Lee Kirksey, MD, issued an unapologetic apology of sorts at the outset of his discussion of diversity, equity and inclusion (DEI) issues. “If I ruffle any feathers I apologize, but I think it’s a conversation that’s important to have,” said Society for Vascular Surgery (SVS) member Kirksey, of the Cleveland Clinic. ”Let’s move beyond the problem we understand exists and let’s move on to solutions.”
His address, “Equity challenges in vascular surgery: Closing the gap,” kicked off an hour-long session covering DEI issues, including a slew of scientific abstract talks.
The coronavirus “unveiled longstanding inequities … and laid bare problems that have existed for many years for poor brown, Black and white Americans,” he said, adding that evidence of these inequities in medical care and outcomes converged amidst a background of social unrest.
He reviewed some of the history of addressing such issues with the SVS, including a report from 2010, the creation of the DEI Task Force (now a committee), its recommendations and other positive steps the SVS has taken in the past few years. The existence of an equity action plan demonstrates the Society’s focus, he said.
“Inequality and inequity do not exist in a vacuum,” he said. “It impacts the way we care for patients.”
He acknowledged issues within SVS, including representation of various demographic groups. Women have made good strides; they now comprise 15% of SVS membership and hold 29% of committee and council member positions (including 25% of chair positions). Among trainees, 25% of vascular fellows and 34% of residents are women.
However, only 2% of SVS members are Black and just 6% are Hispanic. No Blacks or Hispanics are members of SVS councils, with only 3% of committee members from these demographic groups.
“Senior female leadership, with the energetic support of early- and mid-career female surgeons have made progress,” he said. “In terms of race, we have a long way to go.”
One issue is that only 60% of SVS members have identified their race/ethnicity to the Society, he said. “DEI tactics start with this,” he stressed. “We need membership buy-in to get demographic information.”
He urged development of a pipeline to spur those Under-Represented in Medicine (URiM) to go into medicine and enhancement of the Develop a URiM pipeline and then enhancement, specifically, of the vascular surgery URiM pipeline. He also advocated medicine identify a group specifically tasked with a strategic action plan to enhance the visibility of role model vascular surgeons amongst Hispanic, Black and Native American medical students
There have been positive developments within the SVS, he said. A “silver lining” during COVID has been the creation of a network of Black vascular surgeons. Past President Ronald L. Dalman, MD and Executive Director Kenneth M. Slaw, PhD, enthusiastically supported this group working in concert with SVS, said Kirksey.
Other tactics and possible solutions include maintaining accurate demographics, plus optimizing awareness of implicit bias (IB) amongst discordant providers, including implicit bias training and expanding the definition of vascular care providers.
Kirksey enumerated several ways bias—conscious or not—impacts care, including in revascularization procedures and amputations. “Vascular surgeons are involved in all levels of intervention and population health,” he said. “We must fully understand as a group and actively engage in conversations around the value-based care delivery model, which is predicated on thoughtful healthcare provision. We have the quality data and appropriateness data to drive models of efficient care delivery that bring value to both health care insurers and health care systems.”
Efforts to improve healthcare include a bill that has been introduced to amend a section of the Social Security Act “to provide for coverage of peripheral arterial disease screening for at-risk beneficiaries, disallow non-traumatic amputation services without anatomical testing under the Medicare program, and for other purposes.” Another is a prospective trial on peripheral arterial disease (ARISE MP—ABI to Reduce CDV Incidence: Screening and Effectiveness in Minority Populations) now seeking National Institutes of Health funding that has received SVS support. “To date only two trials in the cardiovascular space have exclusive enrolled Black and Hispanic patients. This will be the first in the PAD space,” Kirksey said.
He ended his talk with a quote from author James Baldwin: “Not everything that is faced can be changed, but nothing can be changed until it is faced.”
“You decide if it applies,” Kirksey told the audience. “Discussing inequity is indeed a difficult conversation, but we should focus on solutions and avoid casting blame.”
Quotas don’t work. Affirmative action programs don’t. Discrimination based on skin color is discrimination not merit. Black and Hispanic medical students make up a small percentage of possible recruitment opportunities to vascular surgery. The quality of life, stress of our profession, professional al dissatisfaction with hospitals and administration and the high divorce rate amongst Vascular surgeons are our biggest problem. Not a lack of diversity.
Actually it is not true to say that Black and Hispanic students are not present in high enough numbers to recruit to become Vascular surgeons. Institutions need to be targeted about it but of course, must WANT to do so first. HBCU are an excellent places to start as an example. Most schools of medicine have student groups that can be approached for recruitment efforts. The other issues (divorce, burnout etc) are of course important and can be addressed simultaneously. We are good multi-taskers