point of view, the barriers built into the traditional model are formidable, emphasized Lamont R. Jones, MD, MBA, an otolaryngologist at Henry Ford Health in Detroit. “When you look at the decision-making tree, part of it is being able to relate to the people who are already in the specialty you’re choosing: their personalities, lifestyle, interests. Seeing oneself in other people is important not only in deciding what you want to do, but because of the potential subjectiveness you may encounter when it comes to being chosen for residency or in the evaluation process,” he explained. “That plays a huge role in what the specialty looks like to you and, ultimately, what it will look like in the future.” 

Not seeing oneself reflected in residency and/or leadership roles can discourage talented people from entering a field in which they might have much to contribute. A gifted and ambitious physician who also happens to be a person of color might end up “withering on the vine” in otolaryngology, said Dr. Jones. “When people see that there isn’t upward mobility for them, they get turned off by what they see as a lack of opportunity. They become disengaged and, often, look for other opportunities elsewhere.” 

Creating a Framework

Diversification isn’t simply a numbers game. True change occurs when a culture is systemically transformed—that is, when it has integrated inclusive policies, approaches, and attitudes into every aspect of the system. In this model, people of color and allies are permanently committed to working together to garner and develop more minority otolaryngologists and otolaryngology leaders.

The University of Michigan in Ann Arbor is often held up as a national leader in diversity, equity, and inclusion innovation. David J. Brown, MD, associate professor of otolaryngology–head and neck surgery and associate vice president and associate dean for health equity and inclusion at the university’s medical school, credits the vision of earlier leaders such as Charles J. Krause, MD, who served as otolaryngology department chair from 1977 to 1992. “Because this interest in diversity started decades ago, it has been instilled into our culture. We’ve been on this journey a little longer than most places,” Dr. Brown explained. “People of color and underrepresented individuals of all backgrounds may feel more comfortable here because we have a long history of being accepting and inclusive. There’s still room to make things better, however.”

Dr. Brown emphasizes the importance of an alliance between a medical school’s departments and the larger institution in which they function. “We benefit from a university and a healthcare system that really value diversity,” he acknowledged. The culture is reinforced within the otolaryngology specialty. “Our current chair, Dr. Mark Prince, has established four values for our department: inclusion, engagement, civility, and accountability,” said Dr. Brown, whose unique role covers both the hospital and the medical school, enabling him to spearhead multiple projects. “As a healthcare system, we’re doing a lot of work for Pathways programs, and training and professional development for faculty, staff, and learners. We already have a curriculum for residents for healthcare equity, and we’re developing a curriculum for faculty who want to study healthcare disparities.”

Outreach and Mentorship

Although the desire to go into medicine often starts in early in life, a subspecialty like otolaryngology is rarely on any young person’s radar. Early exposure and mentoring are key to encouraging minoritized individuals to enter this rewarding field, said Angela Powell, MD, an otolaryngologist in private practice in Plattsburgh, N.Y. Dr. Powell decided early in life that she wanted to be a doctor. “I initially thought that I would pursue a career in neurosurgery,” she said. “At the time that I was contemplating that career path, I probably would have been the first African American female in most neurosurgical programs.” 

There’s this desire to say, ‘I’m colorblind; I’m just looking for the best and the brightest. But I’ve done a lot of reading and thinking into this melting pot concept, and it isn’t a way to diversify. We must be actively engaged in looking for difference. —Angela Powell, MD

During elective surgical rotations as a third-year medical student at Northwestern University Medical School in Chicago, however, Dr. Powell had a life-changing epiphany. “The chair of otolaryngology at Northwestern at the time, Dr. David Hansen, would have medical students rotating with him in his clinic, so we would get one-on-one interaction with the department chair—something that isn’t very common in medical student rotations in general and certainly not something I’d ever experienced,” she said. “One of the days that I was rotating, he brought me into the exam room and said, ‘I’m going to teach you how to do a full head and neck exam.’ And it was a formative experience for me. It opened my eyes to the possibility of doing something other than neurosurgery, where I would be seeing more patients and garnering a larger breadth of clinical medicine experience.” Dr. Powell pivoted to otolaryngology, subsequently applying for residency, and matched at the University of Pittsburgh. “In its 125-year lifespan of residents, they had I think, four other African American residents before I started,” she said.

Dr. Powell went on to serve as a staff surgeon and teacher in the military at numerous naval hospitals, ultimately in the otolaryngology department at Walter Reed in Washington, D.C. She chaired the Women in Otolaryngology section of the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) and is immediate past chair of the Harry Barnes Medical Society (HBMS) (https://harrybarnesoto.org). Named for the first certified Black otolaryngology specialist in 1924, HBMS is solely dedicated to increasing opportunities for underrepresented racial and ethnic groups in otolaryngology.

The impact of mentorship by established otolaryngologists, including those who are White/European, is an essential element to achieving equity, noted Dana Thompson, MD, MS, MBA, chief of pediatric otolaryngology at Northwestern and Triological Society middle section immediate past vice president. “The majority need to provide intentional mentorship and prioritize it for their department and trainees,” she said. 

Proactive strategies to boost diversity extend beyond the walls of medical school. In Baltimore, Dr. Taylor and his colleagues are reaching out to historically Black institutions and some of their STEM and premed programs to introduce otolaryngology early on and provide mentorship. Another program seeks to interest potential talent even earlier: The University of Maryland School of Medicine established the CURE program and entered a partnership to target several middle schools in underserved areas of the city. “The goal is to excite and prepare young students—and some of our most at-risk students—to pursue careers in healthcare and healthcare-related research. And in otolaryngology,” Dr. Taylor explained. “The first cohort of sixth graders in our program are now in college, and we continue to keep in touch with them.”

Meanwhile, HBMS holds student outreach events every year. “Last year, we brought in program directors to answer specific questions about the application process and the interview process,” said Dr. Powell. “If you could imagine the question, we had someone there to answer it.”

Leadership and Networking

The experience of working in a cultural climate where almost no one looks like you or has a similar world view to yours can be extremely difficult, said Shannon Fayson, MD, chief otolaryngology resident at Michigan Medicine. “Nationally, only 2.3% of otolaryngology residents are Black and 36% are women. I was fortunate that my first otolaryngology mentor, Dr. Minka Schofield, was a Black woman who I could relate to and emulate. My journey to otolaryngology was lonely, however, because I didn’t know many Black otolaryngology faculty, trainees, or medical students applying into otolaryngology,” she said. She experienced a true sense of belonging from the community of Black residents at Michigan Medicine, first as a medical student during her away rotation and then as a resident after the match. 

This community ultimately inspired her to create The Black Otolaryngologist Network (www.theblackotonetwork.com) to connect Black otolaryngologists around the country with a mission to promote Black excellence and advancement in otolaryngology through mentorship, sponsorship, community building, and advocacy. The network’s first meeting was held in April 2020. Together with cofounders Dr. Brown and Terrence Pleasant, MD, Dr. Fayson outlined the organization’s mission and developed its website.

The nonprofit network hosts general meetings, student outreach events, and the annual Medical Education Conference dinner, runs a mentorship program for trainees and faculty members, and raises funds to support student grants. Dr. Powell lauds the organization’s online group sessions, which encompass topics from financial planning to the personal experience of being a minority in a majority specialty. “The sessions have addressed navigating some of the microaggressions and other challenges related to being either ‘the one’ or ‘one of the few’ within a sea of majority residents,” she noted. “I was present for one of the sessions that was literally a check-in to see how everyone was doing on their rotations and with their mental health, and whether they were setting aside time for self-care.”  

A network does not always have to be formalized. Recently, Dr. Taylor was among a small group of Black leaders to reach out to medical students, residents, and junior faculty, “such that people know where to go and how to access resources,” he said. “They can continue to get help even after having entered the field so they can ascend within otolaryngology to leadership one day. Leadership doesn’t happen by accident; we can be more deliberate about reaching out to junior faculty and others who have the desire but not yet the path for creating their leadership journey.” 

When well-established otolaryngology leaders come together to pull up minority residents, the support not only bolsters otolaryngology itself; it also helps to secure future leaders who are then poised to become role models and mentors themselves. Dr. Taylor says that such leadership already exists in the AAO-HNS, which offers an affordable medical student academy membership and mentorship program. Dr. Powell likens the role of program directors and department chairs to those of talent scouts for competitive sports. “Talent doesn’t have a race.”

Achieving Critical Mass

Meaningful, systemic change will always come up against resistance, which is usually based on fear. In the case of diversifying a narrow and competitive field like otolaryngology, that fear stems in part from the knowledge that there are only so many residency openings. As Dr. Powell explained, “The question is, ‘How do we increase the percentages of applicants and matches from traditionally underrepresented groups, recognizing that this means some majority applicants aren’t going to match?’ How do you establish that this isn’t a selective bias, that we’re not reducing our requirements in some way, and that all we want is for our field to represent the population?”  

Dr. Powell shared how some institutions have introduced deidentification into the application screening process, such that information on race and gender isn’t visible to decision makers. “There’s this desire to say, ‘I’m colorblind; I’m just looking for the best and the brightest,” she said. “But I’ve done a lot of reading and thinking into this melting pot concept, and it isn’t a way to diversify. We must be actively engaged in looking for difference.” 

Patient preference and care are major factors in this equation as well. Many patients of color not only seek out physicians with similar backgrounds, but are also more likely to share their story, comply with instructions, keep follow-up appointments, and even rate them highly (JAMA Netw Open. 2020;3:e2024583). “There have been studies about communication and trust building for our minoritized patients showing that when these patients come into a clinic, department, or hospital, they’re often seeking people who look diverse in some way,” Dr. Taylor said. “And that gives a sense of comfort or discomfort.” 

Indeed, Dr. Jones reported frequently receiving requests to work with patients who are interested in seeing an African American physician. “For some patients, having that level of comfort is one less thing for them to worry about when dealing with a medical problem,” he said. 

As diversity in otolaryngology improves, the benefits will be broad and multifaceted. Overall equity in the system will expand, talented people from diverse backgrounds will have more opportunities to provide their unique perspectives, patient trust will grow, and care will improve. For the entire system to benefit on a national scale from the application of current diversity and equity strategies, however, better metrics are needed. 

“Otolaryngology has the lowest performance in scientific contribution to health equity research,” Dr. Thompson said. “We don’t have enough people studying it, and likely will not until we have more people of color in the specialty.” Progress in this area is taking place, though, said Dr. Taylor, who pointed to the University of Kansas Medical Center in Kansas City and the work taking place under Alex Chiu, MD, chair of otolaryngology–head and neck surgery department, as an example. “They’re organizing leaders in our field to ask tougher questions,” Dr. Taylor said, “and they’re beginning to obtain data and do research that will truly shed light on what diversity can mean to our field and our ability to solve problems.” 

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Linda Kossoff is a freelance medical writer based in Woodland Hills, Calif.