The specialty of orthopaedic surgery continues to lag in the collective category of diversity, equity, and inclusion (DEI) in relation to medicine at large. At the AAOS 2022 Annual Meeting in Chicago, a special President’s Forum focused on a persistent impediment to progress: harassment, bullying, and recurring indignities known as microaggressions. Women and members of underrepresented racial, ethnic, and other marginalized groups find themselves the frequent targets of these entrenched behaviors. Harassment and microaggressions may discourage many talented individuals from even considering orthopaedics and demoralize those who do train in the specialty.
“When issues arise that threaten our profession, we cannot afford even the smallest amount of indifference,” said AAOS then-President Daniel K. Guy, MD, FAAOS, while introducing the session. “Today, we are not assembled to discuss a new threat, but one that has been around, has many faces, and is 180 degrees opposite the traits of ethical and professional behavior. This polar opposite is harassment, which includes any unwanted or offensive behavior. There is absolutely no place in our profession for it.”
Panel member Jennifer M. Weiss, MD, FAAOS, described how she and three other orthopaedic surgeons (Lisa K. Cannada, MD, FAAOS; Arianna Gianakos, DO; and Nancy Yen Shipley, MD, FAAOS) felt compelled to launch #SpeakUpOrtho in response to disturbing stories they were receiving from young women in orthopaedics about horrific incidents.
“These stories are not unique; there are hundreds of them,” said Dr. Weiss, who is chair of the AAOS Communications Committee. “We want to find solutions. We are grateful that our community cares, but we want to remind you that this happens in 2022. Although white women are more vulnerable than white men,” she said, “women of color are the most vulnerable, and I’d like to give a shoutout to the Black Women Orthopaedic Surgeons, who have partnered with us to make sure all voices are heard.”
Following Dr. Weiss was a woman from outside of orthopaedics but with years of experience regarding these issues within the corporate environment. Nashunda Williams is the global head of Diversity, Equity, and Inclusion at JLL, a commercial real estate company with 95,000 employees around the world. JLL has been recognized for its DEI awareness and “Ethics Everywhere” business philosophy.
Ms. Williams has been involved with diversity efforts throughout her 20-year career, helping to create impactful diversity and inclusion programs. As a “proud mother of three,” she observed: “The next generation is unforgiving when it comes to this topic. They are ready for change.”
Tailoring her advice to the AAOS audience, Ms. Williams said, “From the Academy’s perspective, leadership is enthusiastic about DEI and creating a better culture. But sometimes there’s a disconnect between leadership commitment and the members of an organization.”
Ms. Williams said an effective strategy starts with everyone understanding they have the power to make a difference.
“Strategy is a document that drives direction, but unless each member feels they play a part in the solution, the strategy won’t go anywhere,” she said. “You have an opportunity every single day to impact the culture.”
She shared an example of how orthopaedic surgeons who have private practices can make a difference by asking questions. “When was the last time you asked your staff, ‘Are we creating an inclusive environment?’ Questions are powerful to change narratives. Your staff probably have more data and insights than you can imagine. Ask. Make them feel empowered.”
Ms. Williams added, “Every time you operate on someone, there is a story when they leave that OR. Will they say, ‘This was a great experience, and I am going to refer others’? Or will they say, ‘I was really uncomfortable in that situation’? Every action you take is either moving toward making this organization more inclusive or going away.”
Monica Payares, MD, FAAOS, a pediatric orthopaedic surgeon at Nicklaus Children’s Hospital in Miami, spoke to the issues of microaggressions and bullying from the perspective of a Latina physician. “‘Microaggressions’ is a misnomer,” she said. “They are anything but micro. A lot of us women in the room and people of color experience this in our daily lives.”
Dr. Payares said banishing microaggressions should not require a great personal transformation. “As we train the next generation of surgeons, it means we pause before we say the next thing. It’s not about blaming or guilt; it’s asking you to be kind with your words. Before you make that [inappropriate] comment, pause for a second, and be supportive. Imagine your child was there, or your daughter is that resident in front of you.”
She implored her colleagues to contemplate: “How do we support those students? How do we eliminate those bullying comments? You just accepted that first Black female resident? Good for you. Now support them throughout their residency to make sure they graduate. Make sure they know the routes to academic appointments and get the promotion opportunities.” Speaking from her perspective and experience, Dr. Payares added, “When we are asked to be on boards and committees, we should have some routes to lead those one day as well. And when you ask us to speak at panels and conferences, make sure it is not only for sessions about diversity.”
Casey Jo Humbyrd, MD, FAAOS, a foot and ankle surgeon and director of the surgical ethics program at the University of Pennsylvania, spoke about the ethics of sexism and its harm to the profession. She noted that evidence indicates that female patients receive worse care than men. “Physicians are more likely to view women’s medical concerns as inorganic in nature, caused by psychological issues and therefore not real,” she said. This situation leads to two types of harms to female patients: “direct harm from worse care based on dismissal of organic symptoms and indirect harm to all patients but particularly female patients when there are fewer female surgeons.”
James R. Ficke, MD, FAAOS, FACS, a foot and ankle surgeon and chair of orthopaedics at Johns Hopkins University, spoke about “allyship” in support of women and minority colleagues and DEI efforts as leaders. Dr. Ficke said that when he is called to act as an ally, “I am honored, because I have a position as a department chair where I can make a difference. This affords a platform to set an example and expectations for others to model.”
As allies, he said, “We are called to be agents of change, with respect to how we move from indifference to action in allyship, from ‘there is no race problem, no harassing in my department’ to calling out unacceptable behaviors whenever observed. This must be an active process at every level from individual behaviors to institutional culture.”
Serving as a moderator for audience questions and comments was Valerae O. Lewis, MD, FAAOS, chair of orthopaedic oncology at the University of Texas MD Anderson Cancer Center.
She advised, “As a leader, don’t be afraid to stop the line. We do it in the OR all the time.” Abusive behavior and bullying are “just as detrimental to the health of your residents” as mishaps in surgery might be. Addressing the behavior, Dr. Lewis said, will help your patients.
Future articles in AAOS Now will explore in greater depth the issues raised by the panelists in this symposium.
Terry Stanton is the senior medical writer for AAOS Now. He can be reached at firstname.lastname@example.org.