Statistics that appear in a 2021 commentary published in Otolaryngology–Head and Neck Surgery tell the story: In 2018, White people comprised approximately 51% of otolaryngology resident applicants in the United States yet accounted for more than 66% of actual otolaryngology residents that same year—a figure commensurate with that of the White U.S. population at that time (2021;164:6-8). By contrast, that same year, 6% of otolaryngology applicants for residency were Black—despite comprising 13% of the U.S. population—and this group represented only slightly more than 2% of actual otolaryngology residents. The numbers become even more disparate when looking at professorships and residency chairs and chiefs (Laryngoscope. 2022;132:1729–1737).
Explore This IssueFebruary 2023
Although the 2021 commentary also shows some incremental progress from 2010 to 2018, the evidence is clear. Otolaryngology still has a long way to go to achieve a level of diversity that accurately reflects the public it serves. The good news is, leaders in the field are actively developing and engaging in organized, multifaceted programs to increase lasting opportunities for potential and existing otolaryngologists from underrepresented groups through early exposure, mentorships, networking programs, and more.
An Obsolete Model
Achieving true diversity is a question of will, contended Rodney J. Taylor, MD, MPH, chair of the otorhinolaryngology department at the University of Maryland School of Medicine in Baltimore. “First and foremost, there needs to be a recognition among colleagues that this goal is important and has value,” he said. “Second, there needs to be buy-in, such that it becomes clear among otolaryngologists throughout the country that programs and initiatives to increase diversity are widely endorsed and of great importance to the future of our specialty. It needs to be a priority item.”
There needs to be buy-in, such that it becomes clear among otolaryngologists throughout the country that programs and initiatives to increase diversity are widely endorsed and of great importance to the future of our specialty. It needs to be a priority item. —Rodney J. Taylor, MD, MPH
Prioritizing diversity is more than a moral imperative, Dr. Taylor noted. “What we learn from the data is that, when we’re trying to solve complex problems such as patient care and disease, a diverse group of leaders and thinkers does a better job than a homogeneous group of similarly talented individuals,” he explained. “They’re able to view those issues with the advantage of people who bring a wealth of different experiences, ways of looking at things, and manners of solving problems.”
The traditional model of medicine wasn’t established by a diverse group of individuals, however. And, as Dr. Taylor observed, people tend to get stuck in the status quo. He pointed to residency interviews as an example. “Some of the comments and questions during the course of these interviews reflect that some folks haven’t been exposed to thinking differently about how we evaluate people,” he said. As department chair, he strives to message faculty as to the narrowness of that traditional model, which was “not designed to measure important values and components that would build a broader and more diverse pipeline of individuals.”
From the candidates’ point of view, the barriers built into the traditional model are formidable, emphasized Lamont R. Jones, MD, MBA, an otolaryngologist at Henry Ford Health in Detroit. “When you look at the decision-making tree, part of it is being able to relate to the people who are already in the specialty you’re choosing: their personalities, lifestyle, interests. Seeing oneself in other people is important not only in deciding what you want to do, but because of the potential subjectiveness you may encounter when it comes to being chosen for residency or in the evaluation process,” he explained. “That plays a huge role in what the specialty looks like to you and, ultimately, what it will look like in the future.”
Not seeing oneself reflected in residency and/or leadership roles can discourage talented people from entering a field in which they might have much to contribute. A gifted and ambitious physician who also happens to be a person of color might end up “withering on the vine” in otolaryngology, said Dr. Jones. “When people see that there isn’t upward mobility for them, they get turned off by what they see as a lack of opportunity. They become disengaged and, often, look for other opportunities elsewhere.”
Creating a Framework
Diversification isn’t simply a numbers game. True change occurs when a culture is systemically transformed—that is, when it has integrated inclusive policies, approaches, and attitudes into every aspect of the system. In this model, people of color and allies are permanently committed to working together to garner and develop more minority otolaryngologists and otolaryngology leaders.
The University of Michigan in Ann Arbor is often held up as a national leader in diversity, equity, and inclusion innovation. David J. Brown, MD, associate professor of otolaryngology–head and neck surgery and associate vice president and associate dean for health equity and inclusion at the university’s medical school, credits the vision of earlier leaders such as Charles J. Krause, MD, who served as otolaryngology department chair from 1977 to 1992. “Because this interest in diversity started decades ago, it has been instilled into our culture. We’ve been on this journey a little longer than most places,” Dr. Brown explained. “People of color and underrepresented individuals of all backgrounds may feel more comfortable here because we have a long history of being accepting and inclusive. There’s still room to make things better, however.”
Dr. Brown emphasizes the importance of an alliance between a medical school’s departments and the larger institution in which they function. “We benefit from a university and a healthcare system that really value diversity,” he acknowledged. The culture is reinforced within the otolaryngology specialty. “Our current chair, Dr. Mark Prince, has established four values for our department: inclusion, engagement, civility, and accountability,” said Dr. Brown, whose unique role covers both the hospital and the medical school, enabling him to spearhead multiple projects. “As a healthcare system, we’re doing a lot of work for Pathways programs, and training and professional development for faculty, staff, and learners. We already have a curriculum for residents for healthcare equity, and we’re developing a curriculum for faculty who want to study healthcare disparities.”
Outreach and Mentorship
Although the desire to go into medicine often starts in early in life, a subspecialty like otolaryngology is rarely on any young person’s radar. Early exposure and mentoring are key to encouraging minoritized individuals to enter this rewarding field, said Angela Powell, MD, an otolaryngologist in private practice in Plattsburgh, N.Y. Dr. Powell decided early in life that she wanted to be a doctor. “I initially thought that I would pursue a career in neurosurgery,” she said. “At the time that I was contemplating that career path, I probably would have been the first African American female in most neurosurgical programs.”