It is often said that the first step toward overcoming a problem is admitting that you have one. Since the tragic death of George Floyd in May 2020, the American College of Surgeons (ACS) has confronted the issue of underrepresentation of Black members and staff, particularly in leadership positions. In this month’s column, I review the organization’s past experience with matters of race and describe the steps we are taking to create a more diverse, equitable, and inclusive Fellowship.
Confronting the past
The ACS has, like much of the U.S., struggled with issues of race throughout the first half of the 20th century. One of the College’s founding members was Daniel Hale Williams, MD, FACS, an African-American surgeon from Chicago, IL. Although Dr. Williams was an accomplished surgeon, at least one southern surgeon objected to his nomination, but was overruled, and Dr. Williams was inducted into the College in 1913.*
No other African-American candidates were admitted to the College until Louis T. Wright, MD, FACS, of New York, NY, gained Fellowship in 1934. The College failed to address whether deserving African Americans should be accepted for membership until October 1940, when seven Black applicants were recommended for Fellowship. Charles Drew, MD, FACS, chair of surgery, Howard University, Washington, DC, and director of the first American Red Cross blood bank, was among the surgeons whose applications were deferred for consideration in 1940.
Many southern Regents suggested that, given contemporary cultural norms, Black surgeons’ inclusion would lead to widespread resignations. This viewpoint was so prevalent that Board Chair Irvin Abell, MD, FACS, cited a unanimously carried 1939 resolution that stated, “[No] applicant shall be granted fellowship in the ACS, whose admission would be injurious to the good order, peace, or interest of the College, or derogatory to its dignity, or inconsistent with its purposes.” This resolution was specifically intended to support the conclusion that the College should deny admission to Black surgeons.*
The U.S. military was segregated initially during World War II but became integrated when U.S. President Harry S. Truman issued an Executive Order desegregating the Army. In 1945, Henry Cave, MD, FACS, a Regent and future ACS President, formed the Committee on the Relation of the Colored Surgeon to the ACS, which interviewed Black surgeons and issued questionnaires to more than 200 Fellows. The committee’s findings did not support the fear of mass resignations from the south, and four Black surgeons were approved for Fellowship in 1945. More than 60 Black Fellows were inducted into the College between 1945 and 1950, including Helen Octavia Dickens, MD, FACS, an obstetrician-gynecologist from Philadelphia, PA, the first African-American woman to attain Fellowship in 1950.*
Unfortunately, Dr. Drew did not obtain ACS Fellowship in the College before his untimely death in an automobile accident April 1, 1950; however, he was granted posthumous Fellowship in 1952. Dr. Drew’s legacy lives on in the past and current leadership of the College.*
LaSalle D. Leffall, Jr., MD, FACS, one of Dr. Drew’s students, was elected ACS Secretary in 1983 and President in 1995. Edward E. Cornwell III, MD, FACS, FCCM, FWACS(Hon), the LaSalle D. Leffall Endowed Chair of Surgery, Howard University College of Medicine, was elected Secretary of the College in 2013; and Patricia L. Turner, MD, MBA, FACS, one of Dr. Leffall’s residents at Howard University College of Medicine, now serves as Director, ACS Division of Member Services.*
The College’s journey toward more inclusive leadership also includes the elections of Claude Organ Jr., MD, FACS, and L.D. Britt, MD, MPH, DSc(Hon), FACS, FCCM, FRCSEng(Hon), FRCSEd(Hon), FWACS(Hon), FRCSI(Hon), FCS(SA)(Hon), FRCSGlasg(Hon), to President in 2003 and 2010, respectively, and the election of Lisa Newman, MD, MPH, FACS, FASCO, as Second Vice-President in 2020.*
Regents confront racism today
While the College and the U.S. have made some significant strides toward improving diversity in the last few decades, we acknowledge that much more work needs to be done. In the wake of Mr. Floyd’s death, the ACS formed a Task Force on Racial Issues led by ACS President J. Wayne Meredith, MD, FACS, MCCM. This group developed a proposal and report on how the College can confront racism in surgery, which the ACS Board of Regents unanimously approved at its October 2020 meeting and which was published in the January 2021 issue of the Bulletin.†
While the College and the U.S. have made some significant strides toward improving diversity in the last few decades, we acknowledge that much more work needs to be done. In the wake of Mr. Floyd’s death, the ACS formed a Task Force on Racial Issues led by ACS President J. Wayne Meredith, MD, FACS, MCCM.
Dr. Meredith explained that the ACS’ efforts “to serve all with skill and fidelity” requires that the members of this organization confront racism within the organization, the profession, and surgical education and training. He also explained the five focus areas for improvement—creating a just and inclusive environment, enhancing cultural competency, increasing diversity in the workforce, engaging in public health research, and promoting advocacy and legislative reforms.
To implement the task force’s recommendations, the Board of Regents formed a Committee on Anti-Racism, chaired by Timothy J. Eberlein, MD, FACS, an ACS Regent and the Editor-in-Chief of the Journal of the American College of Surgeons. The committee intends to present its policy recommendations at the virtual Board Meeting in June. The topics covered in the committee’s proposal are as follows:
- Anti-racism values
- Diversity demographics and metrics
- Training and education
- Collaboration with standing committees, including the Committee on Diversity and the Committee on Disparities
- Partnering with other organizations
- Public health research and initiatives
- Advocacy and legislative platform
- Use of minority- and women-owned businesses
The Regents’ document also addresses racial issues as they pertain to our increasingly diverse staff. The College staff have developed the START (Staff Addressing Racism Task Force), which has formed Affinity Groups, and offers Safe Space forums to openly address racial and diversity issues at the ACS headquarters and Washington, DC, office. There are 12 workgroups. In addition, we are conducting a search for a Director of the ACS Office of Diversity Issues, which initially will be housed in Executive Services.
As a next step toward promoting anti-racism and collaboration with other like-minded organizations, the College will host a professional surgical society retreat June 23. This meeting will convene the House of Surgery and will include keynote addresses from Ibram X. Kendi, PhD, Andrew W. Mellon Professor in the Humanities and founding director of the Center for Antiracist Research, Boston University, MA; and Wayne A. I. Frederick, MD, FACS, president and Charles R. Drew Professor of Surgery, Howard University.
As a professional organization with diverse members who serve “all with skill and fidelity,” we must acknowledge our past and move forward with more than promises to do better.
Following the keynote addresses, attendees will transition into breakout sessions to discuss best practices and learn which initiatives can have the most impact. The breakout sessions are intended to achieve the following objectives:
- Develop a comprehensive understanding of diversity, equity, and inclusion (DEI) and anti-racism initiatives that participating organizations are conducting
- Prioritize initiatives that can have the greatest impact on advancing DEI and anti-racism initiatives
- Determine how the ACS can work with other organizations to facilitate and expedite these efforts
- Each participating organization may send up to two representatives to the retreat. Participants must register by Friday, May 14.
- In addition, the ACS will survey participating organizations to determine best practices for implementing DEI and anti-racism initiatives.
Racism in the U.S. has been a problem since our nation’s founding. As a professional organization with diverse members who serve “all with skill and fidelity,” we must acknowledge our past and move forward with more than promises to do better. Surgeons are leaders within their institutions and their communities. We, with the dedicated staff of the ACS, are well equipped to move toward ending the systemic injustices that people of color have faced in organized medicine and in the broader U.S. culture. The time for action is now.
*Stewart JH IV. The ACS, racism and surgery: Evaluating our past to ensure a better future. Bulletin Brief. March 2, 2021. Available at: www.facs.org/publications/bulletin-brief/030221/pulse. Accessed April 3, 2021.
†American College of Surgeons. Task force reports on how the ACS can confront racism in surgery. Bull Am Coll Surg. 2021;106(1):63-68. Available at: https://bulletin.facs.org/2021/01/task-force-reports-on-how-the-acs-can-confront-racism-in-surgery/. Accessed April 3, 2021.