DEI initiatives in vascular surgery: How are we doing?

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The 2022 Vascular Annual Meeting (VAM) has been touted as the most diverse to date. As attendees ourselves, we can attest to the increased representation among attendees, presenters and moderators. 

A dedicated session, named “Building diversity and equitable systems in vascular surgery,” should have been the perfect setting for the membership and leadership to showcase its stated commitment to diversity, equity and inclusion (DEI) initiatives. However, the shockingly low attendance by members and leaders at this session left us feeling like we had witnessed a fumble at the one-yard line. This less-than-optimal outcome was met by notable

expressions of frustration and disappointment by the few attendees who were present. Quickly, these sentiments were being echoed and amplified on social media platforms. The Society for Vascular Surgery (SVS) Executive Board responded to the smoldering controversy with a written statement posted on the official SVS website with a brief statement vowing continued efforts to prioritize DEI principles and accelerate change while acknowledging organizational shortcomings.1 Certainly, scheduling so many competing events had a significant impact. 

Empty seats and sparsely attended sessions notwithstanding, what lessons should the SVS and those of us working on DEI-focused initiatives take away from these events? Does lack of attendance equate with lack of interest in DEI? More importantly, what is the current state of DEI efforts in vascular surgery? Are vascular surgeons appropriately interested, engaged, and equipped with the knowledge and skills to combat health inequities? Do current and future vascular surgeons understand how paramount DEI interventions are to building a diverse workforce more mindful of the barriers our most vulnerable patients face? 

We don’t ask these questions to be hyperbolic. Rather, we ask in the hope of eliciting thoughtful and frank, at times painful, discussions about the root cause of many of these complex issues and our roles in addressing them. Broadly speaking, DEI has been seen as the panacea to increase diversity and inclusion in our workforce, address bias in the clinical learning environment, and eliminate health inequities and disparities.2-3 Each of the objectives are pillars of DEI that exist in their separate but interconnected domains. The SVS has adopted these same principles in its bylaws and efforts to change the organizational culture of vascular surgery. As SVS members, we are all tasked with the work to advance “excellence and innovation in vascular health through education, advocacy, research and public awareness.” As such, advancing DEI initiatives is in keeping with our mission as vascular surgeons. 

However, in its current iteration, we’ve treated DEI as a secondary outcome, whereas it should be treated as a primary outcome. So how, then, do we make this transition to appropriately position DEI efforts within our day-to-day practice? We propose that adopting instruments and metrics to capture and analyze patients’ social determinants of health (SDoH) in clinical care, research, and quality improvement initiatives is a concrete first step that individual and organizations can take today. 

It has been well documented that patients with low-income levels, and racial and ethnic minorities, have worse outcomes with amputations and are more likely to undergo fewer revascularization attempts prior to intervention.4-5 SDoH provides a good mechanism to interrogate the reasons behind these disparate outcomes and help provide evidence-based, patient-centered comprehensive vascular care. Also, integrating these datapoints into our root-cause analysis during peer-review conferences can serve as teaching moments for our trainees and quality improvement opportunities. 

Vascular surgery finds itself at the intersection of SDoH, patient outcomes and a perilous healthcare system. This presents challenges but also opportunities. We are privileged to take care of simultaneously the most diverse, disenfranchised and comorbid populations in our society. As this population ages and the health gap widens, it is more important than ever that we put the correct emphasis on DEI interventions. 

References 

  1. https://vascular.org/news-advocacy/articles-press-releases/prioritizing-dei-principles. Accessed June 22, 2022 
  2. Aulivola B, Mitchell EL, Rowe VL, et al. Ensuring equity, diversity, and inclusion in the Society for Vascular Surgery: A report of the Society for Vascular Surgery Task Force on Equity, Diversity, and Inclusion. J Vasc Surg. 2021 Mar;73(3):745–756.e6. doi: 10.1016/j.jvs.2020.11.049 
  3. Dalman RL, Murphy SA, AbuRahma AF, et al. The Society for Vascular Surgery Executive Board response to the Diversity, Equity and Inclusion Taskforce Report. J Vasc Surg. 2021;73(3):757–761. doi:10.1016/J. JVS.2020.11.048 
  4. Fanaroff AC, Yang L, Nathan AS, et al. Geographic and socioeconomic disparities in major lower extremity amputation rates in metropolitan areas. J Am Heart Assoc. 2021;10(17):21456. doi:10.1161/ JAHA.121.021456 
  5. Gober L, Bui A, Ruddy JM. Racial and gender disparity in achieving optimal medical therapy for inpatients with peripheral artery disease. Ann Vasc Med Res. 2020;7(4). Accessed July 19, 2022. /pmc/articles/ PMC7877491/ 

Imani E. McElroy, MD, is a resident at Massachusetts General Hospital in Boston. Carla C. Moreira, MD, is an associate program director at Alpert Medical School of Brown University in Providence, Rhode Island. 

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