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

Other disciplines have been exemplary. In 2008, the Council of Emergency Medicine Residency Directors (CORD) requested a panel to lead a workgroup on racial and ethnic diversity in emergency medicine as part of the best practices track.⁵ The move was not only intentional but integrated into the fabric of what the specialty considers the best practices for the field. Kane and colleagues looked at the trends in workforce diversity for vascular surgery, interventional radiology, interventional cardiology and general surgery.⁶ These groups were compared with orthopedic surgery because the American Academy of Orthopedic Surgery has been intentional, directive and active in pursuit of increased diversity in its specialty.⁷

Kane’s findings suggest that many programs may have inadvertently met diversity goals by increasing the number of women in their programs. While this is a noble and necessary objective, it sidesteps consideration for the value that socioeconomic and cultural diversity bring to the table. Women represented 14 percent of vascular surgery trainees, while African-American and Hispanic trainees accounted for 4 to 5 percent of all surgeons training in the subspecialty.⁶ Simply looking at the numbers, one must conclude that Caucasian women have derived more benefit from diversity programs than have other underrepresented groups in vascular surgery.

Returning to our specialty, an analysis of the data from 1996 to 2004 revealed that the population of women in otolaryngology increased from 18.5 percent to 23 percent. For African-Americans, representation fell from 3.6 percent in 1996 to 2.3 percent in 2004.⁸ For Hispanic and Native American physicians, the amount of data was apparently too small to submit to statistical analysis. These statistics, coupled with the absence of any plan to rectify the problem, lead to some conclusions.

First, there is a dearth of concrete evidence to support an assertion that the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) has any sense of concern or urgency about addressing the problem. It is not clear that there is a feeling of unease or discontent with the status quo. Secondly, there are examples in other specialties of a more decidedly active response. Drawing on the example of our colleagues in orthopedic surgery, perhaps the first and most critical step is recognition of the problem. Mark Gebhardt, MD, a professor of orthopedic surgery at Harvard University Medical School, writes, “Diversifying residency programs positively affects all residents and their ability to deliver care and create positive physician-patient relationships.”⁷ The author clearly understands that increasing diversity benefits both underrepresented minorities and traditionally represented groups of people. There must be a realization that encompassing myriad cultural backgrounds to create a diverse health care delivery team enhances the team itself as well as the team’s collective ability to provide health care.