Letter from the Editor: Otolaryngology Must Address Diversity, Gender Bias

Cultural conditioning shapes who we think we are at any given point in our lives. Few are those who ever challenge or outgrow the beliefs that have been instilled by family and society during those early years.—Mooji

I have always advised students to avoid the doctors’ lounge, especially those filled with pessimistic physicians who talk about how medicine is not what it used to be or reminisce about how the good old days were so much better. Unfortunately, this attitude is non-productive, is highly contagious, and reinforces old biases and behaviors. I worry about becoming one of those physicians. If I resist change in medicine, is it really different this time or am I just getting old?

While I was fortunate to be involved in our specialty’s leadership at a young age, it was obvious at the time that our leaders did not reflect the reality of my medical school experience in Ann Arbor or residency training in Houston.

In March 2007, at the AAO–HNS annual advocacy conference in Washington, D.C., during Richard Miyamoto’s presidency, I attended a meeting of multiple otolaryngology organization presidents. Everyone was discussing issues within the specialty, most of which were focused on clinical topics, specialty politics, or reimbursement problems. Duane Taylor and Lisa Perry-Gilkes, representing the National Medical Association’s otolaryngology section and the Harry Barnes Society, raised concerns about diversity, health literacy, and cultural competency in our specialty. In the room, these topics seemed out of place and were not further discussed. Yet, their comments clearly resonated with the Academy leadership and quickly led to the development of the Academy’s first diversity policy and the creation of the inaugural Diversity Committee. Around the same time, Sonya Malekzadeh and others led the creation of the Section for Women in Otolaryngology. Both groups were immediately given representation in the Academy’s Board of Directors.

When we attempt to avoid change and cling to the ‘way things were,’ we stop moving forward and growing, and we become part of the problem.

These impactful efforts, reflecting the leadership of many people over the years, opened a new era in an important ongoing conversation within our specialty. Unfortunately, the people who would benefit the most from receiving this information are the most likely to ignore relevant communications or close their minds to the benefits of different perspectives, equity, or new ways of doing things. People who are committed to change and moving forward bear the responsibility to learn, teach, and reach out to help others. Together, we need to develop better ways to frame the benefits to bring along those who are not ready. This is how change works, and there is still a lot of work to do.

Life and medicine are continuously changing at a seemingly accelerating pace. When we attempt to avoid change and cling to the ‘way things were,’ we stop moving forward and growing, and we become part of the problem. We need to open our minds, try to understand
perspectives that are unfamiliar or uncomfortable, and embrace change. Change will never end. We will never get “there.” We are fortunate to have many exceptionally talented and inspiring colleagues who can help us along this journey. They encourage us to improve and help us provide more effective care to our patients.

This issue of ENTtoday highlights ongoing critical issues related to diversity/inclusion, gender bias, and health literacy within otolaryngology–head and neck surgery. The articles include interviews with many leaders in our field who are actively addressing these issues. Erin O’Brien’s viewpoint on the gender gap in otolaryngology provides a timely update. She makes the point, which can be generalized to many problems facing the specialty, that leaders need to participate in order to address these issues, and affected groups cannot be expected to achieve parity without the support and effort of those with the power to make changes. Duane Taylor, now the current president-elect of the AAO–HNS, discusses the importance of the well-informed patient and the Academy’s new tools to help physicians and patients.

As a specialty, let’s not get stuck in the doctor’s lounge; as leaders in medicine, we should stay open minded, be active and honest participants in these conversations, embrace change, and drive our specialty forward to its ultimate potential.

Ronald B. Kuppersmith, MD, MBA
Deputy Editor, ENTtoday

ENT Today

Letter from the Editor: Medicine’s March Madness

As part of our mission to focus on physician wellness, we thought it would be fun to have an issue focused on a theme many of us use as a vehicle for work-life balance: sports! Finding stories and sources around this subject was not difficult. When we came up with the idea to write a story on otolaryngologists who served as team physicians for professional sports teams, we had more than 10 surgeons to speak to. We have otolaryngologists who have been professional athletes, Olympic athletes, and major boosters of athletic teams, and we even have one otolaryngologist who has had the experience of hiring and firing a Division I football coach and athletic director. College athletics is a passion for many otolaryngologists (just ask any Ohio State alumnus), and March Madness is college basketball’s three-week long tournament that consumes the work force and has even the non-sports aficionado searching the internet for tips on how to best fill out their office pool bracket.

So what is the otolaryngology version of March Madness? That would have to be the Otolaryngology Residency Match, which also takes place in March of every calendar year. The residency match is similar to March Madness in many ways. The college basketball season is five months long and comes down to three weeks to crown the champion. Months of residency interviews, letter writing, and phone calls come down to one day to find out who we will spend the next five years training.

Teams such as the University of Virginia, a No. 1 seed in 2018 that many expected to win the National Championship, lost in the first round to tiny UMBC, learning the hard way that you can never take anyone for granted. Otolaryngology as a specialty learned a similar lesson. For as long as I can remember, otolaryngology has been one of the most competitive residencies to match into. As a specialty, we enjoyed having the best and brightest apply to our programs. In fact, the match got so competitive that otolaryngology soon began to get a reputation amongst medical students and deans of medical schools. Students who didn’t have top Step 1 scores and grades were dissuaded from applying. We subjected the students to special interviews and made them submit written paragraphs in order to select the most competitive applicants. There was an air of superiority that filled many of our programs, as we rested on our laurels and stopped looking for talented medical students, assuming they would come to us. Because of this, the applicant pool, albeit as talented as ever, shrunk in size, and for two years, we were left with more residency spots than applicants.

In sports as well as in medicine, learning from our failures is a hallmark of resilience. In 2019, the University of Virginia again entered the tournament as a No. 1 seed. This time they came prepared and have since won their first two games of the tournament. Otolaryngology learned a lesson from the 2018 match, as we quickly began to acknowledge our missteps and look for ways to improve our match results. We began to understand that there are many more things other than a high Step 1 score that go into making a wonderful otolaryngology resident. Departments made tremendous efforts to reinvigorate their student interest groups and began new programs to expose pre-clinical students to the field. We began to show our appreciation to the applicants during interviews. Instead of the usual box lunch, programs were treating applicants to five-course steak dinners and guided tours of their campuses and cities. Much like the UVA basketball team, our efforts have been rewarded, as we have seen an explosion in the number of applicants. We have again become one of the most competitive specialties, and the residency match of 2019 was an extremely successful one for the field.

Much like the winner of this year’s tournament, we should take the time to celebrate our achievements but know that we can’t rest on our laurels. To continue this success, we must continue to work hard to find and attract students who are talented, diverse, and hungry for success.

Thanks for reading, and I look forward to connecting next month.

—Alex

ENT Today