August 1998 Bulletin

AOS told more minority orthopaedists needed

White, non-Hispanic male-dominated profession lags changes in U.S. demographics

The orthopaedic profession is being urged to open its ranks to underrepresented minorities to meet the needs of the changing racial and ethnic composition of the United States.

"It is crucial to our profession if we are going to provide orthopaedic care to the entire population, says Michael A. Simon, MD, president of the Academic Orthopaedic Society (AOS). "We need to diversify ethnically, racially and genderly."

He told an AOS symposium on "Minorities and Orthopaedic Surgery" in June that the orthopaedic profession has not kept up with changes in the demographic patterns of the U.S., or even with changes in the racial and ethnic composition of the medical school graduating classes. Dr. Simon pointed out that 7.3 percent of the 1997 medical school graduating class were African Americans and 6 percent were Hispanics. The number of women in medical schools has increased dramatically in recent years-40 percent of the 1997 graduating class were female-but only 2 percent of orthopaedic surgeons are women.

While orthopaedic surgeons are mainly white, non-Hispanics, this segment of the population is expected to decline to 60 percent in 2030 from 72 percent in 1998. The U.S. Census bureau predicts African Americans will account for 14 percent of the total population in 2030 and the Hispanic population, 19 percent. In 2050, white, non-Hispanics will be 52 percent of the U.S. population and Hispanics, 24 percent.

The reasons for including minorities in medicine go far beyond matching the statistical ratios of various groups in the population. The AOS symposium speakers say minority physicians are needed because they are more likely to serve the minority populations, they relate better to patients of the same racial and ethnic background and inclusion of minorities adheres to the principle of equal opportunity that is a fundamental right of all Americans.

Affirmative action initiatives which accelerated the enrollment of minorities in the 1960s are being challenged by reverse discrimination litigation. The result is a decline in minority enrollments. More pressure is coming from another direction. There is concern that actions to reduce the future orthopaedic workforce by shrinking residency programs also will result in fewer minority physicians.

Augustus A. White III, MD, who organized and moderated the symposium, says diversity to include more minorities and women in orthopaedics advances democratic and humanitarian ideals of equality. Diversity also enhances the medical education of all students. He quoted a statement by the late Supreme Court Justice Lewis Powell that "a medical student with a particular background whether it be ethnic, geographic, culturally advantaged or disadvantaged, may bring to a profession and school of medicine, experiences, outlook and ideas that enrich the training of its student body and better equip its graduates to render the understanding that's necessary to carry out their vital service to humanity."

Dr. White observes that "as conscientious care givers, we wish to avoid offending patients through ignorance or insensitivity about issues of race or ethnicity. This is crucial to the physician-patient relationship. Patient rapport affects our patients compliance, outcome or decision to become or not become a plaintiff."

Diversity in orthopaedics, says Dr. White, "will help us reduce the unconscionably racial disparity in our health care system. It will enhance the practice of culturally competent medicine. It will improve distribution of physicians into needed areas of our society."

Kay Clawson, MD, asserts that "it is a national imperative and important to the health of the nation that we have a medical population that is racially and ethnically diverse and more clearly represents the population to be served." He urges orthopaedic department chairmen to look beyond grade point averages and MCAT and examine the background of the applicants. Dr. Clawson reminded the audience that minority enrollment increased during the civil rights era of the 1960s. The college admission test scores and grade point levels of the minority students did not increase, "our values changed," Dr. Clawson stressed.

He notes that underrepresented minorities are entering medical schools with overall grade point averages and MCATs that are lower than non-Hispanic white students. "The standards used for entry into medical school mirror the middle class and upper class culture that make it very difficult for those from other cultures and educational backgrounds to compete," says Dr. Clawson. "Are these standards or values the correct ones if we are looking at the health of the nation, let alone racial justice? In order to provide the best health care for the diverse population, we must have providers from diverse backgrounds."

Dr. Clawson questions the practical use of mastery of the physical sciences, mathematics and biologics that is demanded in medical schools. "The obstacles the student had to overcome, the diverse life experiences, even the language they speak, whether a dialect or foreign language, may be more important to the practice of medicine than how high he or she scored on MCAT," Dr. Clawson says.

U.S. medical schools

Underrepresented minorities
African American1,153-3.7
Native American119-7.8
Mexican American/Chicano40-8.7
Puerto Rican (Mainland)98-31.0
Other U.S. students
Asian/Pacific Islander3,1677.2
Puerto Rican (Commonwealth)2123.4
Other Hispanic281-13.5

Source: Association of American Medical Colleges

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