More of the Same: Why isn’t otolaryngology becoming more diverse?

As America grows and evolves, its face necessarily changes. Our country rests solidly on the idea that life, liberty and the pursuit of happiness should be available to all. Our collective understanding that access to health care and healthy living are essential to that ideal happiness continues to mature. But while the population becomes more diverse and blended, cultural disparities in health care not only persist, they do not appear to be diminishing. Collectively, African-Americans, Hispanic Americans and Native Americans comprise over one-quarter of our population. Yet, in the year 2000, they made up less than 10 percent of the physician workforce.^1,2 These numbers dwindle even more when we consider surgical subspecialties.

According to data from the Association of American Medical Colleges (AAMC), of the 493 applicants to otolaryngology from allopathic medical schools, only 26 (5 percent) were African-American, forty-two (8.5 percent) were Hispanic and five (1 percent) were Native American, Alaskan Native, Hawaiian or Pacific Islander.³ For comparison, almost 11 percent of applicants for neurological surgery positions were African-American and 6 percent were Hispanic. Native American, Alaskan Native, Hawaiian and Pacific Islander residents together made up less than 1 percent of all applicants.

Otolaryngology-head and neck surgery has been slow to enact policies to adapt to our changing world. When Paul Keller wrote in 1983 in the Southern Medical Journal about the maturation of otolaryngology from 1940 to 1983, he remarked, “The residencies that once had to search for young men to fill vacancies now have a choice of the finest minds coming out of our medical schools, and the future of the specialty looks bright indeed. We are privileged to be part of this group of enthusiastic, capable and well-trained young men who will, I am sure, carry the specialty on to heights of which we can only now catch a faint glimpse.”⁴ While the author did not explicitly say so, this quote almost assuredly referred to young Caucasian men; in my opinion, our collective history supports the assertion that young African-American, Hispanic American, and Native American males were not thought to possess the finest minds coming out of medical school in the American South in 1983. The idea that a premium was placed on the recruitment of Caucasian males is, perhaps, the unstated policy we still need to address.