A new study highlights the urgent need to boost opportunities for women and underrepresented minority groups in leadership positions within surgery.
Currently, women and those from minority ethnic groups are underrepresented in medicine (URiM). Not only do they occupy fewer leadership roles in surgical departments but they also tend to be clustered into certain leadership roles.
This is according to experts from the Perelman School of Medicine at the University of Pennsylvania.
They observed that their roles in leadership tended to be as vice chairs overseeing diversity, equity and inclusion (DEI) or wellness.
They often had ambiguous pathways to reach the position of department chair.
The report, published in JAMA Surgery, is spearheaded by Oluwadamilola ‘Lola’ Fayanju, MD, MA, MPHS, who serves as the Helen O Dickens Presidential Associate Professor and heads the Breast Surgery Division.
Dr Fayanju is the first black division chief in the history of Penn's Department of Surgery, joining the institution in 2021.
White men have led the field of surgery for decades and still make up approximately 46.2% of practising general surgeons, according to the Association of American Medical Colleges (AAMC).
While there has been a push to recruit a diverse pool of physicians in recent years, it may take time to see this diversity reflected at leadership levels, the authors say.
Currently, women hold just 14.1% of surgery department chair positions and just 8.9% of leadership roles in surgery departments at academic medical centres in the US.
Dr Fayanju said: ‘A traditional measure of diversity in medicine’s success has been the number of women and individuals from certain backgrounds who achieve department chair positions, representing the pinnacle of accomplishment in academic medicine.
‘With this study, we aimed to explore various levels of leadership, which serve as indicators of one’s trajectory through leadership, across all surgical specialties. The objective is to determine if the medical field is appropriately cultivating pipelines and endpoints to attain physician leadership diversity that better mirrors the diversity of the US patient population.’
The study examined data from 165 surgery departments, encompassing surgery, neurosurgery, obstetrics and gynaecology (OBGYN), ophthalmology, orthopaedics, and otolaryngology in US medical schools and affiliated hospitals, as well as those in Puerto Rico. The researchers employed a methodology previously utilised in other studies to ascertain the demographics of 2,000-plus surgery leaders based on publicly available online profiles, biographies and visual information.
The team employed a multi-coder system with a diverse group of reviewers to address potential limitations.
In academic medicine, which involves medical schools associated with hospitals providing patient care, department chairs are typically physicians or researchers who also hold administrative roles, overseeing a large group of faculty members sharing their areas of expertise, such as surgery or medicine.
They may be supported by a leadership team comprising vice chairs, who typically lack direct reports and division chiefs, whose responsibilities are similar to those of the chair but on a smaller scale, overseeing staff, budgets, and programs for a more specialised group of faculty members, such as cardiovascular surgery or haematology-oncology.
Recent years have seen the emergence of additional vice chair roles that support newly prioritised focus areas, such as diversity, equity, and inclusion (DEI) or faculty development, especially with increased emphasis on racial justice and work-life balance.
Vice chairs responsible for DEI were predominantly female (64.5%). They included many individuals from underrepresented backgrounds (51.6%), whereas vice chairs overseeing faculty development were evenly divided between men and women, with only 17.9% of individuals from underrepresented backgrounds. Breast/Endocrine surgery was the sole specialty where women constituted the majority (63.6%) of division chief roles. No individuals from underrepresented backgrounds held the position of vice chair of research.
The demographics of surgery division chiefs closely resembled those of surgery department chairs. However, women and individuals from underrepresented backgrounds were less likely to hold these roles.
The study’s authors suggest that this might result from a delayed effect of recruitment efforts and the creation of new leadership roles, or it could indicate that women and individuals from underrepresented backgrounds are being promoted to leadership roles that lack a clear path to chair positions.
The authors contend that these findings should encourage leaders in academic medicine to reconsider traditional pathways and criteria for promotion, such as grant funding, publications, and other metrics that may not necessarily correlate with leadership aptitude.
Dr Fayanju emphasises: ‘We should explore alternative methods of recognising excellence and promoting individuals, without necessarily elevating them to leadership positions simply because it's the next logical step. It’s essential to provide diverse individuals with the skills and opportunities necessary for leadership so that everyone can pursue leadership roles that align with their interests and career aspirations.’
. Not only do they occupy fewer leadership roles in surgical departments but they also tend to be clustered into certain leadership roles. This is according to experts from the Perelman School of Medicine at the University of Pennsylvania. They observed that their roles in leadership tended to be as vice chairs overseeing diversity, equity and inclusion (DEI) or wellness. They often had ambiguous pathways to reach the position of department chair. The report, published in JAMA Surgery, is spearheaded by Oluwadamilola ‘Lola’ Fayanju, MD, MA, MPHS, who serves as the Helen O Dickens Presidential Associate Professor and heads the Breast Surgery Division. Dr Fayanju is the first black division chief in the history of Penn's Department of Surgery, joining the institution in 2021. White men have led the field of surgery for decades and still make up approximately 46.2% of practising general surgeons, according to the Association of American Medical Colleges (AAMC). While there has been a push to recruit a diverse pool of physicians in recent years, it may take time to see this diversity reflected at leadership levels, the authors say. Currently, women hold just 14.1% of surgery department chair positions and just 8.9% of leadership roles in surgery departments at academic medical centres in the US. Dr Fayanju said: ‘A traditional measure of diversity in medicine’s success has been the number of women and individuals from certain backgrounds who achieve department chair positions, representing the pinnacle of accomplishment in academic medicine. ‘With this study, we aimed to explore various levels of leadership, which serve as indicators of one’s trajectory through leadership, across all surgical specialties. The objective is to determine if the medical field is appropriately cultivating pipelines and endpoints to attain physician leadership diversity that better mirrors the diversity of the US patient population.’ The study examined data from 165 surgery departments, encompassing surgery, neurosurgery, obstetrics and gynaecology (OBGYN), ophthalmology, orthopaedics, and otolaryngology in US medical schools and affiliated hospitals, as well as those in Puerto Rico. The researchers employed a methodology previously utilised in other studies to ascertain the demographics of 2,000-plus surgery leaders based on publicly available online profiles, biographies and visual information. The team employed a multi-coder system with a diverse group of reviewers to address potential limitations. In academic medicine, which involves medical schools associated with hospitals providing patient care, department chairs are typically physicians or researchers who also hold administrative roles, overseeing a large group of faculty members sharing their areas of expertise, such as surgery or medicine. They may be supported by a leadership team comprising vice chairs, who typically lack direct reports and division chiefs, whose responsibilities are similar to those of the chair but on a smaller scale, overseeing staff, budgets, and programs for a more specialised group of faculty members, such as cardiovascular surgery or haematology-oncology. Recent years have seen the emergence of additional vice chair roles that support newly prioritised focus areas, such as diversity, equity, and inclusion (DEI) or faculty development, especially with increased emphasis on racial justice and work-life balance. Vice chairs responsible for DEI were predominantly female (64.5%). They included many individuals from underrepresented backgrounds (51.6%), whereas vice chairs overseeing faculty development were evenly divided between men and women, with only 17.9% of individuals from underrepresented backgrounds. Breast/Endocrine surgery was the sole specialty where women constituted the majority (63.6%) of division chief roles. No individuals from underrepresented backgrounds held the position of vice chair of research. The demographics of surgery division chiefs closely resembled those of surgery department chairs. However, women and individuals from underrepresented backgrounds were less likely to hold these roles. The study’s authors suggest that this might result from a delayed effect of recruitment efforts and the creation of new leadership roles, or it could indicate that women and individuals from underrepresented backgrounds are being promoted to leadership roles that lack a clear path to chair positions. The authors contend that these findings should encourage leaders in academic medicine to reconsider traditional pathways and criteria for promotion, such as grant funding, publications, and other metrics that may not necessarily correlate with leadership aptitude. Dr Fayanju emphasises: ‘We should explore alternative methods of recognising excellence and promoting individuals, without necessarily elevating them to leadership positions simply because it's the next logical step. It’s essential to provide diverse individuals with the skills and opportunities necessary for leadership so that everyone can pursue leadership roles that align with their interests and career aspirations.’){kind=link}