Despite the efforts that have been made in recent years to improve diversity, equity, and inclusion within medicine and, specifically, within surgery, the data suggest that the profession has a lot of work to do to accomplish our stated goal of making our environments diverse and inclusive and the health care we provide to our patients equitable.
The coronavirus 2019 (COVID-19) pandemic has brought to the fore prevailing inequities in health care and in outcomes for patients who are underrepresented minorities (URMs) or from disadvantaged backgrounds. Ongoing racial violence has continued to shatter our communities in these difficult times, and added challenges to individuals most vulnerable in our profession at a time of great stress for all who serve in health care fields. Women continue to be underpaid in surgery and remain underrepresented in leadership positions in academic medicine. URMs in medicine (URiMs) by definition remain underrepresented in our profession relative to their proportion in the overall population. The glass ceiling for women, URiMs, and lesbian, gay, bisexual, transgender, queer, and other (LGBTQ+) members of our profession, has yet to shatter in a meaningful way. Despite the best intentions, the care we provide to our patients is affected at the societal level by explicit biases and at an individual level by the implicit biases we all hold.
Nonetheless, we have reason for hope. Professional organizations, such as the American College of Surgeons (ACS), are making efforts to address the societal, institutional, and individual barriers to diversity, equity, and inclusion. Some surgical societies under the leadership of high-profile academic surgeons have promised to turn their attention to promoting diversity, equity, and inclusion within surgery and within surgical leadership. Prominent departments have changed their recruitment and hiring processes to attract, retain, and nurture candidates from diverse backgrounds and have addressed the culture within their surgery departments to make the environment hospitable and welcoming.
The ACS Board of Regents, in response to a request from the Resident and Associate Society of the College (RAS-ACS) announced an ACS Task Force on Racial Issues this year to address diversity, equity, and inclusion within surgery. The task force’s efforts and recommendations are described elsewhere in this issue.
The RAS-ACS, meanwhile, has taken a number of small steps that we anticipate will grow to a larger movement within surgery and help change expectations and the environment at national meetings. For example, the RAS-ACS Executive Committee two years ago agreed to encourage diversity of representation in RAS programming. Any panel discussion sponsored by RAS-ACS must now include at least one woman and/or a URiM. We have followed our policy of “no manels” these last two years with great success and have showcased talent that otherwise might have gone overlooked. The RAS-ACS has advocated for improved parental leave policies. RAS convened a task force in response to the COVID-19 pandemic; that workgroup is assessing the needs of trainees and young faculty and anticipates offering tailored programming for colleagues who identify as most vulnerable. The RAS-ACS has hosted webinars and panel discussions on these topics.
Each year, the RAS-ACS selects a theme for one edition of the Bulletin of the American College of Surgeons, and we selected Diversity, Equity, and Inclusion as our theme in 2020 to engage members in research on a variety of issues and to engender creative ideas to help us make progress within surgery. Included in this issue are articles by members of each of the five standing committees of the RAS-ACS. Topics addressed herein are as follows:
- How the composition of the surgical workforce affects patient care
- The literature on diversity and inclusion in surgery as it relates to trainees and leadership, and recommendations and strategies to promote a more inclusive and diverse surgical workforce
- Disparities facing URiMs in surgery and solutions to increase diversity within surgical societies
- Disparities in surgical education and training
- How surgical societies, including the ACS, can improve efforts to be more inclusive and promote diversity in the workforce and better respond to patient needs
We welcome ideas and suggestions from our readers, and, most importantly, we welcome RAS-ACS members to engage with any of our five standing committees and bring forth ideas for education, research projects, and advocacy to advance diversity, equity, and inclusion in our profession.